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Crohn's Disease Forum » Surgery » Stoma Subforum » This is how I change my ostomy pouch (PooCh)


02-17-2013, 11:30 AM   #1
Pie-Guy
 
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This is how I change my PooCh

As promised, I thought I would share the process I go through when changing my ostomy bag (from here on called a PooCh which is short for Poo Pouch. I gave it that name in the Hospital after I received my ileostomy and it stuck). I have always been good at comeing up with ways to do things faster. It may be laziness but if there is a better way, I want to find it. The first time I emptied my PooCh I got more on my hands and legs than the toilet. I knew I had to come up with techniques for emptying and changing my PooCh. I also wanted to do all I could to ensure no leaks. I haven't had a leak in a couple of years at least (it's been almost 4 since I got my PooCh).So here is what I do. I hope some of you will gain helpful tips that may make life with a PooCh a little easier.

1. I keep all my supplies in a tool box. I used to have them scattered and I would have to gather them up when we had company. Now I just keep them in a plastic 3 door toolbox. Any supply overflow is hidden away.



2. I set up my sink with the necessary supplies.

We have:
  • Ostomy Bag (I use Coloplast Sensura 15531 and have since the beginning 5 years ago)
  • Paper towels to clean stoma (behind faucet and one at lip of sink)
  • Black bag for discarded PooCh (I bought them online http://www.BagItAway.com as the Ostomy Bags I buy come with fewer waste bags than ostomy bags - not sure what their thinking is on that one).
  • A razor
  • Convtec Stomahesive (a paste used to form a seal between the PooCh and your skin.
  • Mirror (more on that later)
  • Blow Dryer

3. First I empty my PooCh (in the toilet of course). When I plan to go out or change my PooCh I empty and clean it. To do this I have a little metal jug type thing (you will see it one of the pics below). I basically poor water into my PooCh, close it, shake well, empty it. This is in an attempt to clean the PooCh and Stoma as much as possible. I do this twice.

Now fill a cup/glass/container with very hot water and drop the stoma-hesive in it. (That is the same cup I use to clean in above step - it has a bit of a spout)


4. I take off all my clothes and lean against the sink. The paper towel at the lip is their to catch anything. I change it first thing in the morning (as per the advice of my ostomy nurse) so it usually isn't very active. I always try to make sure if there is some action, no waste makes it's way down the drain.
On a side note, I change my PooCh twice a week - Thursday and Sunday morning.

5. I remove the PooCh, put it in the waste bag.

6. I clean my stoma. First I fill the sink about 1/4 way with warm water. I then take a paper towel, bend it in half along the long side (if that makes sense) and immerse it about one inch of it in the water in the sink (I tried to take a pic but it is a little...off). I then use it to clean my stoma - you know that piece of small intestine hanging out of the front of your abdomen. Nothing abnormal about that. Repeat as needed until it's shiny and new.


7. Once clean, I lather up some soap, soap up the area around my stoma and shave the area. I shave any area that could have the PooCh flange or Hypafix on it (more on Hypafix in a second but it is similar to medical tape).

8. Now rinse the soap off your stoma and surrounding. This can be tricky. I take a small towel and place it at the same spot where the paper towel was on the lip of the sink. So pick up the paper towel at the lip of the sink and hold it beneath the stoma just in case your stoma decides to become active at that very moment. Take a small towel and put it where the paper towel was. Lean over the sink so your stoma is practically over the drain. Scoop warm running water with your hand and use it to rinse off the stoma and surrounding area. The towel should catch any water that makes it's way down. Once done, grab a paper towel and dry the area. You can remove the towel and place the paper towel back at the lip.

9. Dry the area around the stoma as best you can with the paper towel. Fan the area with the paper towel. Any place that is cool is still damp/wet. Do this until it is mostly dry.

10. Turn on the hot water and put the stomahesive directly under the hot running water. Take your ostomy bag and put it under one arm. Use the other to grab the blow dryer and blow dry the area around your stoma until it is dry. Having your ostomy bag under your arm will help get it warm. Once the area around the stoma is dry, use the blow dryer to heat up the ostomy bag a little more.

11. Peel off the backing of the ostomy bag and apply stomahesive (which should be fairly easy to apply thanks to running it under the hot water). When I first got my PooCh the ostomy nurse came over and told me about stomahesive and how it helped keep the bag from leaking. She then put some on before helping me put on my PooCh. I tried to put the stomahesive on myself the next time and it looked I had done it with my feet. My point is, it will take a while before you can do it without thinking about it or making any mistakes (having it too thin/thick in spots etc.). I try to keep it uniform and I have a bit of paste go over the lip of the opening which helps ensure a good seal.
I hold the top about 1/8 of an inch away from the PooCh and squeeze and let it come out and then ooze out of the sides. With practice you can make subtle adjustments and become a pro (not that I'm a pro). Practice on your toothbrush . (i mean with toothpaste)


