In this blog post I’ll be answering a question that many new ostomates have: when should I change my appliance?
Table of Contents
Intro
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.
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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.
Smells
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.
Info: To learn why stomas can change size or shape, please check out THIS article.
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.
Clogged Filters
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.
Info: If you’re interested in knowing more about one-piece and two-piece appliances, please check out THIS article.
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.
Info: I’ve got an entire article on shaving around the stoma, which you can check out HERE.
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!
Conclusion
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!
If you’ve got any other tips to share, please leave it in the comment section below.
Hi, I have a question about pouch changes. When inspecting the back of the wafer when changing the pouch, is it normal to have a little bit of seepage? Not enough to make a leak, but just a little underneath the wafer/barrier ring. I’ve had some ostomy nurses say that this is totally fine and others say that it should always be clean and without any sign of output underneath. I guess I’m trying to figure out the balance between achieving a system that works but not trying for unrealistic perfectionism. I’m also wondering if in the photo you showed of your used wafers if you were using barrier rings. I’ve been seeing mixed reviews about whether the barrier rings are needed. I was given them in the hospital, but I’m not sure if they are helping or possibly actually unnecessary for my pouching system. Thanks so much for any thoughts.
Hi Ki,
In my experience, a little seepage is pretty normal and if it’s not causing damage to the skin, I wouldn’t worry about it.
You may notice itching around the stoma when this seepage happens, so it may even be a good thing since it gives you a heads-up that your wafer will need to be changed soon.
In those photos, I was NOT using a barrier ring, although I will say that the swelling effect you see appears more exaggerated than what I get now. If your output is on the liquid side, the wafer will likely look like the photo.
If you suffer from leaks, barrier rings can be helpful, but I would prefer someone to find an appliance that works for them without needing to use extra supplies.
What is your wear time like with and without the barrier rings (if you’ve been using those for long)?
Thanks so much for this response.
So far I’ve actually never tried just wearing a wafer without barrier rings. My first ileostomy surgery went horribly wrong (stoma ended up being flush and about 5mm in diameter. Saw a new surgeon and he said it was one of the worst cases of retraction he’d ever seen). With that one I never got a real sense of wear times because the situation was so messed up. Now I’m 6 weeks out from the revision surgery when the malfunctioned loop was changed to an end and I’ve been changing the pouch every other day and I’ve been using the barrier rings every time. I’ve experimented with different rings though and found certain ones hold up better than others for me. No major leaks so far, just the little bit of seepage I mentioned sometimes visible under the skin barrier when I change it. I guess since I was instructed to use the rings in the hospital I had assumed that it was just a part of the pouching system. My output is typically thick applesauce consistency, sometimes gets a little more liquidy at night. I want to experiment with other set ups, but it causes me a lot of anxiety too.
If you have the time to experiment, try seeing what it’s like without the barrier ring.
I trust that your new stoma is no longer retracted and sticks out a bit? If so, it should be fairly uncomplicated to try new things.
I personally find that wafers have far better adhesion to my skin than barrier rings, so I can push my wear time to 7-10 days without leaks, where barrier rings would usually top out on my after maybe 4 days.
Post again with an update if you do decide to try new things.
Good luck :)
You may want to à stoma RN to assess if convex flange could be better for you. This helped me to forgo the barrier ring.
Hi Gerry, All the best and most of the things we worry about never happen. You found a great site here. Read,ask and learn 👍
Unless you are me and then they all happen. Plus other things no one even thought to worry about. 😂😂
Best wishes to you, Gerry. My stoma is three and a half years old. I remember feeling apprehensive and hopeful. The adjustment was not difficult, and my life is better – in fact, I might not even be here at all if it wasn’t for the colostomy. Not long after my surgery I found VeganOstomy (I was on the internet looking for clothing options, and VO popped up!) and learned so much. I am very thankful to Eric, and to the wonderful people on the VO forums.
I am scheduled for Colostomy surgery in a few weeks. Thank you for the information, especially the pictures. I’m scared but being informed will help.
Good luck, Gerry! Being informed is a great way to build confidence, too.
Just keep in mind that while I cover a lot of topics here, not every situation will happen or even be relevant for all ostomates. That should hopefully help to make things less scary as you prepare.
