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.

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).

[MUSIC PLAYING] Hi I'm Jan Colwell. I'm one of the Advanced Practice Nurses at Ostomy Care at the University of Chicago Medicine. This video is going to cover how to empty your ostomy pouch. There's going to be two parts. The first part will show you how a person empties their pouch directly into the toilet, the second portion of our video is going to cover how a person will empty the ostomy pouch into a container to measure, because we do that for the first couple of weeks after surgery.

So this is it going to be the first portion, and this is going to be the part that's going to cover how to empty the pouch directly into the toilet.

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I wanted to demonstrate a little tip to make it a little easier to empty your ostomy pouch. When you get a brand new pouch before you put it on, what you might want to do is you might want to open the ends because it's easier to do when there's nothing in the pouch, and then pinch a crease at the top and the bottom. The reason we do that is it closes no problem and you just roll it off as you do normally. But when you're ready to empty it, you can open it up and you can pinch it and it follows that crease and it becomes much easier to open and empty.

So what most people do is they sit on the toilet and they sit back down the toilet just a little bit so they can see the water in the toilet bowl, and then what they do is pick up the ends of the pouch, and you'll see that's what Michelle's doing now. She's folding it up, and she's going to open the end of the pouch slowly, making sure she's holding it up so nothing can come out.

This type of pouch, if you push it the end, you're able to open it up and now she's going to direct the contents into the toilet. And if it doesn't flow easily, what you see her doing is just kind of helping everything come out. You see her right hand is a little bit from the ends of the pouch so she doesn't get it soiled. She's not going to get every little piece out, but she'll get most of the volume out and do a little bit of squeezing. And when she thinks it's good she's going to take some toilet tissue and she's going to wipe the end because she's going to roll that end up and we want it to be clean.

Many of our patients will take a second piece of tissue have just cleaned the inside just a little bit, so that when they close it, none of the stool will be there. What you can see right now, Michelle's going to show you. There's a little crease right there. Do you see the crease at the top and the bottom? She made that crease when she first put the pouch on because it made it much easier for her to open.

So now she's going to close it. This type of pouch gets rolled up three times and then she pinches a closed. And that is now an empty pouch. Most people enter their pouch with an ileostomy between four and six times a day. You don't really want the pouch to get more than about a third fold because it'll be too heavy. So just keep an eye on an empty and it when it's about a third full.

And one other thing. Not everybody sits on a toilet when they empty their pouch. It will depend on what works best for you. Some of our patients may stand and flush the toilet as they're emptying, so work with your WOC nurse, you're ostomy me nurse and find out the best way to empty for you.

OK, in this segment, we're going to show you how you're going to empty your pouch while you're in the hospital and for the first two weeks you're at home. What's different about this technique is you're going to empty it while you're sitting on the toilet, but on top of the toilet itself will be a container. The stool will be emptied into the toilet, and the container has numbers on it so you'll be able to record the volume on a piece of paper that I'll show you in a few minutes. And you'll be able to bring that paper with you to clinic so we can make sure that there's no signs of dehydration.

So Michelle's going to demonstrate how to empty the pouch into a container now. What she's going to do is she's going to pick up the end of the pouch holding it upwards, and she's going to open the end of the pouch. Once she's got it open, she's going to pinch it open, and she's going to direct the output into a container that you'll receive in the hospital and you'll put on the toilet under the seats before you sit down.

The reason that we have this container is it will hold onto the stool and the inside of the container are measurements that will help us understand how much output is coming out. Now, when she's finished, she's going to pick up the pouch, as you can see, and hold it upward so that she can tissue off any stool that's there. She's also tissue in the inside of it as well because if there's a little bit at the edge, sometimes that will come out.

When she's finished, she'll be closing it and just putting the tissue into the toilet. And the usual roll up three times, put the flap over. Next thing that she's going to do, and she can either look straight down or get up and do it, she's going to look into the container. And if you look into the container, it's a little hard to see that there's a 100 mark just underneath the 200. This would be about 100, I would say, if I was going to document it. And the reason I'm pointing that out to you, is I'd like you to take a look at this sheet right here.

OK, so now you know that there was 100 cc's this time you emptied. You should go to the sheet that we'll be providing you in your workbook, it's called daily stoma and urinary output tracker. We're just going to talk about the stoma output right now. What you would do is you would write down today's date, and this would be the worksheet for the entire day, and we had 100 cc's, so you write 100.

And then you look at the column that's called consistency, what it looks like, and you circle one. Was the output watery, was it applesauce, or oatmeal? And I think it was oatmeal this time, so you'd be circling. Now you've got room for any other empty that you do today. And then when you're finished, you can total that amount. Go to the other sheet that's in your workbook and it's called the 24 hour stoma and urinary tracker.

And you can see right here, day one, and you put total amount for stoma, and you would put that amount here. And under consistency, what it looks like most of the time. That'll just give us an idea of most of the time more than 50% was it watery, applesauce, or oatmeal? After you've emptied the pouch, don't forget that you need to empty out the container.

What you'll do is you'll pick it up and empty it into the toilet, you'll rinse it out, empty it into the toilet, and then you'll have it handy for the next time that you're going to empty.

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OK in this segment, we're going to go over how to empty your pouch into a container in a standing position, because for some people, it's a little easier to stand than to sit on the toilet. So you'll get the container. Again, remember we're going to send this container home with you. And then you just pick up the end of your pouch, put it at a good height for you. You're going to open up the end, pull the tab and unroll it while you're holding it, and then you'll pinch the end and you'll allow the stool to empty. Again, you might have to help it if it's kind of thick.

