This information will help you change your disposable urostomy pouching (bag) system after you’re discharged from (leave) the hospital. A urostomy pouching system is sometimes called a urostomy appliance.
To learn more about your urostomy and caring for your urostomy pouching system, read About Your Urostomy. You can also watch How to Change Your Urostomy Pouching System at Home.
Changing your pouching (bag) system
Your pouching (bag) system has 2 parts. A wafer is the part that sticks to your skin. The pouch is the bag that holds your urine (pee).
With a 2-piece pouching system, the wafer and the pouch are separate pieces that can be taken apart. With a 1-piece pouching system, the wafer and pouch are connected.
You should change your pouching system about every 3 to 4 days. If it’s leaking urine, change it right away. It’s best to change your pouching system in the morning before you drink any liquids. There’s often less urine coming out of your stoma in the morning.
You can change your pouching system wherever you’re most comfortable. You can do it either sitting down or standing up. Most people like to change it in the bathroom in front of the mirror. You can also remove your pouching system and clean around your stoma as part of your normal shower routine.
Supplies
Gather your supplies before you start. You will need:
- Adhesive remover spray (if you cannot get the spray, use adhesive remover pads)
- Gauze pads, paper towels, or clean washcloths
- Warm water
- Lubricant (if you’re using a 2-piece pouching system)
- Measuring guide
- Pen or marker
- Scissors (if you’re using a cut-to-fit wafer)
- New pouching (bag) system
You should also gather any extra supplies you’re using, such as:
- Mirror (for a better view of your movements)
- Blow dryer or handheld fan
- Thin hydrocolloid sheet (optional)
- Liquid skin protectant (optional)
- Barrier ring or protective seal (optional)
- Elastic barrier strips (optional)
- Ostomy belt (optional)
Instructions
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Clean your hands.
- If you’re using soap and water, wet your hands and apply soap. Rub your hands together for at least 20 seconds, then rinse. Dry your hands with a paper towel. Use that same towel to turn off the faucet.
- If you’re using an alcohol-based hand sanitizer, be sure to cover all parts of your hands with it. Rub your hands together until they are dry.
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Empty your pouch (bag).
- Open the spout or valve at the bottom of your pouch. This will let the urine run out of the pouch.
- Make sure you do this over a toilet to catch the urine. You can put a piece of toilet paper in the toilet first to keep the urine from splashing.
- Once the pouch is empty, wipe it with toilet paper. Then, close it so no more urine runs out.
- Clean your hands. Follow the instructions in step 1.
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Take your pouching system off. Remove the wafer and pouch together.
- Spray adhesive remover spray over the wafer.
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Press down on your skin with 1 hand. With your other hand, gently lift an edge of the wafer and roll it away from your skin. Do not pull the wafer straight away from your skin. The skin around your stoma is sensitive, so it’s important to be gentle. Spray more adhesive remover spray under the wafer as you go, until you roll it all the way down.
- If you’re removing your pouching system in the shower, you must still use adhesive remover spray. Using water alone will not loosen the wafer from your skin.
- Once you have removed the pouching system, throw it in the trash.
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Hold a dry piece of gauze, paper towel, or clean washcloth over your stoma opening. This will keep urine from leaking out. Change the gauze, paper towel, or washcloth if it gets soaked with urine.
- If you’re removing your pouching system in the shower, you do not need to do this. The urine will flow down the shower drain.
- Many people enjoy leaving their skin uncovered for 15 to 30 minutes after removing the pouching system. This is called a skin break. You can decide if you want to take a skin break. If you do, hold a towel, portable urinal, or other container over your stoma. This will catch the urine that leaks out.
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Clean and dry the skin around your stoma.
- Wet a piece of gauze, paper towel, or clean washcloth with warm water. Use it to gently clean the skin around your stoma. Do not use any soap.
- Dry the skin around your stoma. You can use a blow dryer on the “cool” setting or a handheld fan. Or, you can pat your skin dry with a dry piece of gauze, paper towel, or clean washcloth.
- Make sure the area is fully dry. Your skin should not be sticky.
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Measure your stoma size.
- Your stoma will slowly get smaller over the first 6 to 8 weeks after your surgery. During this time, use a measuring guide to measure your stoma and fit the wafer. Use the measuring guide every time you change your pouching system. Once your stoma reaches its permanent size, you can start using a pre-cut wafer.
- If your stoma is round, use the measuring guide to measure your stoma. Compare the holes in the measuring guide to the size of your stoma. Choose the hole that fits exactly around your stoma with no gaps.
- If your stoma is not round, measure the vertical side first, then the horizontal side.