Welcome, Gerry. I came to this site when I was told I needed a permanent colostomy. I was scared, too but Eric’s story did much to prepare me for the operation. It’s always good to go into any situation well informed and to have support. Do not be a stranger to this site. There are a lot of good people who are great cheerleaders and have experienced what you are going through now.
God bless,
Stella
@ Gerry W …Welcome to VO! Agreeing to my ileostomy, just over 12 years ago was the best thing I had done for myself in a long time! Before that there had been about 8 bowel surgeries. Different people different situations. Fear is normal but if your feeling high anxiety the day of surgery do yourself a favor & tell the nurse looking after you. Sometimes they can give you a little magic pill to help you relax better. Its well worth the honestly! Lol!
I know you haven’t really asked for advice but I would like to encourage you to get up go for walks “with assistance", as soon as your told its safe after surgery. Its the best way to encourage you guts & whole body to wake up & get moving. Drink lots of fluids after to help wash the drowsiness away & stay hydrated. Don’t be a hero over the pain situation. Let the Nurses & Doctor know if its not under control & don’t be afraid to say so. I think I’ve found the 1st 3 days to be the most challenging. Once over that hump you’ll do much better.
Go armed with a journal so you can write down questions & answers for the Doctor & information like keeping track of how your guts respond to foods once your eating again.
Stay in touch & let us know how your doing. Slow & steady wins the race! Lol! Maybe when your up to it you can start a new forum & tell us your story & introduce yourself to the group. We do like to give newbies a hearty welcome! Any questions… know we are here for you!! Hospitals have a guest internet you can sign into if your up to viewing Erics ever so helpful videos! All the best & be as well as you can be!
I’ll be praying for you!
Linda
I am currently using coloplast appliances. I have tried several brands over the last 2 years with the same on going problem. It seem that all the barriers are made of the same plastic. My output keeps breaking down the plastic around my stoma, it shreds. The opening becomes bigger and bigger allowing all the poop to go through. I have to change it at least 2 times minimum daily. I’m reaching out to anyone who might have this problem. Or possibly have an answer 😊.
Thanks !!!
Hi Suzanne. Have you tried any “extended wear" products? They should help to prevent that, but most wafers will swell up to fill any gaps between your stoma and the cutout. I wonder if your stoma is getting larger and smaller during the day, which is causing these leaks.
Hi Suzanne, welcome. I had a bit of a problem with this when I first had my stoma. Two things changed this for me. One was simple,I drank more milk and ate yogurt twice a day. This seemed to cut the acid in my output and meant less bad sores. Also, when you cut the hole in your bag, are you turning the bag or the scissors? Turning the scissors gave me a crooked edge and small slits I did not want, causing me to have to move the hole over a bit to fix it. The sharper edges also hurt my stoma causing a bit of minor bleeding when I bent over to pick something up or to pet the dog. I always turn the bag when cutting the hole for my stoma, it gives a softer edge and more control over your cutting.
(Edited by VeganOstomy: Hi Linda, I’ve created a new topic for your hair removal question.).
Same here. My partner had emergency surgery in October, she soent 10 days in ICU andxalmost dudnt oull through! . We are in our mid seventies. She has an ileostomy and during recovery I was and still am her sole support. She is getting better at changing her bad herself, but still needs me around to help with cleaning around the stoma, etc. It seems that the leaks are more frequent. She uses the coloplast transparent bags x 10 wafers which is covered by our health care, We live in Spain. All other accessories are not covered. I tend to think because the stoma retracts under the skin, is the cause of the leaks and a convex wafer is the answer. We are seeing out stoma nurse and will ask if we can changer the wafer. This has been life changing, not only is she dealing with this but has Metestatic cancer and you can imagine, when once we were able to travel without a care in the world, now doctors appointments are are the new normal and our emergency stoma bag goes Wherever we go! If I could give her my colon, I would! There were so many other complications that only now is she managing to get her mobility back and walk short distances. We are both sleep deprived but will live this out the best way we can! Thank you all for such encouraging reads and blogs. Bless you all, onwards and Upwards ????????????????
Lesley, you are certainly dealing with a lot! You are absolutely correct about a convex wafer. My stoma is almost flush, and I had lots of leaks early on. When I changed to a convex wafer, the leaks stopped immediately. I’m sure your stoma nurse will agree to try it. Best of luck to you both, and glad you found us.
Laurie