How to Change an Ostomy Appliance (w/ video)

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Changing an ostomy appliance doesn’t have to be complicated, but there are a few things you’ll want to do in order to do it right.

Intro to Changing Your Ostomy Appliance

The following steps assume that you have an uncomplicated stoma and use a regular one or two-piece appliance. This guide should be helpful to all ostomates (urostomates, ileostomates, colostomates), although some steps may need to be tweaked/omitted depending on the stoma type.

The most common optional steps have been listed, although there are many more special steps that some ostomates may need due to a complication or difficult stoma.

Disclaimer: As always, I suggest speaking to a stoma nurse if you are having problems with your stoma or ostomy appliance.

If you’re a new ostomate you may not know when to change your appliance. You’ll get better with experience, but I do have a guide to help HERE.

Video (recommended)

http://youtu.be/7iQQ_BcN1Tg

Supplies used in this video include:

Preparation

Preparation is an important step that helps to keep stress levels down and provides you with a clean and organized workspace.

This includes gathering any supplies you’ll be needing as well as making sure that you don’t have anything urgent to get to during the next hour or so.

Gather your ostomy supplies
Some basics supplies for an appliance change. (The right half are extras that may not be needed)

Here are supplies I tend to always have on hand when doing an appliance change:

  • Stoma bag and wafer (or just a bag if it’s a one-piece appliance). Obviously, this will be required!
  • Adhesive remover spray and/or wipes. Absolutely necessary if you find that your appliance or other supplies are difficult to remove from your skin.
  • Ostomy scissors. These are only necessary if you are cutting your wafer, so there’s no need for them if you use a pre-cut or moldable wafer.  I recommend this pair from Coloplast (Amazon.com affiliate link)
  • Small bag to dispose of soiled supplies and to catch any output that comes out while I’ve got my appliance off. “Kitchen catcher” bags tend to be perfect for this.
  • Mirror. This can either be a small, pocket mirror or one that sits on the bathroom sink. Make sure to use one that stands on its own, preferably one that can be adjusted.
  • Gauze or paper towels. I use gauze to clean around my stoma, to make sure my stoma is dry before putting my appliance on. I prefer using gauze over toilet paper or paper towel because it doesn’t stick or break apart easily (my insurance covers gauze, so that helps).
  • Pen or marker. If you are cutting your own wafer then this will be handy, although not absolutely necessary.
  • (optional) Stoma measuring guide. Makes measuring your stoma easier if you use cut-to-fit wafers.
  • (optional) Tampons(!). I’ve had more than a few people (with either a urostomy or ileostomy) tell me that they use tampons to absorb urine/output while cleaning around their stoma. This can be an alternative to using gauze.
  • (optional) Barrier rings, barrier wipes, stoma paste, adhesive, protective sheets, etc. Not everyone needs these, but if your nurse has told you to use them then you’ll want these easily accessible during your appliance change.
  • (optional) Gelling products, pouch deodorants, wafer extenders.

