The frequency of ostomy bag change does not have a consensus. However, ostomy patients tend to change their ostomy bags around three times a day, every other day, every two days or even after more than five days. Although it varies, the general recommendation is not to exceed seven days. Some factors interfere with the ostomy bag changing frequency and affect the pouch durability.
“Your stoma will begin to work shortly after your operation, usually within a few days. At first, the output will be a watery liquid and may be strong-smelling as your bowel hasn’t been working for a while. Occasionally your bowel motions may be mixed with blood. However, please be reassured that the consistency will thicken slightly and the smell will settle as you resume a more balanced diet. Initially, it is also likely that a certain amount of noisy wind (or flatus) will come from the stoma – again this is perfectly normal.”1
Bag frequency change depends on your diet and type of ostomy, modifying your hygiene habits and routine. “Ostomy surgery radically alters urine or fecal elimination, forcing the client to learn new physical skills in order to manage the ostomy itself, fecal or urinary effluent produced by the ostomy and the peristomal skin. Clients with a new ostomy must master multiple psychomotor skills to remove their pouch, clean the ostomy and peristomal skin and empty and dispose of effluent from the pouch.”2
The following are the main variables impacting an ostomy bag’s durability. If you have any concerns, please refer to your ostomy professional for advice.
Emptying the Pouch
“Emptying your pouch is the first skill that you will need to learn after your operation and the one you will use more often.
The feces are often quite watery when the stoma first starts to work after the operation. Your nursing staff will help with emptying the bag, and other tasks, until you are ready and have learned how to do it for yourself.
It’s a good idea to begin to establish a routine for changing your bag and to try and keep this as simple as possible. As you get used to your stoma you will find that at certain times of the day it’s more active than others, for example shortly after a meal.
Don’t choose this time to change the bag but select a time when it’s relatively inactive – perhaps first thing in the morning. Before starting to change the bag make sure you have everything to hand that you will need. Just like everything else in life, a little bit of forward planning can help a lot.” 3
When to Empty Your Pouch
“Empty the pouch when it is ⅓ to ½ way full (for Colostomy and Ileostomy)
In the beginning, your stool will be loose and you may have to empty the pouch 3-4 times per day
As your stool thickens, you will empty the pouch about 2 times per day
If your stool gets formed, you may prefer to wear a pouch that can be discarded with each bowel movement
The skin barrier that sticks to your belly around your stoma (called a wafer) is changed every 5-7 days
In the beginning, your stool will be loose and you may have to empty the pouch 6-8 times per day
As your stool thickens (toothpaste consistency), you will empty the pouch about 4-5 times per day
The skin barrier that sticks to your belly around your stoma (called a wafer) is changed every 3-4 days.” 4
Check the Pouch Level
“A Bag that is too full may start to pull away from your skin.
You will not feel stool or urine coming out of your stoma You will need to check for fullness by placing your hand over your pouch and feeling it.5
How often do I need to empty or change my bag?
“This will vary from person to person. The stoma bag only needs to be changed when required – usually between one and three times per day depending on the amount of feces and how often you open your bowel.
Draining an ostomy bag
Some bags can be drained of their contents and do not require replacing every time the bag becomes full. These bags will need to be emptied 4-6 times per day or as required.
For bags that allow for drainage, the steps are:
1) Open the clamp
2) Drain and empty the contents into the toilet, place toilet paper in the bowl to avoid splashback
3) Rinse the pouch
4) Close clamp.
Changing a one-piece or a two-piece ostomy bag
It is important to be prepared and have all the equipment at hand before starting to change the pouch.
Gather the equipment needed:
- Waste bag
- Dry wipes for washing and drying
- Adhesive removal wipes (if needed)
- Warm water for washing
- New pouch
- New wafer/base plate, cut to size (For two-piece ostomy bag)
- Scissors for cutting the wafer/base plate to size (if needed)
- Scissors for cutting the flange (if required on one-piece ostomy bags) or for cutting the wafer/base plate to size (if needed/ on two-piece ostomy bag)
A person may feel that this could have a significant impact during social events. Wanting to be with others socially will remain an important part of life and needs to be incorporated into their changed circumstances. 6
Colostomy Bag Changing Frequency
A colostomy is likely to have periods of relative inactivity over the course of the day and tends to function more in keeping with what patients have been used to as their usual bowel habit.