12. Now put on your PooCh. I wear it completely sideways (more on this in a second). I try to put it on so the flange is as even as possible. There will be bumps and ridges most of the time. Time for the blow dryer again. Heat up any bumps/ridges with the hair dryer while pressing down and then lifting up on the ridge. Basically apply heat, press down for a second, let go for a second until the ridge sticks completely. Once you are happy remove the heat but continue to press/release while it cools down. If you do it correctly, you can flatten out all ridges almost completely.
I mentioned above that I wear my PooCh completely sideways. My stoma is on my right so when mounting sideways my PooCh opening is near my belly button. This allows me to wear a belly band to help support my PooCh and also means my PooCh won't squish when I sit down. This is especially handy when you are at a restaurant and it is starting to fill up.
I used to wear my PooCh straight down. The problem is when you sit down it bends in half and it can be a little worrisome when you start to feel your PooCh as you move around. Wearing it sideways allows it to fill up with more waste without feeling the pressure that comes when it is bent in half. Add in the fact that it is supported by a belly band (maternal belly band) and I feel confident I won't have an incident as their is much more room for my PooCh to move as it fills up. I buy the belly bands from e-bay (do a search fo Bella Vonna Belly Bands - those are what I use). They are usually 10 bucks each. I get them in white as I always wear a white t-shirt under anything I wear. A quick glance if my shirt rides up and it will look like more shirt.

13. Now I apply the Hypafix (pics below). According to what I found on the net, Hypafix is a self adhesive, non-woven tape for wide area dressing fixation. It is like medical tape but sticks very well. I use it to seal the bottom of my flange and to hold the top part of my PooCh in place.
First the bottom piece. I cup a piece of Hypafix maybe 4x4 inches. I then cut out a semi-circle at one end. I use scotch tape to tape my bag up so I can see what I'm doing. I put the mirror on the counter and lean against the counter so I can see the bottom of my PooCh. I apply the Hypafix with the semi-circle hugging the middle of the flange where my stoma is. I have only had leaks a couple of times in my life and it was always at the bottom flange where my body bends. The lip of the flange will start to peel up. The Hypafix prevents that.
Next I put a 4x4 piece of Hypafix along the top of my PooCh. This has a dual role. It keeps my PooCh from moving around too much and it also helps reduce the appearance of an ostomy bag through my clothing It basically keeps it flat making it more difficult for people to notice what appears to be a small rodent under your shirt.

Hypafix:


How PooCh looks (sort of) from front:


How PooCh looks from back (again sort of):


and finally, this is how it looks if you saw me with my shirt off - which isn't going to happen - just imagine the belly band is over my PooCh and not under - you have to look hard to see the stomahesive at the bottom of my PooCh).


Other Tips/Tricks/Techniques/Ramblings

When I first got my PooCh and I had to empty it in a public/work bathroom, I would basically lower my pants/underwear like I used to when I went to the bathroom via my bum. I started wearing suspenders after I got out of the hospital so I could leave my pants loose. I was afraid a belt would hit my stoma. I have since switched back after some experimentation put my fears to rest. I digress. Anyway, I now empty my PooCh without shedding an article of clothing or even sitting on the toilet.
My technique:
1. Grab a wad of TP (toilet paper) to use to clean out my PooCh.
2. Unroll a bunch of TP and lay it in the toilet, towards the front. You are trying to prevent splashing so if the TP gets water logged, add more.
3. Expose the PooCh, open it up, crouch so the PooCh is as close to the TP as you can
4. Empty it - Clean it - Done
5. I am in and out of the bathroom in a couple of minutes and I didn't have to touch the toilet in any way.

I wear normal clothes. I used to wear suspenders but went back to a belt after experimenting to ensure my belt didn't affect my stoma. The only thing I do because of my PooCh is wear a white t-shirt under everything I wear, be it another t-shirt or a sweat shirt etc. I wear a 2XL shirt to ensure the bottom comes out of whatever shirt I am wearing, if only just a little. It's a little bit 80's but then again so am I. Having the t-shirt helps flatten my PooCh and once the second shirt is over it, it is hardly noticeable. You have to know it's there to see it and even then, most of the time it is imperceptible (did I spell that right?). The belly band helps keep it flat as well.

So that's all I can think of for now.

Thanks,
Robb
02-17-2013, 12:10 PM   #2
Dukeis
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Thanks! This very helpful. Maybe it is a man thing, I told my wife the other day I was going to get me a tool box to put all my supplies in.
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02-17-2013, 05:11 PM   #3
katiesue1506
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Well of course a man would use a toolbox! Your method is similar to mine except I showered beforehand so u didn't have to use soap and water on a paper towel. I also used the stick paste instead of pastey paste. I really liked the coloplast and will use that brand in the future if I need a stoma again.
02-21-2013, 03:09 AM   #4
annawato
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Pie guy this is fantastic and sure to be a lot of help to many people. I never thought of heating the stoma paste - great idea cos its often a bit thick and difficult to get an even amount. But I'm curious about why you don't heat the bag in your bra like the rest of us?
Laughed my head off at the comment about a small rodent under your clothing - that is exactly what it looks like when full!

