Following bowel surgery for colon cancer you may have a permanent or temporary colostomy. The boxes of supplies and care instructions that accompany your new colostomy may not inspire confidence, but changing your pouch is not as complicated as it may look. Once you are proficient, changing your appliance may only take 15 minutes or less.
How often you need to change your colostomy appliance is dependent on a few different factors:
- The location of your ostomy
- Your bowel movement frequency and consistency
- The oiliness of your skin
- Your activity level
- Indoor and outdoor temperatures
- Type of colostomy appliance you use – one piece or two piece
The location of your colostomy – transverse, ascending, descending or sigmoid colon – determines the consistency of your bowel movements and the frequency that you'll have to change your colostomy pouch. Transverse and ascending colostomies usually have looser stools that can be very irritating to your skin and require more frequent pouch changes (or at least irrigation and cleaning of the bag). The most common colostomies, descending and sigmoid colostomies, usually produce semi-formed, regular bowel movements and should not require care as frequently.
If your skin is moist, oily, or it's hot outside, the colostomy pouch may not adhere as well requiring more frequent appliance changes to prevent leaks. Likewise, if you are very active or exercise, you may need to change your colostomy bag daily depending on how much you sweat.
Follow the instructions and guidelines provided to you by your doctor or ET nurse – but typically, you will need to change your colostomy appliance at least every two to three days. If you have a one piece (bag attached to wafer) unit, you may need to change it more frequently, based on how often your bowels move. Do not let your colostomy bag get more than 1/3 full of waste, as the weight can place excess stress on your stoma and surrounding skin, and the seal on your appliance can come loose causing leakage of scent and stool.
Gathering Your Supplies
Before you change your colostomy appliance for the first time make sure that you have all the supplies you will need handy:
- Soap, water and towels
- Colostomy appliance (one piece or two piece unit) with a clip (if drainable)
- Small scissors for a two piece unit – to trim the skin barrier wafer to the size of your stoma
- Skin adhesive or prep
- Stoma paste and powder
- Disposable plastic shopping bag
Set up your supplies in your bathroom. Most people prefer to use a small stool – rather the toilet – to sit on, so that you can empty your old bag into the toilet before changing it. You can change your appliance while standing, but it might be more comfortable to do while sitting.
Remove the Old Appliance
If you have a drainable pouch with a clip, open the clip and drain the contents into the toilet before removing your bag and set the clip aside, do not throw it out. Do not rip the wafer off of your skin like a band aid. This can cause unnecessary stress on the skin and stoma, which can cause bleeding and irritation. Instead, press down on the skin barrier (wafer) with one hand while gently pulling your skin away from it. If you have excess hair around the stoma it is okay to carefully trim the hair with scissors or a razor. This will reduce your discomfort while changing your appliance and allow for a better seal around your stoma. Dispose of the old appliance in a disposable plastic shopping bag and tie the top in a knot to reduce odor.
Wash the Skin and Stoma
It is perfectly okay to leave your stoma open to the air and take a shower or bath. If you prefer, wash your hands with soap and water and then wash the skin surrounding your stoma with a washcloth and unscented soap. Pat or air dry the skin surrounding the stoma before proceeding.
Pay attention the appearance of your stoma. Immediately following surgery, the stoma may be slightly inflamed and a deep red color. However, in the weeks following, it should become soft, pink or red and moist. There should not be excessive bleeding (a drop or two is okay) and there should not be any foul odor, redness or swelling surrounding the stoma.
Applying the Wafer Skin Barrier
If you have a one piece system, the stoma opening will be precut for you and the bag is attached to the skin barrier. If you have a two piece system, you will need to cut the opening in the center of the wafer to fit your stoma. Cut the wafer opening to match your stoma before applying it to your skin. The opening should match your stoma; if the opening is too large, bowel contents will irritate the skin and if the opening is too small, your stoma can become inflamed. If the surrounding skin is moist, apply skin wipe (prep), a little stoma powder, then repeat the skin wipe over the powder. Apply stoma paste to the hole in the wafer then apply it to your skin. Hold the wafer in place for a minute or two to create a good seal. If you have a two piece unit you will need to snap the pouch into place on the wafer flange. Make sure the clip is in place to seal the bag (if you have an open drainage system) and you are done.
What to Report to Your Doctor
After a few weeks, you will know what your normal colostomy output is and start to become used to the appearance of your stoma. If you see something out of the ordinary it is best to report it to your doctor or ET nurse including:
- Pus or purulent discharge around the stoma
- Bright red bleeding (not just a drop or smear) out of the stoma
- You have a fever
- Your stoma has a foul odor when the appliance is removed
- You are vomiting or nauseous
- You have pain, swelling, or bloating in your belly, especially around the stoma
- The stoma is not producing gas or stool for four hours or more
American Cancer Society. (n.d.). Colostomy: A Guide. Changing the Pouching System. Accessed online June 19, 2013.
Medline Plus. (n.d.). Changing Your Ostomy Pouch. Accessed online June 17, 2013.
American Cancer Society. (n.d.). Colostomy: A Guide. Helpful Hints. Accessed online June 21, 2013.