To successfully manage your ostomy, you will need to learn how and when to empty your pouching system, as well as how to assess and care for the stoma and the peristomal skin. It's also important to know what to do if you see something that is not normal.

[MUSIC PLAYING] Hi. My name is Maggie Mae Baenziger. And I'm one of the certified wound ostomy incontinence nurses here at the University of Chicago. What we're going to do today is we're going to demonstrate how a pouching system is changed. And I'm here with Debra. Debra is one of our past patients.

Thank you, Maggie. Hi. My name is Debra. I've had an ostomy for 17 years. And today, I'd like to walk you through the process of how to change your ostomy pouch.

Before we get started, I wanted to point out to you that we've laid everything out in front of us here for demonstration purposes. But the majority of people, when they change their ostomy pouch, do so in a bathroom. They lay everything out on the sink. And then they get started with the procedure.

Here I have my wet paper towels, my dry paper towels, an ostomy pouch, my scissors, a ring, and a bag to dispose of all the old debris. I know that my stoma is one and a fourth inch. So what I'm going to do is first pre-cut along the one and a fourth inch circle.

Now while Debra is doing that, I will tell you that, at times, it's smart to measure your stoma, especially right after surgery. The stoma is going to change in size and shape. Just to be assured that the size of the opening in the skin barrier or the wafer matches the stoma because we want all of the skin to be covered with the adhesive. That way stool won't make any contact with the skin. And there won't be any issues with skin irritation later.

Now that I've cut the one and a fourth inch circle, I removed the paper on the back to reveal the sticky side. And I put this, again, in the trash. My next step is to apply the ring around the circle of the wafer.

And so what Debra is going to do is she's going to stretch out that ring to mirror the size of the hole we cut. Some patients prefer to place the ring directly around their stoma, and then place their pouching system over that. But we're just going to show you today how you put it on the back of the pouch. The ring is very forgiving. So you can kind of stretch and mold it.

After I apply the ring and everything is laid out, the next step is to remove my old pouch.

Now Debra is going to gently remove the outer adhesive. So you can see what she's doing here. She's rolling out the edges to get it started. And then once she gets the edges rolled out, she can gently press her skin away from the adhesive. And then she's going to go around the outer edge and go from the top and pull the pouch completely off.

Now that I removed it, I will roll it up and put it in the bag. Then I'll take a dry paper towel and start removing some of the debris that's on the stoma.

Remember, stomas don't have any nerve endings to them. So she's not causing herself any discomfort. She's trying to get any stool that might be loose off, so it won't get on her skin when she starts to clean her skin.

Now that I've removed that, I'll take a wet paper towel and wash the skin.

And as Debra pointed out, it's a wet paper towel. Water from the sink only. There's some people who would prefer to use soap, which is OK, but many soaps have moisturizers in them. So you need to be sure that the type of soap you're using and then do a good rinse job afterwards. I would also recommend avoiding baby wipes or cleansing cloths because it could contain an ingredient which impedes the adhesive from adhering to your skin.

This is also a great time while you're cleaning to take a look at the skin and see if there's any skin damage or irritation around the area. You might see a little bit of pinkness, which is pretty normal. When you take off any kind of adhesives, your skin will start to pink up.

Next, I'm going to take a dry paper towel. And I'm going to make sure that the skin around my stoma is dry.

One of the things that I need to point out is that Deborah has had her stoma for so long, so she knows that it measures at one and a quarter-inch opening. But if it wasn't, I wanted to demonstrate to you how a person might measure to know what size to cut the opening. Many people use a measure guide that looks similar to this. It has a variety of sizes to start with and what you might think is a reasonable size.

So for instance, I would just hold this up over. And you can see that there's a lot of skin exposed to her stoma which, if we cut the hole this big, would cause skin damage around her stoma. So we need to find one that fits snugly, just like her one and a quarter inch that she measures to.

Now that my skin is dry, the next step is to apply the pouch, which I've already prepared with the ring. And I'm going to center it over the stoma.

And you can see why it's advisable to stand. Debra has a great view of her stoma in this position. So she can easily center the pouch. And she's pressing down right along the stoma edges and the outer portion of the wafer to ensure that the adhesive is in place. Some patients also prefer to apply their hand over the pouching system. The warmth of her hand is going to warm the adhesive to her skin, which will make it seal quicker.