Seriously, thankyou for writing all this and taking the time to to take pictures,
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you name it, i've tried and failed it! currently on- waiting to see whats new and reducing pred
temp. ileostomy reversed feb 2011, new ileostomy, nov 2012
4 resections plus removal of adhesions etc, recurrent intestinal abscesses
lyme disease, depression, sacroileitis, chronic pain and......Crohn's..........
02-21-2013, 06:21 AM   #5
Pie-Guy
 
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No problem at all. I know it's tips and tricks that help us get through this stuff.
02-23-2013, 08:22 PM   #6
annawato
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Now this has been made a sticky I thought I'd also add that another helpful thread on this topic is "how do you change yours"
You can access it here:
http://www.crohnsforum.com/showthread.php?t=46083

Last edited by annawato; 02-23-2013 at 09:29 PM.
02-23-2013, 08:42 PM   #7
Jim (POPS)
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I no longer have a stoma, was reversed about 5 months ago and so far so good. BUT, a tip that i have is: I found a small bottle that the opening was just a bit bigger than my stoma. My stoma had it's own mind and it was hard to tell when it wanted ti say "HI" if you know what I mean. SO, when changing my bag I would but the botle over my stoma while I cleaned the area to get ready to put the new one on. This worked really well. Funny thing is that my wife also has a stoma and we both had them at the sametime. No , we didn't meet at a support group. We have been together for 40 year. She found out she had IBD-C when we first got married and got a "J pouch" but after 20 years she had to have a ileostomy. So when I retired I thought that it was time to have fun. I was retired about 1 year and had lost 20lbs and when to have my apendix removed and they found crohns and did a resection on the spot. 7 days later it failed and I went septic and they fixed me, with a ilyostomy. I am so glad that my wife was a PRO at changing the bag, but she said "I"m only going to change it a few times for you and then you are on your own. How convenient it was having someone so close to you that could help. We both named or stoma's and everything. I had "George" for about 9 months until they said that I could have it reversed. Glad I did but my crohns came back 2 months after the reversal, oo well. No more George but Lou Lou is still around and will be as long as I am married to my wonderful wife. I am glad that I don't have to change my bag anymore , but I do have some fond memories of my wife and I having a changing party.
02-23-2013, 09:31 PM   #8
annawato
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Pops thats a lovely story. And a great tip for helping when the stoma just won't be quiet when you're changing the bag.
02-28-2013, 01:19 AM   #9
KazT17
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What is stoma paste? Do you use a particular one?

Thanks for this it's fab xxx
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02-28-2013, 04:03 AM   #10
annawato
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I use convatec stoma paste - its a paste you apply around the rim of the opening on the flange, or directly around stoma, to help prevent leaks. Sort of like an eakin seal except its a paste about the consistency of toothpaste.
02-28-2013, 04:05 AM   #11
KazT17
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Thanks Anna, I will have to try this. Hope you are keeping well xx
05-27-2015, 09:19 AM   #12
SupportiveMom
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If I show this to my kid she will want a whole cabinet, a tool box won't do! This was great info, pics were fantastic.
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07-15-2015, 02:13 PM   #13
fuzzy butterfly
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Hi im Mandy. My tip when changing a pouch is.. I tuck a facecloth (used for this only) just into my pants ,knickers ,pj bottoms , then i use two pegs to clip the disposable bag onto my pants/ facecloth one on each loop tie of the bag . So when i peel off my pouch it can drop right into the bag, along with any wipes etc, also if stoma kicks in i just open bag out a little lean forward abit and catch any poop in the bag. Neat clean n easy. Just un peg and tie up to go in the dustbin. Hope you understand my discription lol. If not look up 'Thalia my ostomy' on utube im sure she does a demo of this. ..
11-07-2015, 10:35 PM   #14
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OK...I must be the queen of lazy...I always change after showering.
1) Remove bag & wafer...take shower.
2) Dry off, warm wafer with hair dryer
3) Stick on wafer, attach bag, done.
02-15-2016, 01:59 PM   #15
Bufford
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I remove the old bag n flange and toss it into the wood furnace, even it its partly filled. Then carefully go upstairs holding my underwear under the stoma because it may erupt something awful brown without warning.

In bathroom I wipe glue remover around the area and then thoroughly shower. I pat dry the area, using a hairdryer on low, carefully dry the area and applying several coats of skin barrier. Once dried I apply paste to the flange, plant it on the stoma, add the bag, and the stoma strap.

I don't trust two piece systems, but these work for me. As an added level of safety I add several small strips of electrical tape to hold the flange and pouch together. Electrical tape is best as it is acid resistant and is cheap compared to medical grade tapes. Sometimes I get a pin hole in the pouch, perhaps from the cat on my lap and electrical tape is perfect for fixing pin holes.
02-20-2016, 05:03 AM   #16
Grotbags
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My routine is pretty pared down, I change mine every morning as soon as I get up, I use Salts aloe rings and Coloplast Mio pouch.
Get everything I need, sit on loo, empty pouch, peel it off, clean and dry using swabs and warm water. In the mean time the seal and pouch have been warming on the top of the radiator right next to the loo, fit seal on, then pouch, and that's it.
Never used hair dryers ( does that not dry out your skin ?) and seldom use skin barriers or extra flanges.
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Last edited by Grotbags; 02-20-2016 at 05:19 AM.
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