In this blog post I’ll be answering a question that many new ostomates have: when should I change my appliance?
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This question is quite common and if you are a new ostomate you may not have all the answers.
Some people change their appliance on a fixed schedule (i.e. every third day), while others go by how their appliance feels on them (i.e. is there any itching?).
I’ll go over some of the things that might give you an indication that your appliance needs to be changed. This is based on my experience with having an ileostomy, but it should also apply to colostomates. I don’t know how relevant this information will be for urostomates, but if you’re an experienced urostomate perhaps you can let me know.
Keep in mind that everyone will have their own experience, and a lot of this will come with time.
As you become more familiar with certain patterns, like how quickly your wafer degrades or how your skin reacts, you’ll be able to better determine when you should change your appliance.
Try not to get discouraged as you figure things out; you may need help from an ostomy nurse if things become overwhelming.
Itching and/or Burning
Burning is often a clear indication that your appliance needs to be changed.
If you get to this point, then you’ve likely waited too long. No worries, just note how long you’ve worn your appliance for and change it sooner next time.
A word of caution: If you are getting the burning feeling often, it may indicate that your skin is too sensitive for the product you have on, or that you’re getting leaks that are harming your skin.
You may feel some itchiness under your wafer as you get used to how it feels on your skin. This doesn’t mean that you’ll need to change your appliance immediately, and the feeling will pass after weeks/months of getting used to it.
Itching can also be an indication that your wafer needs to be changed, so be mindful of when it happens and try to identify whether it follows a pattern with your appliance changes.
Bulges Under Your Wafer
As your output comes in contact with your wafer, the wafer will absorb fluids and expand.
This is quite normal, and it helps to get a good seal around your stoma. However, if you notice more bulging than normal, it could indicate that you’ve got a leak or have reached the end of your wafer’s wear time.
On some brands of appliances, especially the Hollister New Image wafers with tape borders, it’s quite easy to see this bulge. It’s not as easy to spot when you’re wearing a more rigid wafer, so this may not work for everyone.
Anecdotally, this seems to be something that many ostomates with dogs can vouch for. But apparently, if your dog is paying too much attention to your bag (sniffing it a lot), it could mean that something is up.
By design, the bags and wafers we wear are meant to contain odors at all time. Understandably, the only times you should notice odor is when you’re changing your appliance or emptying your bag.
You may, however, notice a smell coming from your wafer when it’s past the point of needing to be changed.
This happens because as fluids are absorbed by your wafer, it radiates outwards from the middle of your wafer to the edges. Those fluids carry odors which can be noticed if you don’t catch it in time.
You may notice any odor coming from your bag’s filter, which is fine if you are using a two-piece system, you can just swap out the bag for a new one; if you’re wearing a one-piece then it would be time to change your entire appliance if having a working filter is important to you.
The Condition of Your Wafer’s Underside
One of my favorite ways of to tell whether I’m wearing my appliance for the right amount of time is by checking the bottom of the wafer when I’m doing an appliance change.
You can learn a lot by checking the underside of your wafer:
- How well did it hold up?
- Were there any leaks?
- Did it “melt” more than normal?
- Did it absorb a lot of moisture (i.e. sweat)?
By knowing these things, you’ll be able to get a better idea of how long your wafer can last.
Remember that there are two main groups of adhesives: regular wear and extended wear. Some break down more quickly than others, and some may not be good for long wear times of over three days.
I check my wafers every time I remove them, and I even take photos so that I have an ongoing record of my appliance’s durability. This can be really handy if you’re trying new products and want to compare them between themselves.
It’s also important to check under your wafer if you’re using products like barrier rings, as they can erode and degrade, too.
Look for the signs and act upon them.
Watch That Shrinking Stoma
If you’ve just had surgery, then chances are that your stoma will be swollen, or at least bigger than normal.
This may lead to issues such as leaks or skin irritation as your stoma becomes smaller than the hole in your wafer.
During this recovery phase (which can last over a month post-op), it’s important to make sure that you measure your stoma with each appliance change.
If you use a moldable wafer, it won’t be necessary to measure your stoma, but make sure that you’re molding it properly to avoid issues.
You may also be advised by your stoma nurse to change your appliance more frequently than you normally would.
I was on a two-day schedule for the first 4-6 weeks after my surgery, and at one point I neglected to change my appliance on time, so I developed a very deep skin wound near my stoma as the skin as my output burned it.
This hurt like hell, but it was a good reminder that I needed to keep on top of these things!
Be careful with changing your appliance too often since it may lead to skin irritation caused by the adhesive being pulled off your skin.
Adhesive removers can help if you’ve been told to change your wafer frequently.
Once your stoma normalizes and the size becomes more consistent, you should be able to achieve longer wear times.
Look Around Your Stoma
If you’re wearing a clear bag or a bag with an inspection window, have a peek to see what the condition of your wafer around the stoma looks like.
You can do this if you’ve got a two-piece on and can easily remove the bag, but this may increase the risk of leaks starting at the appliance coupling (where the bag meets the wafer).
If you notice a lot of “melting” of the appliance or if you can visibly see skin around your wafer, it’s probably time to change your appliance.
Not only do clogged filters lead to ballooning and leaks, they can be super annoying to deal with.
If you’ve got a one-piece on and are dealing with a clogged filter, the best thing you can do is change your appliance with a fresh one.
For those who wear two-piece systems, simply swap out your bag for a new one.
Many ostomates who keep their wafer on for more than four days may change their bags daily or twice daily because of clogged filters. If cost isn’t an issue, there’s no real disadvantage to doing this.
Hair, Hair, Long Beautiful Hair
This is likely more of an issue for the guys, but when the hair around my stoma gets long, it ruins my wear time.
If you notice hair coming through your wafer (which you can with tape border products) then it’s time for a change.
Try to shave that skin with every appliance change to reduce the chance of hair getting in the way.
More recently, I’ve been tweezing and epilating the skin around my stoma in order to slow down the growth of that hair. So even if I forget to shave (or don’t have the time to) between appliance changes, my hair won’t be long enough to cause a problem.
Wafer Peeling / Lifting
Most wafers stay on your skin without much hassle, but if you notice that the edges of your wafer beginning to peel or lift, then it might be time to change it.
Sometimes peeling just happens with movement or water exposure, and it doesn’t necessarily mean that your wafer’s seal is compromised.
You can add an extra layer of protection around your wafer by using a wafer extender. I do caution against the use of wafer extenders during a leak; it’s best to change your appliance right away to avoid skin damage after a leak.
The Obvious: You Can See a Leak
While many of the signs that you need to change your appliance are often unseen, leaks can often be seen either through the wafer or on your clothes/bedsheets!
If you see output where it shouldn’t be, it’s time for an appliance change!
I hope that you’ve been able to learn which factors help to determine what schedule works best for you.
As I mentioned before, a lot of this will come with experience, and you may need to look for other clues if you’re trying on new products. Don’t be discouraged during this transition. Eventually, you’ll get it down to a science!