So now that the pouch is on what Debra is going to do is she's going to close her pouch. To do this she would take her pouch, and she would roll it towards herself three times. And then she would take these Velcro edges and secure them to the side.

Now that my ostomy pouch is on, the next step is to dispose of the old pouch. So I take the bag that has been supplied in the box of ostomy pouches. And I'll just tie up everything and put it in the trash, seal any type of odor.

We'll briefly go over now how to empty your pouch. You want to empty your pouch when it fills to about one-third to one-half full. To do this, what you want to do is you want to take those two tabs and open them, roll the pouch out three times, holding slightly upwards toward yourself. On the back of this pouch here are two Velcro dots that you can go ahead and connect.

And then when you pinch the sides, it kind of forms a funnel. And that way when you go into the bathroom, you can go ahead and empty the contents of the pouch and then take some dry toilet paper. You can rinse along the inner portion of the pouch, and then wipe on the outside of the pouch, and dispose of that in the toilet. And then go ahead and roll that back three times towards yourself. And then close the Velcro tabs.

Some patients prefer to sit on the toilet and kind of scoot a little bit farther back and lean forward to empty their pouch, while others may prefer to stand. If you prefer to stand to empty your pouch, I suggest you place some toilet paper in the toilet prior to emptying to prevent any type of splashback. Thank you, Debra, so much for being here today.

This should have given you a very good indication of how a person changes and empties their pouching system. Most people change their pouching system about every three to four days because the adhesive starts to wear at that time. So you should expect to change your pouch about twice a week. And remember, if you're emptying your pouch, when it's a third to a half full, which could be several times a day, about four to six. Thank you.


Emptying the Ostomy Pouch

This is one of the first skills you will learn after surgery. In the hospital, a nurse will help you to measure amount of stool and empty the pouch into a container. Assisting your nurse with pouch emptying will help you transition to self-management. Once you are at home, you will empty the pouch into the toilet, while sitting on the toilet unless you have been instructed to measure the output at home (temporarily).

How often should I empty my pouch?

To prevent the pouch from becoming too heavy, the pouch should be emptied when one-third full. If you allow it to get too full, the weight of the stool may pull the pouch away from the skin. A person with an ileostomy will need to empty the pouch about five or six times in a 24-hour period. If you have a colostomy, you will need to empty the pouch two or three times in a 24-hour period.

Changing the Ostomy Pouch

You will also work with staff nurses and ostomy nurses to learn how to change your ostomy pouching system. If possible, you will have two or three lessons on how to remove and replace the pouching system. While you should understand the steps involved in changing your pouch prior to discharge, you may not have full mastery of the pouch-changing skills right away. We may suggest that a home care nurse make home visits to continue pouch changing lessons.

Our nurses will teach you what is normal for the stoma and the peristomal skin (the skin around the stoma) and what deviates from normal. You will be taught to examine your stoma and skin at every pouch change and instructed on steps to take if you notice anything abnormal.

An important tool that you can use to determine if your skin is within normal parameters (and what to do it there is skin injury) is the Peristomal Assessment Skin Guide.

How often should I change my ostomy pouching system?

The standard wear time of a pouching system is three or four days. Under normal conditions, you will change a pouch about twice a week. A change should be made immediately if a leak is detected. If you are unable to achieve a consistent wear time, you should check with the ostomy nurses for an evaluation of your pouching system.

Concealing the Ostomy Pouch

There are undergarments, wraps and accessories that cover the entire pouching system and keep it flat by distributing contents evenly throughout the pouch. If you cannot pull the undergarments over the pouching system, consider wearing a snug undershirt or camisole that has some stretch to flatten the pouch.

[MUSIC PLAYING] Hi. My name is Jan Colwell. And I'm one of the advanced practice nurses in ostomy care here at the University of Chicago.

Erica, one of the things that many of my patients are worried about is concealment of the ostomy pouch. And I see that you have exercise clothes on. And we can't see that you have a pouch on. How do you consider what kind of clothes you wear to conceal your ostomy pouch?

One of the things I've learned is the looser the clothes, the more you're going to see the ostomy. But you don't want it to be too tight. So what's nice about this outfit is, again, my ostomy is on the angle. So you're not seeing it on the pants leg. And so it's resting on the crotch. So nobody really sees it. And again, it's just-- I'm able to just tuck the ostomy in and pull the shirt down.