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Get the new pouching system ready.
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Place the measuring guide over the back of the wafer. The back is the side that will go against your skin. Use the measuring guide to mold or cut the wafer to the exact size you need. Some wafers have lines to help you. You can also trace the correct size onto the back of the wafer. Check the wafer against your stoma to make sure it’s the right size.
- If you’re using a moldable wafer, turn the wafer over so you’re looking at the front. The front is the side that will face away from your skin. Gently roll back the opening and press down for a few seconds. This will keep it from rolling back too much.
- If you’re using a cut-to-fit wafer, remember to start cutting at the center hole.
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If you’re using a 2-piece system:
- Cut the wafer (see Figure 1). Smooth out any rough edges with your finger.
- Put a small amount of water or lubricant around the rim of the flange on the pouch and wafer. This will help seal them together securely. Then, snap the wafer and pouch together (see Figure 2). Give it a small tug to make sure it’s secure.
Figure 1. Cutting the wafer for a 2-piece system
Figure 2. Attaching the pouch to the wafer in a 2-piece system
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If you’re using a 1-piece system, the pouch and wafer are already attached (see Figure 3).
- Before you start cutting, pull the bag away from the wafer (see Figure 4). This will help make sure you don’t snip or cut into the bag itself as you’re cutting the wafer.
- Once the bag is pulled away, cut the wafer (see Figure 5). Then, smooth out any rough edges with your finger.
Figure 3. Connected pouch and wafer in a 1-piece system
Figure 4. Pulling the bag away from the wafer in a 1-piece system
Figure 5. Cutting the wafer for a 1-piece system
- Check the spout or valve at the bottom to make sure the pouch is closed.
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Place the measuring guide over the back of the wafer. The back is the side that will go against your skin. Use the measuring guide to mold or cut the wafer to the exact size you need. Some wafers have lines to help you. You can also trace the correct size onto the back of the wafer. Check the wafer against your stoma to make sure it’s the right size.
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Get the skin around your stoma ready.
- If any urine leaked out of your stoma while you were getting the pouching system ready, clean the area. Follow the instructions in step 5.
- If the skin around your stoma is irritated or very red, apply a thin hydrocolloid protective sheet or liquid skin protectant. To learn more, read How To Manage Skin Irritation Around Your Urostomy Stoma.
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If you’re using a barrier ring or protective seal, peel the backing from both sides. Then, you can put it on 1 of these ways:
- Stretch the barrier ring or protective seal so it matches the size of the opening in your wafer. Press it onto the back of the wafer.
- Stretch the barrier ring or protective seal to fit over your stoma. Gently press it onto your skin. It should be right against your stoma, without any gaps.
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Put on the pouching system.
- Peel the backing off the wafer and place it over your stoma. It may help to use the mirror. Make sure the wafer is against your skin at the base of your stoma.
- Place your hand over the wafer. The warmth of your hand will help it stick to your skin. Follow the manufacturer’s instructions for how long to leave your hand there. Usually, it’s 5 to 10 minutes.
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Put on any accessory products you’re using.
- If you’re using elastic barrier strips, peel the backing from the strips. Then place them over the wafer, close to the center. It’s OK if a small part is on your skin. But try not to have too much on your skin, as this can cause irritation.
- If you’re using an ostomy belt, attach it to the tabs on the pouching system. Hook the belt to one side of the pouching system. Then wrap it around your waist and hook it to the other side. Adjust it so it fits snugly.
- Clean your hands. Follow the instructions in step 1.
The skin around your stoma
While you’re changing your pouching (bag) system, look at the color of your stoma and the skin around it. Your stoma should be red or pinkish-red, like the color inside your mouth. If it’s any other color, like brown, gray, or black, take a picture of it.
Send the picture to your doctor using your MyMSK account. Then, call your doctor after you finish changing your pouching system. It may be helpful to follow the instructions in Tips for Taking Pictures to Share with Your Healthcare Provider.
The skin around your stoma may be slightly pink (if you have lighter skin). Or, it may be gray-brown (if you have darker skin). This is from the pressure of the wafer and does not mean your skin is irritated. Your skin should go back to its normal color if you leave it uncovered for 15 to 30 minutes.
Caring for irritated skin
Irritated skin will look bright red, not pink. You may also feel burning, itching, or pain in the area. If you notice that the skin around your stoma is irritated, take a picture of it. Send the picture to your doctor using your MyMSK account. Then, call your doctor after you finish changing your pouching (bag) system. You can also follow the instructions in How To Manage Skin Irritation Around Your Urostomy Stoma.
