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    Ileostomy - changing your pouch

    Standard ileostomy - pouch change; Brooke ileostomy - pouch change; Continent ileostomy - changing; Abdominal pouch changing; End ileostomy - pouch change; Ostomy - pouch change

    You had an injury or disease in your digestive system and needed an operation called an ileostomy. The operation changed the way your body gets rid of waste (stool, feces, or poop).

    Now you have an opening called a stoma in your belly. Waste will pass through the stoma into a pouch that collects it. You will need to take care of the stoma and empty the pouch many times a day.

    When to Change Your Pouch

    Change your pouch every 5- 8 days. If you have itching or leakage, change it right away.

    If you have a pouch system made of 2 pieces (a pouch and a wafer) you can use 2 different pouches during the week. Wash and rinse the pouch not being used, and let it dry well.

    Choose a time of day when there is less stool output from your stoma. Early in the morning before you eat or drink anything (or at least 1 hour after a meal) is best.

    You may need to change your pouch more often if:

    • You have been sweating more than usual, from hot weather or exercise.
    • You have oily skin.
    • Your stool output is more watery than usual.

    Steps for Changing Your Pouch

    Wash your hands well and have all equipment available. Put on a clean pair of medical gloves.

    Gently remove the pouch. Push the skin away from the seal. Do not pull the ostomy away from your skin.

    Wash your stoma and the skin around it carefully with soapy water.

    • Use mild soap, such as Ivory, Safeguard, or Dial.
    • Do not use a soap that has perfume or lotion added to it.
    • Look carefully at your stoma and the skin around it for any changes. Allow your stoma to dry completely before connecting the new pouch.

    Trace the shape of your stoma onto the back of the new pouch and barrier or wafer (wafers are part of a 2-piece pouch system).

    • Use a stoma guide with different sizes and shapes, if you have one.
    • Or, draw the shape of your stoma on a piece of paper. You may want to cut out your drawing and hold it up to your stoma to make sure it is the right size and shape. The edges of the opening should be close to the stoma, but they should not touch the stoma itself.

    Trace this shape onto the back of your new pouch or wafer. Then cut the wafer to the shape.

    Use skin barrier powder or paste around the stoma, if your doctor or nurse has recommended this.

    • If the stoma is at or below the level of your skin, or if the skin around your stoma is uneven, using the paste will help seal it better.
    • The skin around your stoma should be dry and smooth. There should no wrinkles in the skin around the stoma.

    Remove the backing from the pouch. Make sure the opening of the new pouch is centered over the stoma and pressed firmly onto your skin.

    • Hold your hand over the pouch and barrier for about 30 seconds after you have placed it. This will help seal it better.
    • Ask your nurse or doctor about using tape around the sides of the pouch or wafer to help seal them better.

    Fold the bag and secure it.

    When to Call the Doctor

    Call your doctor or nurse if:

    • Your stoma is swelling and is more than a half inch larger than normal.
    • Your stoma is pulling in, below the skin level.
    • Your stoma is bleeding more than normal.
    • Your stoma has turned purple, black, or white.
    • Your stoma is leaking often.
    • Your stoma does not seem to fit as well as it did before.
    • You have to change the appliance every day or two.
    • You have a skin rash, or the skin around your stoma is raw.
    • You have a discharge from the stoma that smells bad.
    • Your skin around your stoma is pushing out.
    • You have any kind of sore on the skin around your stoma.
    • You have any signs of being dehydrated (there is not enough water in your body). Some signs are dry mouth, urinating less often, and feeling lightheaded or weak.
    • You have diarrhea that is not going away.

    References

    Cima RR. Pemberton JH. Ileostomy, colostomy, and pouches. In: Feldman M. Friedman LS, Brandt LJ. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 113.

    Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend Jr. CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 50.

    American Cancer Institute. Ileostomy guide. Last Revised: 03/17/2011. Accessed 07/08/2012.

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              Review Date: 7/1/2012

              Reviewed By: Joshua Kunin, MD, Consulting Colorectal Surgeon, Zichron Yaakov, Israel. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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