Caring for an ostomy at home: emptying and changing the pouch

Coming home with a new ostomy brings a lot to learn at once. The routine settles quickly with practice: empty the pouch before it gets heavy, change it every few days, and keep the skin around the stoma healthy. This note covers the steps and the signs to call about.

Empty and change on a schedule

Empty the pouch when it’s about a third full.¹ Change it about every 2 to 4 days, or as often as the nurse says.¹

Have the supplies ready

A new pouch (one-piece, or two-piece with a wafer), a clip, scissors, a clean towel, stoma powder, stoma paste or a ring seal, skin wipes, a measuring card and a pen.¹

The change, step by step

Wash hands before and after.¹ Remove the old pouch gently, pressing on the skin around the stoma as you lift the seal.¹ Clean the skin with warm water, soap and a washcloth, and pat it dry.¹ If any skin is wet or open, sprinkle stoma powder only there.¹ Use the measuring card to find the circle that matches the stoma, trace it on the back of the seal and cut it out.¹ Press the new seal in place and hold it for a few minutes; a warm washcloth helps it stick.¹

What healthy looks like

The stoma should look pink or red. Call if it turns purple, black or blue.¹

When to call

Call for a fever of 100.4°F or higher or chills; no gas or stool for 4 hours; a bad smell, pus or heavy bleeding from the stoma; changes in the stoma’s color, length or position; bulging around the stoma; blood in the stool; nausea or vomiting; or severe belly pain or bloating.¹

Help at home

A home health nurse can teach pouch changes until they feel routine, help with leaks and sore skin, and keep watch for problems.