How to Clean an Ostomy Pouch

Ostomy bags are odor resistant and heavy duty to prevent leaks but need to be changed regularly. Here’s a primer on how to properly change your ostomy pouch.

During ostomy surgery, surgeons create an opening, called a stoma, in the abdominal wall to allow waste to leave the body. This procedure may be necessary for people with an inflammatory bowel disease (IBD) — such as ulcerative colitis or Crohn’s disease — colon or rectal cancer, diverticulitis, or an injury to or blockage of the bowels.

There are several types of stomas, but the most common ones include:

Waste moves from your body through the stoma involuntarily and into a pouch called an ostomy bag, where feces collects. The pouch attaches to your skin around the stoma via an adhesive called a skin barrier, which also protects the skin. The bag can be hidden beneath clothing.

Ostomy bags are odor resistant and sealed to prevent leaks but need to be changed regularly. After ostomy surgery, your nurse will explain in detail how to care for your stoma and change your ostomy bag. Here is a quick review of what you need to know to keep your stoma clean and healthy and change your pouch most efficiently.

Your ostomy bag and skin barrier make up what’s called an ostomy pouching system. There are two types of ostomy pouching systems, per University of Chicago Medicine, which include:

Your ostomy pouch should be cleaned every few days, according to MedlinePlus. Exactly how long you go between changes will depend on the type of ostomy you have, says Jackie McHugh RN, a certified wound, ostomy, and continence nurse at the Digestive Disease & Surgery Institute at Cleveland Clinic.

With an ileostomy, the pouch will need to be cleaned about every three days. “Due to the acidic nature of the small bowel, the bag will wear at the barrier more quickly,” McHugh says.

For a colostomy, it may be possible to keep the same bag on for a week, but she advises no longer than that. “There are extended-wear barriers, but no barrier should be worn for more than 7 days, to prevent skin breakdown,” she says.

A good rule of thumb is to never let the pouch fill more than halfway. “This keeps the pouch low profile, which prevents leakage, as well as keeps the pouch hidden under clothing,” McHugh says.

McHugh offers the following step-by-step guide for changing your ostomy bag.

The first step is to gather the supplies you’ll need to change your ostomy bag and clean your stoma. These include:

The bathroom is a good place to change your ostomy bag. Thoroughly wash your hands before you begin. Then, you’ll want to remove the pouch and empty the contents into the toilet.

“Using the adhesive remover, gently press down on your skin and pull up on the pouch,” McHugh advises. “Work from the top to the bottom.”

After emptying it, dispose of the pouch in a regular trash bin.

If you’re using a pouching system that doesn’t come with a precut skin barrier, you’ll need to size and cut an opening. You’ll first trace the pattern of your stoma on the back of the skin barrier. Cut the barrier, making sure you cut on the outside edge of the tracing.

“If you are not sure if you cut the opening large enough, or if you think it is too big, you can do a dry fit by laying the skin barrier over the stoma while the backing is on,” McHugh says.

After you have checked the size of the opening, remove the adhesive covering and apply a thin layer of paste around the opening of the skin barrier. “Think about the amount of toothpaste that you use,” McHugh says. “That thin bead of paste is the right amount of coverage needed to fill any gaps.”

The next step is to clean your stoma. Wipe any stool away with toilet paper and dispose of it in the toilet. Then, clean your skin using a moist, soapy towel or paper towels in a circular motion, starting at the base of the stoma and working outward, McHugh advises.

Be sure to rinse the skin well with a moist paper towel and then pat dry.

Next, be sure to examine the skin surrounding the stoma for any problems.

Red, raw, irritated skin can be treated with stoma powder, which can also be used to prevent irritation.

“When using the powder, apply a generous amount, but be sure to brush away the excess powder,” McHugh says. “The powder will stick where it is needed, but leaving too much can prevent the pouch from adhering to your skin.”

Begin securing the ostomy bag by applying the pouch with the skin barrier laying directly on your skin. If you’re using a two-piece system, you can attach the pouch to the flange before or after applying the skin barrier.

“After you have placed the skin barrier against your skin, hold the pouching system in place for a few minutes,” McHugh says. “This will help it mold to your body, along with warming the material for a better seal.”

Wash your hands again thoroughly when you’re done.

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