The output from an ileostomy is looser, as stool will not have passed through the colon where the majority of water is reabsorbed, giving the stool its form and consistency. The volume of output passed from an ileostomy increase inversely to the length of remaining small bowel in continuity, but a normal output for a terminal ileostomy is considered to be 600–800 ml in 24 hours. 7
Regulating the defecation cycle in patients with a colostomy
“In this case, two methods are applied:
The first comprises leading a very regular lifestyle. This mainly implies regular meal times and their number (3–5 meals consumed in a calm atmosphere), regular sleeping times, systematic physical activity and a proper amount of water drunk daily. Such a regular lifestyle can induce regular defecation hours not only in ostomy patients but in all persons.
The second method involves the systematic irrigation of the ostomy. Such procedures, if performed every day, ensure total control over defecation (during the irrigation). The patients who apply irrigation can wear small and very discrete pouches.”8
Dietary Habits and Ostomy Bag Changing Frequency
“It is important to know the effects that different foods and beverages have on the stoma output. Depending on the type of stoma, the effects may vary. It is important to introduce new foods gradually, chew all foods well and have an adequate fluid intake.
Some general guidelines of what some foods and beverages can do to stoma output:
Foods and drinks that can increase output
Alcohol, beef, bran cereals, broccoli, cooked cabbage, fresh fruit – not bananas, grape juice, leafy greens, licorice, milk, prunes and juice, raisins, spicy foods, raw vegetables
Foods and drinks that can thicken output
Apple sauce, stewed apples, bananas, bread, buttermilk, cheese, marshmallows, boiled milk, noodles, pasta, peanut butter, pretzels, white rice, tapioca, toast, yogurt.” 9
Ileostomy Waste Consistency and Bag Durability
Copious stool, as in people with an ileostomy, diminishes skin barrier and wafer life. In one-piece ostomy bag systems, a damaged skin barrier means a whole bag change.
“Ileostomy patients should increase fluid intake to a minimum of 8 to 10 glasses daily, unless contraindicated. Chewing food well will help to avoid blockage. Patients should avoid hard-to-digest foods such as nuts, popcorn, and foods with skin or seeds for 6 weeks. Eating foods such as bananas, potatoes, pasta, and creamy peanut butter may help to thicken the stool.
Urostomy Patient should drink at least 8 to 10 glasses of liquid a day, unless contraindicated.”11
Types of Ostomy Bags and its Changing Frequency
“There are a number of variations of ostomy bags in use today, some of which are meant for longer-term wear and can be emptied (reducing the number of times the adhesive must be removed from the skin), and some of which are meant for shorter-term wear (bags are filled, removed, sealed, discarded and a new bag is attached).
Despite the improvements to ostomy appliances over the years, the present inventors have realized that there remains an unrecognized and unsolved problem in the art that plagues ostomy patients. The appliance has a wear time which is not only limited by the capacity of the device, but also by (a) the varying amount of waste collected from the patient, (b) failure of the adhesion to the patient’s abdomen, and (c) failure (rupture, leak, etc.) of the device’s containing function. And, these conditions may affect each other, for example, a full bag is more likely to rupture or lose adhesion than a new, nearly empty bag. Usually, there are very limited warning signs that these conditions are imminent. Unexpectedly reaching capacity or failure of an appliance may occur at an inconvenient time and place.10
Skin Health Alterations and Bag Durability
Peristomal skin rashes force frequent checks on the affected area. This requires continuous detachment of the ostomy bag and the skin barrier, causing them to lose grip on the peristomal area.
