Top tips for changing your ileostomy bag
There is no one ideal way to change a pouch, and everyone will have their own nuances when it comes to doing so.
If fact if you have just received your pouch, more likely than not the method you will use for changing it will likely change from that taught to you by the stoma therapy nurses in hospital.
While you will have to get comfortable with using your own approach, having had my pouch for ~7 years now I’ve had plenty of opportunity for trial-and-error, so I thought it worth sharing my method below.
When I left hospital I was getting leaks under the flange fairly regularly; now I get a leak maybe 4-6 times a year and this with a very active lifestyle including weight training, sit-ups, boxing, running, swimming, tennis, and cycling. And even when I do get a leak I’ve learnt to recognise the ‘early warning’ signs, and rarely find myself in an embarrassing situation.
TOP TIPS FOR CHANGING YOUR ILEOSTOMY
Step 1: Change your pouch lying down
Can you change your pouch while sitting? Sure, if you want. But speaking from personal experience I get a much better result attaching the new bag if I change it lying down. Why is this?
If you think about it, the skin under your flange subtly stretches and contracts depending on whether you’re standing, sitting or lying down. Have a look next time you have your pouch off: sit on the edge of the couch or bed, observe how the skin around the area where your flange sticks sits, then stretch out in the lying down position and feel how that area of skin lengthens.
I have achieved much greater integrity out of the flange adhesion by attaching the pouch when the skin around my stoma is stretched out while lying down as opposed to more ‘bunched up’ when sitting. I think this is because if you attached the flange sitting, when you then stand or lie down the skin tries to stretch under it, creating micro tears or ‘pulls’ in the adhesion with your skin. If you take the reverse approach and apply the pouch lying down, given sufficient time for the adhesion to ‘cure’ (ie. stick) the flange seems to cope better with then transitioning to a more ’rounded’ position when you’re next in a seated position.
Step 2: Dispense with expensive wipes, all you need is paper towel
In hospital I was advised by the stoma therapy nurses to use baby wipes to clean the area around my stoma in preparation for a fresh pouch. The only problem with this is if you look carefully, these wipes can contain an alcohol-based steriliser or equivalent. And what is great for dissolving the adhesive on your flange? Anything with an alcohol base.
The solution? Grab a roll of basic paper towel from your local supermarket to use instead (I use Handee Ultra). Apart from being a far cheaper solution, these days paper towel is very robust and you can generally scrub away around your stoma to your hearts’ content without the paper towel tearing or flaking into smaller pieces. If you’re using a remover wipe (I use Hollister remover wipes) to remove excess adhesive from your skin in preparation for the next pouch, the alcohol in that is sterilising the area around your stoma anyway.
I tend to tear off 6 or 7 squares of paper towel, fold them in half and then half again into useable squares, then use those and a small bowl of water to clean AND dry the area around the stoma. Given paper towel is designed to be absorbent, it’s really hard to beat for ensuring a super-dry finish around your stoma in preparation for the fresh pouch.
Step 3: Change your pouch right before going to bed
There are 2 reasons for this. Firstly I find that by changing my pouch right before going to bed, when I subsequently fall asleep on it the pressure of my body lying on top of the pouch on the bed ensures a strong seal develops between it and my skin by the time I wake up, as it is held firmly against my side for an extended period. The second reason is after a day of activity, whichever way you look at it the flange adhesion will have weakened. This being the case, if you don’t change your pouch before going to bed the the chances of a leak occurring under the flange increase, and you’re potentially faced with a pouch and bedsheet change in the middle of the night.
Step 4: Warm the flange with your hand to activate the glue and encourage better adhesion
I use Coloplast 1-piece Sensura pouches, and while I find the adhesion quality out of the box pretty good, I found I greatly reduced the incidences of leaks under the flange if I heated it up with my hand after applying the pouch. This activates the glue on the flange, ensuring more robust adhesion to your skin. How do I do this?
After I have applied my pouch as described above, I quickly rub my hands together to warm them up then place one hand firmly on the pouch, over the area where the flange sticks to my body. I remain like this for approximately 2 minutes, until I can feel the skin under the flange heating up. And then – voila! I’m ready to go (to bed).
While the above process may not work for all of you it’s something that I have perfected in the 7 years that I have been living with a pouch, so if you’re currently having issues with adhesion I encourage you to try the steps I use. If I had to single out the 2 most important steps I would say use paper towel (not wipes) to clean and dry the area around the stoma, and make sure to warm the pouch area over the flange with your hand after applying. These 2 alone will significantly reduce the number of leaks you’re experiencing.
As a side note, our up-coming ContfiTape product (www.confitape.com) will also assist in providing added support to the flange, be sure to send us your email if you want to be notified when the product is available for sale (email me at firstname.lastname@example.org).
What tips and techniques do you have for changing your pouch?