Steps to Changing Your Appliance

  • Get supplies ready. It’s important to get everything ready before you start because it’ll help things to go smoothly and it’ll keep the stress down. If you don’t have a lot of counter space in your bathroom, invest in a hanging toiletry bag to keep your supplies in for easy access.
  • (Optional, but highly recommended). I hang a bag under my stoma to catch any output during my change. It also makes it easier to dispose of soiled supplies. You can use plain “kitchen catcher” bags or you can even find similar bags that are scented to help mask any odors during your appliance change.
    Place a catch bag under your stoma
    Place a catch bag under your stoma to protect your clothes (and the floor) from falling output.
  • Gently remove your old appliance. Be careful not to pull your wafer off too fast or you may damage your skin.  If you find that you often have a lot of adhesive residues left on your skin or the wafer doesn’t come off very easily, try using an adhesive remover.
    Remove your previous appliance
    Use an adhesive remover if your appliance is difficult to remove or leaves a lot of residues.
  • Clean and dry the area around your stoma. You can do this with just plain water, but avoid using soaps with moisturizer if you do use soap. If there’s any residue on your skin use an adhesive remover wipe to gently get rid of it, then rinse with water and dry. It’s really important that your skin is dry before applying any other products, including your wafer.
    Clean around your stoma
    I prefer cleaning around my stoma with gauze because it doesn’t leave any bits and is absorbent.
  • Shave if needed. Allowing hair to grow under your wafer can cause leaks, irritation, ingrown hairs, and can itch. Guys with hairy stomachs may need to do this with every appliance change, and some women may find that shaving any fine hairs makes removing the wafer easier. For a guide to shaving around your stoma please check out THIS guide.
    Shave around your stoma
    Shave to remove any hair that might interfere with the adhesive under your wafer.
  • Measure your stoma and cut a hole in the wafer. You can skip this step if you use a moldable wafer.  It’s important to make sure that you do this properly and if you’re having trouble then I have a separate guide you can read HERE.
    Cut a hole in your wafer
    Make sure you leave just a small gap between your stoma and the hole in your wafer (a few millimeters).
  • (Optional) Apply barrier products, stoma powder, etc. If you use any other supplies, you can apply them to your skin now. As a side note, don’t use extra supplies just because you can – more often than not, less is better!
    Apply barrier rings or other accessories
    While not necessary for every ostomate, you may need to use extra supplies.
  • Do a “Dry run” to make sure the appliance is cut right. To do this, place your wafer over your stoma without removing the back liner. Check to make sure that everything has been cut properly and it fits around your stoma with enough of a gap. Adjust the hole that you’ve cut in your wafer if you need to.
    Do a dry run to make sure your ostomy wafer fits
    Using a mirror, check to make sure your wafer is cut right before you actually apply it.
  • Remove the liner from the wafer and apply the new wafer to your skin. If you’ve got a two-piece then attach your bag after applying your wafer. One suggestion that I would make during this step is to dry your stoma with some gauze so that it’s not really wet or leaking; any moisture that comes in contact with your wafer will cause it not to stick.
    Remove release liner and apply new wafer
    Remove release liner and carefully apply your new wafer.
  • Use your hand and apply gentle but firm pressure over your appliance for about a minute. The heat and pressure will help the adhesive to work better. I often find that having a hot shower AFTER putting on my appliance causes the adhesive to bond even better with my skin (resulting in longer wear times).
    Use gentle pressure to heat wafer
    Using gentle pressure and heat will allow the adhesives to stick better.
  • (Optional) Add pouch deodorant and/or gelling products to the bag.  If you’re using a one-piece or a two-piece with a closed-ended bag, you’re going to want to do this step before applying your wafer or bag.
  • Clean up. And you are done!

This entire process can take five minutes or an hour. Go at your own pace – the goal is to wear an appliance that’s reliable, not set any land speed records!

Tips for Active stomas (ileostomy/colostomy)

One of the biggest challenges you might face when it comes time to change your appliance is an active stoma.

Having a stoma that’s constantly outputting will make pretty much all appliance changes more difficult.

Here are a few suggestions to help with that:

  • Time your appliance changes. You may notice that your stoma is less active during certain parts of the day. Try to schedule your appliance changes during those times.
  • Don’t eat/drink before an appliance change. Eating and drinking stimulate the peristalsis in your gut (it gets things moving!), so you’ll want to avoid eating/drinking a few hours before changing your appliance.
  • Imodium. Some ostomates will use Imodium, or something similar, to slow down their bowels before an appliance change.
  • Marshmallows. Many ostomates swear by this, but eating marshmallows can slow down your bowel movements. You can find vegan marshmallows on Amazon.com (Affiliate link).
  • Laying down. I don’t recommend this, as it creates some other challenges during your appliance change, but some people might find that their stoma is less active when they are laying on their back.
If you’re having a problem with liquid output then you may find THIS guide to be helpful.

