How to change an ostomy bag at home: 9 safe and pain-free steps

After colostomy surgery, getting used to an ostomy bag can be a source of anxiety for many, especially when changing the ostomy bag at home for the first time. Some care instructions suggest that bags may need to be changed approximately 1–2 times per day, depending on the type of bag and individual circumstances.

More importantly, proper bag changes not only help prevent leaks but also protect the skin around the stoma from irritation, burning, and damage. This article helps you understand the basic steps for changing an ostomy bag, how to clean and dry the skin, check for a proper fit, and identify abnormal signs that require contact with medical professionals. Tiptory will provide simple, easy-to-follow instructions to make ostomy care less stressful and help you feel more confident in your daily life.

Part 1: How to Change an Ostomy Bag Safely

Step 1: Clean the bag before changing

Empty the ostomy bag before changing

• Before changing your ostomy bag, check and empty the old bag if it contains stool. This makes the changing process cleaner, easier to handle, and reduces the risk of leaks.

• Hold the bag close to the toilet, open the bottom or release clamp depending on the design of the ostomy bag, and then slowly empty the waste into the toilet. For bags that can be detached, hold the top of the bag downwards to allow waste to drain easily.

• If the bag is about 1/3 to 1/2 full, it's advisable to empty it rather than waiting until it's overly full. An overfilled bag can increase stress on the adhesive system and raise the risk of detachment or leakage.

Dispose of the bag according to the type being used

• Not all ostomy bags are designed the same. Some types have an open bottom for emptying and continued use, while closed bags need to be replaced when full.

• With a two-piece bag system, the bag can be detached from the flange or baseplate for cleaning or replacement according to product instructions. With a one-piece system, the bag and baseplate are usually replaced together.

• Do not flush entire bags or parts of the system down the toilet without explicit instructions. Only flush parts confirmed by the manufacturer as flushable; other parts should be disposed of according to healthcare facility or manufacturer guidelines.

Prepare before changing the bag

• After emptying the bag, prepare a new bag, cleaning supplies, a disposal bag, and any skin barrier products if instructed by your ostomy care nurse.

• Wash your hands before starting ostomy care. Having all supplies ready before removing the bag ensures a quick changing process and avoids having to search for items while the skin around the stoma is exposed.

• If instructed to change at a time when waste output is lower, choose a time that suits your body's routine. For some, changing the bag in the morning before eating may be more convenient.

Step 2: Wash hands thoroughly before changing the bag

Wash hands thoroughly before ostomy care

• Before changing your ostomy bag, wash your hands thoroughly with soap and clean water. This is a basic hygiene step to help prevent bacteria from entering the skin around the stoma.

• If immediate handwashing is not possible, an alcohol-based hand sanitizer can be used. However, if hands are visibly soiled or contaminated with waste, prioritize washing with soap and water.

Protect clothing before changing the bag

• Place a clean towel over your lap before starting ostomy care. You can secure the top part of the towel to your waistband to create a protective layer, helping to prevent waste or fluid from the bag from staining your clothes.

• Keep towels and necessary supplies within reach to ensure the ostomy bag change proceeds smoothly, especially when performing it at home.

Maintain hygiene throughout the bag change process

• After completion, wash your hands again with soap and clean water. If your hands came into contact with waste during the bag change, thoroughly clean them before touching other items.

• Maintaining hand hygiene and a clean changing area helps make ostomy care safer and reduces the risk of contamination during the removal and application of a new bag.

Step 3: Remove the bag gently, protecting the skin

Remove the ostomy bag slowly

• When changing your ostomy bag, gently hold the skin around the stoma with one hand to prevent the skin from being pulled taut.

• With the other hand, locate the tab or removal aid on the bag, then slowly peel the bag and wafer off the skin. Avoid pulling sharply as this can cause pain, damage the protective skin layer, or lead to skin irritation.

Use adhesive remover if needed

• If the adhesive is strongly attached and difficult to remove, you can use an adhesive remover specifically designed for ostomy systems, following the instructions of your healthcare professional or the manufacturer.

• When using an ostomy adhesive remover, apply the correct amount and slowly peel off the wafer. Avoid forcing it when the adhesive is still firmly attached.

Prioritize protecting the skin around the stoma

• During ostomy care, observe the skin after removing the bag. The skin may be slightly red due to contact with the adhesive, but prolonged redness, burning, ulcers, or visible damage are signs that need to be evaluated by a healthcare professional.

• Gentle handling each time you change your ostomy bag helps reduce skin damage and allows the new bag system to adhere more securely.

Step 4: Check skin and stoma

Check the skin around the stoma

• After removing the ostomy bag, examine the surrounding skin to detect any irritation or damage early. The skin may be slightly red or light pink, but persistent redness, burning, ulcers, or discharge should be evaluated by a healthcare professional.

