A colostomy is a surgical procedure that creates an opening, called a stoma, on the abdomen to divert the large intestine. This new pathway allows stool and gas to exit the body, bypassing the rectum and anus. Since the stoma does not have a sphincter muscle to control output, a pouching system is placed over the opening to collect the waste. Managing this appliance involves two routines: emptying the pouch and replacing the entire system, both of which require a reliable schedule.
Emptying vs. Changing: Clarifying the Terms
The terms “emptying” and “changing” refer to two different procedures with vastly different frequencies. Emptying, or draining, involves opening the bottom of the pouch to release collected stool into the toilet multiple times throughout the day without removing the appliance from the skin. Changing, or replacing, means removing the entire pouching system, including the collection pouch and the adhesive skin barrier, and applying a completely new one. This full process involves cleaning the skin around the stoma and applying a fresh barrier and pouch, with frequency measured in days rather than hours.
Standard Frequency for Pouch Emptying
Draining the pouch is the most common part of colostomy management and is typically done multiple times daily. The pouch should be emptied when it is between one-third (1/3) and one-half (1/2) full. Waiting until the pouch is too full creates a risk because the weight of the contents can pull on the adhesive barrier, compromising the seal and potentially causing leakage. Since a colostomy generally produces thicker, more formed stool, emptying may occur one to three times per day. Consistent emptying helps maintain a lighter system and prolongs the lifespan of the skin barrier.
Determining the Appliance Change Schedule
The general recommendation is to replace the entire pouching system, including the skin barrier, every three to seven days. This range exists because the adhesive barrier naturally begins to degrade after several days of contact with body heat, moisture, and output. Factors like skin health, stool consistency, and physical activity influence where an individual falls within this range. A successful schedule maximizes skin protection by ensuring the barrier maintains a secure seal without causing irritation from excessive removal or infrequent changes.
One-Piece vs. Two-Piece Systems
The specific wear time depends on the type of system used. With a one-piece system, the adhesive barrier and the collection pouch are permanently joined, meaning they are replaced together at the three-to-seven-day interval. In contrast, a two-piece system allows the pouch to be detached and replaced daily without disturbing the skin barrier. The barrier on a two-piece system remains in place for the full multi-day wear time.
When to Change Immediately: Warning Signs
Certain warning signs indicate that the appliance must be replaced immediately, regardless of the planned wear time. The most important sign is any feeling of itching, burning, or pain beneath the skin barrier, suggesting output has leaked onto the skin. This exposure can quickly lead to peristomal dermatitis, a painful breakdown of the skin surrounding the stoma. Other signs include visible degradation or failure of the adhesive barrier, such as edges lifting or output seeping beneath the adhesive. A persistent, noticeable odor, even after cleaning the pouch, can also signal a seal failure requiring a full system replacement.