Another option would be yoga pants like these, where you can pull them up and then fold it down. And that can help hide if there's a little bulge of the ostomy bag. But it just depends on what you are most comfortable with.

I understand. Pull your top up one more time. So really, the idea is to make sure that it's above your pouch, so it's not cutting off the flow of the stool, right?


Talk to me about, say, dresses or skirts.

Really, when I look at a dress, I don't think really of my ostomy bag. I think of my undergarment. So I really have no limitations on the type of dress I wear. I just have to make sure I adjust what I wear underneath.

One option is, this is a Spanx slip. And it's got a little stretch to it. I go up the size, so that way I'm not putting too much pressure on the ostomy. But what's nice about this is if my ostomy's low, I can keep it here. Or you can move it up. It just depends on where your ostomy placement is. And then I pull out my dress. And you don't see it.

Another option-- since it's cold here in Chicago-- tights. As long as they're not control top or nylons, you can wear those as well. And that can help hide it. And some looser dresses like maxi dresses, I might wear boy short underwear, where I'll tuck the ostomy bag in.

For your advice then, it's mostly about the support directly over the pouch, as opposed to some of the clothes?


You've got blue jeans on. They look great. I'm wondering what some of the considerations are when you choose blue jeans.

Sure. Now, I don't want ones that cut off the stoma. So this one is actually right at my belt line. So I could just fold this over and usually just conceal it that way. But sometimes I'll add an extra layer. And this will help smooth things out. And I could just tuck that into my pants. And you'll never know.

Well, that'd be great. Pick this up again. I bet that would be great for someone whose stoma might be a little higher.


They'd be able to conceal it with a little stretch and a cami like this.

And you also try to find some specialty underwear that might be a little bit higher as well. I tend to wear just regular bikini underwear. And I actually put the ostomy bag over it. And the pants keep it flush up against my side.

You're right. It looks really natural. Good. Good tip, thanks.

Josh, you look really good. I like that you've got blue jeans on. You can't really tell that you have an ostomy pouch.

Thank you.

What are some of the things you consider when you're looking at clothes and concealment of your pouching system?

Honestly, I don't really take anything into consideration with clothes. It's whatever looks good and whatever is comfortable. All I do is I wear this neoprene belt. It's called a Stealth Belt. It's just an elastic material that just straps on. And I wear that and don't really have to worry about belts or anything else.

I got it. And your stoma's somewhere in this area here.


And what I feel is kind of a firm little something. What is this that I feel?

That's just a plastic stoma guard. And that actually just slides up into the belt. And the tension of the belt holds it in place over the ostomy.

Oh, I-- so it protects it, say, when you're roughhousing with your kids?

With kids, with seat belts, with yard work, with whatever.

Oh, that makes sense. And now your belt on your pants, is it cutting the flow off at all of the stool? Is there any issue there?

Not really, no.

Nice. So this is really key. And I've seen some other people that have similar types of belts. So there's a few other companies that make these. But your pouch actually folds into this belt, is that right?


I got it.

Or you can just have it hang underneath, either way.

Ah, OK. Well, it really looks good. It really allows you to wear what you want to wear them.


Great. Some good tips, thank you.

You're welcome.

What you've just seen are two people who have demonstrated that they're doing absolutely what they want to do when they want to do it. They just need to give some consideration to the type of clothes they wear so it supports the pouch and it conceals it, no matter what kind of activities they like to be involved in.


Additional Resources

Our ostomy nurses and educators lead an online support group once a month to provide information and support for new and future ostomy patients, caregivers and families. We bring in guest speakers and supplier representatives, and coordinate round table discussions to share the most up-to-date care options. Additionally, wound nurses attend every meeting to provide technical support and advice.

Our group meets every third Wednesday of each month at 7PM (Central). Meetings are held over Zoom.

Learn how you can join us at our next meeting

Request an Appointment

The information you provide will enable us to assist you as efficiently as possible. A representative will contact you within one to two business days to help you schedule an appointment.

You can also make an appointment with our providers by:

Scheduling a virtual video visit to see a provider from the comfort of your home

Requesting an online second opinion from our specialists

To speak to someone directly, please call 1-888-824-0200. If you have symptoms of an urgent nature, please call your doctor or go to the emergency room immediately.


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