• When performing ostomy care, the skin around the opening should be monitored every time you change your ostomy bag. If the skin becomes increasingly red, painful, moist, or damaged, the bag system may not fit properly or the skin may be reacting to the products used.

Observe the color of the stoma

• A healthy stoma typically has a pink to red color, a moist surface, and resembles the mucous membrane inside the cheek. After surgery, the color and size may change during the healing process, so compare it to your normal condition.

• If the stoma becomes pale, bluish, dark purple, or black, or shows any obvious abnormal color change, contact a doctor or ostomy nurse for early evaluation.

Note any unusual changes

• During ostomy bag changes, check if the stoma has significantly changed in size, shape, or position. A stoma that retracts inward or protrudes more than usual can both be complications that require evaluation.

• If there is significant bleeding, pus, visible damage, severe abdominal pain, nausea or vomiting, or an abnormal decrease or complete cessation of waste output, contact a healthcare facility immediately as these could be signs of complications.

• A few small spots of blood on the stoma may appear during cleaning or bag changes due to the presence of many small blood vessels in the tissue. However, if the bleeding does not stop or is excessive, contact your doctor or ostomy care nurse.

Step 5: Clean the stoma properly

Gently clean the stoma area

• After removing the old bag, use warm water and a soft cloth or clean gauze to gently clean the stoma area and the surrounding skin.

• If soap is needed, choose a mild, oil-free, and fragrance-free type. Do not scrub vigorously as this can damage or irritate the skin around the stoma.

Dry the skin before changing the bag

• After cleaning, gently pat the skin dry with a clean towel or gauze until it is completely dry. Do not rub or wipe vigorously.

• The skin needs to be sufficiently clean and dry before changing the ostomy bag so that the baseplate can adhere more securely, and to reduce the risk of waste leakage causing skin irritation.

Measure the stoma size when necessary

• If instructed by your doctor or nurse, use a specialized measuring guide to check the stoma size before attaching a new bag.

• Stoma size can change, especially in the initial period after surgery. Measuring the correct size helps in choosing or cutting the appropriate hole on the baseplate, preventing a gap that is too large and allows waste to come into contact with the skin.

• If you don't know how to measure or notice significant size changes, you should consult an ostomy care nurse instead of adjusting it yourself.

Wash hands before attaching a new bag

• After completing the cleaning process, wash your hands again with soap and clean water before handling the new ostomy bag.

• This step helps prevent transferring dirt or bacteria from the old bag and cleaning process to the new bag system, contributing to cleaner and safer ostomy care.

Step 6: Use skin barrier powder if needed

Consider using skin barrier powder

• Ostomy skin barrier powder, often called stoma powder, can be used when the skin around the stoma is moist, abraded, or slightly irritated. This is a supportive step and not everyone needs to use it every time they change their ostomy bag.

• The primary purpose of the product is to create a protective layer on damaged skin and to make the skin surface more suitable for the ostomy bag's adhesive baseplate to adhere to.

Apply powder in the correct location

• After cleaning and drying the skin, sprinkle a small amount of powder onto the skin around the stoma, focusing on areas that are moist or irritated.

• Do not sprinkle powder directly onto the stoma. After sprinkling, use a clean, dry gauze or cloth to gently brush off any excess powder to avoid creating too thick a layer.

Allow skin to dry before attaching a new bag

• Wait for the product to dry according to package instructions before attaching the new ostomy bag. Do not fix the baseplate if the powder or skin is still damp, as this may reduce adhesion.

• If you use powder regularly and the redness, pain, discharge, or skin damage does not improve, you should consult your doctor or an ostomy care nurse to identify the cause instead of continuing to increase the amount of product.

• Do not arbitrarily use multiple types of creams, ointments, or moisturizers under the baseplate. Some products can reduce the adhesion of the bag system or make irritation difficult to control.

Step 7: Prepare the new bag to fit the stoma

Check and prepare the new bag

• Before changing your ostomy bag, inspect the new bag and baseplate to ensure there are no tears, deformities, or damage. If using a system with pre-cut holes of the appropriate size, you can use it directly according to the manufacturer's instructions.

• For baseplates that require adjustment, measure the stoma size before cutting. This is especially important during the initial period after surgery as stoma size can change as tissue continues to heal.

Cut the baseplate hole to fit

• If you need to cut the baseplate, use clean, sharp scissors to create a hole according to the measured size. Some products have pre-marked guides to make cutting easier.

• The hole in the baseplate should fit snugly around the stoma, leaving no large gap that allows waste to contact the skin. At the same time, do not cut too close to the point where the baseplate compresses or rubs against the stoma.

• One size should not be applied to everyone. Prioritize the size recommended by your doctor or nurse based on your actual stoma size.

Amelia Wilson Doctor of Medicine, General practitioner

Trained at Columbia University Vagelos College of Physicians and Surgeons, with over 14 years of experience in treating common diseases and caring for the elderly. Currently working at NYU Langone Health with a focus on personalized treatment.