Conclusion

I hope this guide has given you some direction on how to change an ostomy appliance.

Each person, stoma, and situation are different, so adjust these steps as you see fit.

I encourage you to also visit a stoma nurse so they can see how you’re changing your appliance and possibly offer ways to improve upon it.

Good luck!

Remember, if you’re having difficulty with your appliance, you should speak with an ET Nurse, who can guide you through specific techniques for your skin and body shape.

QUESTION: Do you have any tips to share for pouch and wafer changes?
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6 thoughts on “How to Change an Ostomy Appliance (w/ video)

  1. Eric,
    In 2 weeks I will be joining your ranks as I have rectal cancer so an APR surgery is looming. Not sure how things will fare with Stage 3 cancer as I’m not doing chemo etc. BUT your video was
    so helpful in reducing my anxiety level. Wish I would have found it a few months ago. Anyway just wanted to thank you for taking all that time helping others.
    donna

  2. Eric,

    I am new to your site and want to say thanks for all the great and relevant information you provide! As someone who has lived with an ilostomy for seven years now, I have gotten some wonderful new tips from you to help me live a better life as an ostomate.

    Here’s something that works for me that you haven’t mentioned.

    When it comes to changing my appliance, I use the hollister adhesive spray to help me attach the wafer to my skin. I find that it creates a better seal, reduces leaks, and increases the average useful life of the appliance from 3 days to 5 days.

    I begin with the same steps that you describe. However, in the “Optional – Barrior Products” step, I will lie down and then carefully apply a thin coat of the spray adhesive only to the skin around the stoma that will be covered by the wafer. I then will wait one or two minutes for the adhesive to become a little tacky. I find that fanning the area with a piece of paper or the appliance to be used helps the adhesive start to set-up/become tacky. After that, I just apply the appliance similar to the steps you describe.

    I have used the spray adhesive with both Hollister and Coloplast appliances and find it works well with both.

    Upon removal of the appliance, I find the clean-up the same whether I use the adhesive or not. It has never been a problem.

    My only caveats are not to spray too thick a coat and only spray on the area of the skin to be covered by the wafer. If I spray too thick a coat it tends to run off the side of my stomach, but this is easily wiped off with a paper towel or towelette. Also, a thicker coat will take longer to set-up/dry. If I spray an area wider than the wafer, after I apply the appliance the bag portion tends to stick to my skin. Again, any excess is easily wiped off and not an issue once dried.

    I’m not sure if this is for everyone, but as an active ostomate, this additional step has been beneficial for me.

    Thanks,

    Bret

  3. Hi. Thanks so much for you wonderful video. My husband is 61 and just found out he has bladder cancer. He starts chemo next week for 4 treatments in 6wks. Then wait 1mth, surgery to remove bladder and prostate. Right now his anxiety level is very high and not sleeping. Got him some Zanex. I’ve been doing all the looking on line to help prepare him. I have found websites that offer belts to wear over the bag. StelthBelt is one. What is your opinion? I noticed your wedding ring. You are so young. Has having your prostate out affected your sexual activity? You know, I don’t really care, I’m just grateful he is by my side. Did you have any kind of counseling when you had this done? Thanks for listening. Yvonne Brodzinski

    • Hi Yvonne, I wish your husband all the best with his treatment.

      I still have my prostate, but my colon, rectum and anus were removed last year. I did not experience any issues with having sex, getting/maintaining an erection or having an orgasm, although the risk was there due to the nerves around the areas that needed to be cut. His surgeon should be able to give you more insight about that.

      I do use the StealthBelt and have reviewed it here: https://www.veganostomy.ca/2013/10/stealth-belt-review.html

      If you do get one, my suggestion would be to wait until he’s healed and in case there’s any weight loss/gain that happens during the time the belt is being made. I ordered mine when I was underweight and it’s getting tight now (time to get a larger one!), but it works well.

      Take care, and please let me know if you have any other questions.

      Eric

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