“Large areas of skin that are red, sore and weeping (always wet) will make it difficult to achieve a good seal around the stoma. It is important to treat minor irritations right away. If there is a large irritated area, contact the doctor or ostomy nurse. They may prescribe medicine to help dry out and heal your skin.12
A study found that the majority of problems are experienced by patients with an ileostomy, of whom 57% have peristomal skin problems. Of those with an ileal conduit 48% experience issues, while 35% of colostomies have problems. These findings could well be attributed to the amount and type of output being contained, but even taking this into account, it is clear that for every 10 colostomies who are still using the vast majority of their gut complement and will, therefore, have a more conventional stool, at least 3 will still experience issues with their peristomal skin. Woo et al (2009) offered that of those ostomists diagnosed with a peristomal skin disorder, 77% could be related to contact with their stoma output.13
Factors That Compromise Bag Integrity
- Comfort: Itching or burning may force rubbing or taking off the bag to soothe the peristomal skin.
- Skin Kind: Oily skin reduces skin barrier and ostomy bag stickiness.
- Stoma Length: A retracted stoma may spread mucus, affecting the adhesiveness from the skin barrier and the ostomy bag.
- Skin Shape/Texture: Effective use of the ostomy bag requires that adaptation to the contours of the peristomal skin. Smooth, hard, flat, or creased skin will require a regular, semi-convex, or convex solution.
- Personal Preference: Some ostomy patients prefer not to handle the cleaning and deodorizing the ostomy bag and opt for frequent changes during the day.
- Know-How: More experience offers efficient management of supplies: improved ostomy bag placement, adequate stoma maintenance, and a healthy peristomal skin area, which contributes to reduced use of ostomy bags and supplies.
- Leakages Below Barrier: The causes vary, but the situation requires a new ostomy bag to avoid skin problems.
- Stoma Age:Recently discharged ostomy patients usually demand more appliances. Stoma size adjustments in the first two months allow errors and consequent increased use of ostomy bags.
- Type of Ostomy: Ileostomy and urostomy patients usually require more changes than colostomy ones.
- Sickness: Fever may affect adhesiveness leading to extra use of appliances.
Social Impact of Ostomy Bag Changing Frequency
“The impact that the Ostomy Bag Changing Frequency may have on the social aspect of their lives, are particularly associated with odor. A person may feel that this could have a significant impact during social events. Wanting to be with others socially will remain an important part of life and needs to be incorporated into their changed circumstances. Remember that there are resources available, particularly Stomal Therapy Nurses who offer practical advice and support on managing the stoma and ostomy bag.
Points to remember:
- Change and acceptance of that change takes time
- The individual can still travel and wear normal clothes.”14
Patients should seek assistance in case of stool consistency changes, skin or stoma complications or unresolved leaking.
(1, 3) Your guide to living with a colostomy https://www.coloplast.co.za/Documents/Stoma/CPOC_CP_Care_User_Colostomy_Essential_advice_A5%20LOW.pdf
(2) Ostomy Care and Management. https://rnao.ca/sites/rnao-ca/files/Ostomy_Care__Management.pdf
(4) Patient & Family Guide to Ostomy Surgery. http://www.uphs.upenn.edu/surgery/Clinical/Colon_Rectal/Ostomy/Ostomy_Surgery.pdf
(5, 10) Semanticscholar.org. Discharge Planning for a Patient with a New Ostomy: Best Practice for Clinicians. https://pdfs.semanticscholar.org/34da/02bae17c37f4ab389fdc73844f4685b603a4.pdf
(6, 9, 12) Premium Health First Aid and Specialised Health Solutions. Ostomy and stoma care workbook
(14) Premium Health Training Solutions. https://premiumhealth.com.au/wp-content/uploads/2017/07/PHSC2009-Ostomy-and-Stoma-Care-Workbook.pdf
(7, 13) Care and management of a stoma: maintaining peristomal skin health- https://www.bbraun.com/content/dam/catalog/bbraun/bbraunProductCatalog/S/AEM2015/en-01/b8/maintaining-peristomalskinhealth.pdf.bb-.01791862/maintaining-peristomalskinhealth.pdf
(8) US National Library of Medicine National Institutes of Health. ncbi.nlm.nih.gov https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934070/
(11) Patentimage. OSTOMY APPLIANCE WEARTIME PREDICTION