Empty as much of the pouch as you can possibly do so we can see how much is in there, and you can see Michelle's just kind of squeezing it out trying to get the end empty if she can. She's wiping the end off, throwing away the tissue. And then she's taking another tissue and what she's going to do is just wipe that inside out so that when she pinches it close, there won't be a problem, and then she'll just roll it up three times put the flap over it and pinch it.

Now take a look inside the container. And what you want to do is get an idea of how much is in there, and you can see that 100, it just barely gets there. We're really looking for an approximation. So if I went to write down the volume of this time, when you emptied, I would say 100. You write 100 cc's down on the form that I showed you in the previous segment, and when you look at the consistency, it is really pretty thick, so it would be like oatmeal as well.

Well this concludes the video on how to empty your ostomy pouch. Just to review, what we did is we covered how you empty your pouch directly into the toilet, which you won't do at the beginning because you're going to empty it into container for the first couple of weeks and bring us the volumes that you'll be recording. If you have any questions about anything that we've covered in the video, please feel free to talk to any of your ostomy nurses. Or remember, we have an ostomy website where you'll find additional information.

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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.

Hi, my name is Jan Colwell, and I'm one of the advanced practice nurses in ostomy care here at the University of Chicago. What we're going to do today is demonstrate to you how a pouching system is changed. And I'm here with Erica. Erica is one of my past patients.

Thank you, Jan. Hi, my name is Erica. I have had an ileostomy for 10 years. And today, I'd like to walk you through the process on 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 the washroom. They lay everything out on the sink. And then they start their procedure.

I have my wet paper towels, my dry paper towels, the pouch, my wafer, scissors, paste, and a bag to dispose of all the old pieces. The first step is to cut the wafer. I know that my stoma is one inch. So what I'm going to do is first pre-cut along the 1 inch circle.

Now, while Erica's 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 size-- 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 the stoma won't make any contact with the skin, and there won't be any issues with skin irritation.

Now that I've cut the 1 inch circle, I remove 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 paste around the circle of the wafer.

And so what Erica is going to do is she's going to squeeze the paste out in a really thick bead right around the edge. That's the caulking technique that she mentioned before. I would tell you there's one other option for getting a secure seal. And they make a paste ring which people can use. Let me show you what that looks like.

This is the same kind of wafer that Erica's applying the paste. But one of the options is, after it's been cut out, to take the paste ring, which is sticky on both sides and has a small inner diameter. And the user just stretches it to the size that they cut in the adhesive and just applies that as well. Some people like it because it can be a little less messy, and it doesn't have any alcohol in it. So for some people, it's not as irritating to skin.

After I apply the paste, I do take a wet piece of paper towel and I kind of smush it down just a little bit. It has to be wet because a dry paper towel stick to the paste. Now that everything is laid out and ready, the next step is to remove the adhesive.

Now Erica's going to gently remove the outer adhesive. So you see what she's doing. She's rolling an edge so that she can get it started. And then once she gets an edge, she's going to press her skin away from the adhesive, and she's going to go around the outer edge on the top and the two sides.

Now that I've removed it, I will roll it up and put it into the bag. And 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 nerves in them. So she's not causing herself any discomfort. But she's trying to get any stool that might be loose off so that it won't get on the skin when she starts to clean it.

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

And as Erica pointed out, it's a wet paper towel, water from the sink only. There are some people who would prefer to use soap, which is OK. But many of the soaps have moisturizer. So you just need to be sure about the type of soap that you're using and then do a good rinse job.

This is a good time while you're cleaning to take a look at the skin and see if there's any issues, any open areas. And you'll see a little bit of pinkness, which is pretty normal because, when you take any kind of adhesive off, the skin pinks up.

Next, I'm going to take a dry paper towel. And I'm going to make sure that the skin-- I'm going to press down-- any sort of moisture is absorbed.

One of the things that I need to point out is that Erica has had her stoma for a while. She knows that it's a 1 inch opening. But if it wasn't, I wanted just to demonstrate to you how a person might measure to know what size to cut the opening. Many people will use a measuring guide that looks like this. It has a variety of sizes. And start with what you might think is a reasonable size.

So for instance, you would just hold it over. But you can see that's an incorrect size because there's so much skin showing. So we would downsize it more like this. And you can see it's a snug fit. What we're looking for is a fit around the stoma right where the stoma comes out of the skin so all the skin is protected.

OK, now that my skin is dry, the next step is to apply the wafer, which we've already prepared with the paste. And I'm going to center it over the stoma.

And you can see why it's advisable to stand. Erica has a good view of what the stoma looks like in this position so that she can easily center it. And now she's taking the release paper off the outside. Remember, the outside is the waterproof adhesive, quite flexible. And she's pressing that down.

And next, she's going to go on the inside and just kind of run her finger around the inside. You see how some of that paste comes up, which is absolutely fine. It's caulking and giving her the seal. And finally, she's going to the outside of the inner [INAUDIBLE] adhesive to be sure she's got a good seal.

The next step is to apply the pouch. So I put it on on an angle. And it snaps on.

Erica is snapping it on because it's a two piece pouching system, and the two adhesives go together. So she goes around two or three times just to be sure it's a secure seal. And then the final thing is, obviously, we need to close the end.

So what she's going to do is roll that end up three times. So one, two, and then the third time, she takes a little flap, lines it up over. And now you see her pinching it very, very firmly so she gets a really tight seal and nothing comes out through the bottom.

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

That should have given you a very good indication of how a person changes their pouching system. Most people change their pouching system about every three or four days because the adhesive starts to wear away. So you should consider that you'd be changing your pouching system about twice a week.

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?

Correct.

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?

Correct.

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.

Exactly.

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.

Correct.

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?

Correct.

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.

Sure.

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.

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