Introduction
Living with a stoma brings new daily tasks, but changing a stoma bag can become quick and easy with practice. This guide will walk you through each step of changing your stoma bag safely and with confidence.
A stoma is a surgical opening that connects your gut or urinary system to the outside of your body. It lets waste leave your body when normal paths can’t be used. Good stoma care helps prevent problems and keeps you feeling your best.
Types of Stomas and Bags
Before we talk about how to change a bag, let’s look at the different types of stomas and bags you might use.
Common Types of Stomas
- Colostomy: Connects to your large bowel. Output is usually firm stool.
- Ileostomy: Connects to your small bowel. Output is loose or liquid stool.
- Urostomy: Connects to your urinary system. Output is urine.
Types of Bags
- One-Piece Systems: The sticky part and bag are joined. You change the whole thing each time.
- Two-Piece Systems: Has a base that sticks to your skin and a bag that clips on. You can change the bag without removing the base.
- Closed Bags: Sealed at the bottom. You throw away the whole bag when it’s full.
- Drainable Bags: Has an opening at the bottom to empty waste.
- Urostomy Bags: Has a tap to drain urine.
What You’ll Need
Gather these items before you start:
- New stoma bag (right for your stoma type)
- Adhesive remover wipes or spray
- Mild soap or stoma wipes
- Clean cloth or paper towels
- Scissors (if you need to cut the bag to fit)
- Measuring guide (for new stomas or size changes)
- Barrier rings or paste (if needed)
- Disposal bag
- Optional: skin wipes, stoma powder, belt
Step-by-Step Guide
Getting Ready
- Pick the right time: Change your bag when output is low (often early morning).
- Get your supplies ready: Have everything within reach.
- Find a clean space: Use a flat surface in a well-lit bathroom.
- Wash your hands: Use soap and warm water to prevent infection.
Taking Off the Old Bag
- Empty the current bag: If it’s drainable, empty it into the toilet first.
- Peel off the sticky part: Start at the top and pull down slowly. Support your skin with your other hand.
- Use adhesive remover if needed: This helps the bag come off more easily.
- Throw it away properly: Put the used bag in a disposal bag and seal it.
Cleaning Your Stoma
- Look at your stoma: It should be pink or red (like the inside of your mouth). Note any changes.
- Clean the stoma gently: Use water or wipes. Pat, don’t rub.
- Clean the skin around it: Work in circles moving away from the stoma.
- Dry thoroughly: Pat the area completely dry. Damp skin will not hold the new bag well.
Putting On the New Bag
- Measure your stoma: Do this if you’re new to stomas or if your stoma size has changed.
- Cut the hole: If needed, cut the opening 1/8 inch larger than your stoma.
- Apply skin products if used:
- Barrier rings or paste help create a seal
- Stoma powder helps with irritated skin
- Barrier wipes create a thin film (let them dry fully)
- Peel the backing off the sticky part
- Center the hole over your stoma: Make sure it fits just right.
- Press gently: Start at the center and work outward. Avoid wrinkles.
- Hold in place: Press gently for 30-60 seconds to activate the adhesive.
- For two-piece systems: Snap the bag onto the base until you hear a click.
Final Steps
- Check the fit: The bag should fully surround the stoma without cutting into it.
- Smooth out the edges: Make sure there are no wrinkles or air pockets.
- Close the outlet: If using a drainable bag, make sure it’s securely closed.
- Throw away all trash
- Wash your hands again
Fixing Common Problems
Leaks
Leaks happen to most people with stomas at some point. Here’s how to prevent them:
- Make sure the hole size is right (not too big, not too small)
- Check that the bag sticks well all around
- Use rings or paste if your skin is uneven
- Change the bag before it gets too full
- Make sure your skin is fully dry before putting on a new bag
Skin Irritation
Red, sore skin around your stoma might mean:
- Waste is touching your skin (fix the seal)
- You might be allergic to the products (try different ones)
- Too-frequent changes or rough removal
- Fungal infection (see your doctor if it won’t go away)
Try these fixes:
- Use barrier powder on sore spots
- Try skin wipes that create a barrier
- Change your bag more often
- Talk to a stoma nurse if problems persist
Odor Control
Keep odors in check by:
- Using deodorizing drops in the bag
- Making sure the bag seals well
- Emptying the bag often
- Watching what you eat (some foods cause more odor)
- Using bags with built-in filters
Special Tips
Swimming and Bathing
- You can shower with your bag on or off
- For swimming, make sure edges are sealed well
- Try waterproof tape around edges for extra security
- Mini-bags or special covers work well for swimming
Travel Tips
- Pack twice as many supplies as you think you’ll need
- Keep essential supplies in your carry-on when flying
- Pre-cut the holes in your barriers before your trip
- Know where to buy supplies at your destination
- Carry a doctor’s note explaining your medical needs
Food and Drink
What you eat matters based on your stoma type:
- Colostomy: Eat normally, but watch for foods that cause blockage or gas
- Ileostomy: Chew food well and drink plenty of fluids to prevent blockage
- Urostomy: Drink lots of water; cranberry juice may help prevent infections
Intimacy
- Change to a fresh bag before intimate moments
- Try smaller bags or covers made for intimacy
- Talk openly with your partner about concerns
- Ask a stoma nurse or therapist for advice if needed
When to Call Your Doctor
Contact your healthcare provider right away if:
- Your stoma changes color (becomes dark, purple, or black)
- Your stoma size changes a lot
- The skin around your stoma breaks down badly
- Your stoma bleeds more than a little during cleaning
- Leaks won’t stop despite your best efforts
- You have signs of blockage (belly pain, swelling, no output)
- Your stoma pulls away from the surrounding skin
Tips from People Who Know
- Keep spare supplies in several places (car, work, travel bag)
- Use a mirror to see better during changes
- Try a hair dryer on cool setting to dry skin thoroughly
- Mark the right hole size on your packaging for quick reference
- Join support groups to share tips with others
Common Questions
Q: How often should I change my bag?
A: One-piece bags need changing every 1-3 days. With two-piece systems, the base can stay on for 3-7 days while you change the bag more often.
Q: Will changing the bag hurt?
A: Your stoma has no nerve endings, so touching it won’t hurt. The skin around it does feel sensation, so be gentle when removing the sticky part.
Q: How do I throw away used bags?
A: Empty the contents into the toilet. Wrap the bag in a disposal bag and put it in regular trash (don’t flush it). Carry disposal bags when you’re out.
Q: Can I use bags more than once?
A: No, bags are made for single use. Reusing them risks hygiene issues and poor adhesion.
Q: Is it normal for my stoma to bleed a little?
A: Yes, stomas have many blood vessels and may bleed slightly during cleaning. Heavy or ongoing bleeding needs medical attention.
Q: How do I handle bag changes at work or while traveling?
A: Carry a small kit with pre-cut barriers, a new bag, wipes, and disposal bags. Know where the bathrooms are ahead of time.
Conclusion
Getting good at changing your stoma bag takes practice, but it will become easier over time. Most people develop quick routines that work for them. Remember that each stoma is unique, and you may need to adjust these steps to fit your needs.
Keep seeing your healthcare team, especially stoma nurses, even as you get more comfortable with self-care. They can give you personal advice, spot potential problems early, and suggest products that might work better for you.