What happens when you change a colostomy bag
Changing a colostomy bag means removing the used pouch and skin barrier from your abdomen and putting on a new one. The skin barrier is the adhesive ring that sticks to your skin and holds the pouch in place. Most people change their bag once or twice a day, though the timing depends on what type of colostomy you have and how often output occurs. The whole process takes about 5 to 15 minutes once you know the steps.
You will need to do this in a bathroom or private space where you can see your stoma — the opening in your abdomen where waste leaves your body. The stoma itself has no nerve endings, so you cannot hurt it by touching it. Your skin around the stoma is sensitive, though, and that is what you are protecting when you change the barrier.
Key Takeaways
- Gather all supplies before you start: new pouch, skin barrier, scissors, wipes, and a small trash bag for the used pouch.
- Remove the old pouch by gently peeling it away from your skin, starting at the top and working downward at a 45-degree angle.
- Clean the skin around your stoma with warm water and a washcloth or wipes, then dry it completely before applying the new barrier.
- Cut the opening in the new skin barrier to fit your stoma size exactly, leaving about one-eighth inch of space between the barrier and the stoma edge.
- Press the new pouch firmly onto the barrier for at least one minute so the adhesive seals properly to your skin.
Gather your supplies before you start
Have everything within arm's reach before you remove the old pouch. If you have to search for supplies while your skin is exposed, you waste time and risk irritation. Lay out: one new pouch (or a two-piece system with barrier and pouch), one new skin barrier if you use a one-piece system, scissors, a washcloth or wipes, a small trash bag or container for the used pouch, and a mirror if you need one to see your stoma clearly.
If you use a two-piece system, the barrier and pouch are separate. You may change only the pouch and keep the barrier on for several days, or you may change both at once. Check your prescription or the package instructions to see what your system is designed for. Some barriers are meant to stay on for three to five days; others last longer.
Keep a spare pouch and barrier in your bag, car, or desk in case you need to change unexpectedly. Accidents happen, and having a backup means you are not stuck waiting to get home.
Remove the old pouch safely
Empty the pouch into the toilet first if it contains output. Flush, then return to your changing area. Start peeling the pouch away from your skin at the top, working slowly downward at a 45-degree angle rather than pulling straight out. This angle reduces the chance of tearing your skin or causing irritation. Use one hand to peel and the other to support the skin underneath as you go.
If the pouch is stuck tight, dampen the edge with a washcloth or use a commercial adhesive remover spray (ask your supplier which brands work with your barrier). Let it sit for 30 seconds, then try again. Never yank the pouch off quickly — the adhesive is meant to stay on, and forcing it causes pain and skin damage.
Once the pouch is off, dispose of it in the trash bag. Do not flush it down the toilet, even if the package says it is flushable — it can clog pipes.
Clean and dry the skin around your stoma
Wet a washcloth with warm water and gently wipe the skin around your stoma to remove any adhesive residue, dried output, or powder. Use a circular motion, working outward from the stoma. If you see bits of old adhesive, keep wiping until they are gone. Adhesive left on your skin prevents the new barrier from sticking properly.
Pat the area dry with a clean towel or let it air-dry for one to two minutes. Moisture under the new barrier causes it to slip or peel away early. Make sure the skin is completely dry before you move to the next step. If your skin is irritated or red, you can apply a skin protectant powder or barrier spray designed for ostomy use, but only if your nurse or supplier has told you to do so — some products interfere with adhesion.
Measure and cut the new barrier opening
Your stoma size may change slightly over time, so measure it each time you change your pouch. Use a measuring guide (most supply kits include one) or a ruler. Measure the widest part of your stoma. Write the size down so you remember it for next time.
Place the new barrier on a flat surface. Using the measurement, mark the opening size on the barrier with a pen. Cut along the line using scissors. The opening should be about one-eighth inch larger than your stoma — large enough that the barrier does not press on the stoma, but small enough that skin is covered and protected. If you cut it too large, output will touch your skin and cause irritation. If you cut it too small, the barrier will rub the stoma and cause bleeding or pain.
Some people use a pre-cut barrier that comes in standard sizes. If that works for your stoma, you can skip the measuring and cutting step. Check with your supplier about which option is right for you.
Apply the new barrier and pouch
Remove the backing from the new barrier to expose the adhesive side. Center the opening over your stoma and press the barrier onto your skin, starting in the middle and working outward. Use the palm of your hand to press firmly, smoothing out any wrinkles or air bubbles as you go. Press for at least one full minute — this gives the adhesive time to bond to your skin.
If you use a one-piece system, the pouch is already attached to the barrier. If you use a two-piece system, you now attach the pouch to the barrier by pressing the pouch ring onto the barrier ring until you hear or feel a click. Make sure it is seated all the way around.
Wear the new pouch for at least 30 minutes before you move around a lot. This allows the adhesive to set fully. After that, you can bathe, exercise, or do your normal activities.
Troubleshooting common problems
If the barrier peels up at the edges within a few hours, the skin was not completely dry when you applied it, or you did not press it on long enough. Next time, wait longer for the skin to dry and press for the full minute. You can also use a barrier adhesive spray or paste around the edges for extra hold, but only if your supplier recommends it for your specific barrier.
If you see redness, itching, or a rash around your stoma, the barrier opening may be too large and output is touching your skin. Measure and cut a smaller opening next time. If the rash does not improve after two or three bag changes, contact your nurse or supplier — you may have a skin infection or an allergy to the barrier material.
If output leaks onto your clothes, the pouch may be full and you did not empty it in time, or the barrier seal is broken. Empty the pouch when it is one-third to one-half full, not when it is completely full. If leaks happen regularly, ask your supplier whether a different pouch style or barrier might work better for your output type.
Frequently Asked Questions
How often should I change my colostomy bag?
Most people change their pouch once or twice a day, but it depends on your output. If you have a colostomy, output is usually thicker and less frequent than with an ileostomy, so you may change less often. Empty the pouch when it is one-third to one-half full to prevent leaks. Change the skin barrier every three to five days, or sooner if it starts to peel or leak.
Can I shower or bathe with my colostomy bag on?
Yes. Most barriers are waterproof and designed to stay on during bathing. You can shower or bathe normally. Some people prefer to change their bag before bathing so they have a fresh one on afterward. If water gets under the barrier edge, pat it dry when you are done and press the edge down firmly.
What should I do if my stoma bleeds when I change the bag?
A small amount of bleeding is normal — the stoma has many blood vessels close to the surface. Gently wipe away the blood with a damp cloth and let it stop on its own. If bleeding is heavy or does not stop after a few minutes, or if it happens every time you change your bag, contact your nurse. The barrier opening may be too small and rubbing the stoma.
Is it normal for my stoma to change size?
Yes. Swelling is common in the first few weeks after surgery. Your stoma may also change size slightly based on what you eat, how much you drink, and your activity level. Measure your stoma regularly and adjust your barrier opening as needed. If the size changes a lot, ask your supplier whether you need a different pre-cut size.
What if I am allergic to the barrier adhesive?
Tell your supplier about the rash or itching. They can recommend a different barrier material — some are made with gentler adhesives or hypoallergenic formulas. You may also use a barrier film or protective spray under the adhesive to reduce direct contact with your skin. Your nurse can show you how to apply these products correctly.