An ileostomy pouch is a medical device that collects waste after an ileostomy. This surgery diverts the small intestine through an abdominal opening called a stoma. The pouch attaches to the skin around the stoma to collect liquid or soft stool.
Regular changes of an ileostomy pouch are important for hygiene, skin protection, and comfort. Peristomal skin can become irritated if exposed to digestive output, so a secure pouching system is necessary. Consistent care prevents complications like skin breakdown or infection, allowing effective ileostomy management.
Gathering Supplies and Preparing Your Space
Before changing an ileostomy pouch, gather all necessary supplies and prepare a clean, private space. Having everything within reach minimizes interruptions and promotes a smoother change. Ensure a new pouching system and any accessory products are available.
Essential supplies include a new ileostomy pouching system (one-piece or two-piece), a stoma measuring guide for correct barrier opening size, stoma paste or rings to flatten skin creases, skin barrier wipes or sprays for skin protection, and specialized scissors for cutting the barrier.
A disposal bag, clean cloths or paper towels, and warm water are important for hygiene. An adhesive remover wipe can assist with gentle removal. Prepare a clean, well-lit surface, like a bathroom counter, for clear visibility.
Removing the Used Pouch
Remove the old ileostomy pouch gently to protect peristomal skin. Carefully peel the adhesive barrier from top down, supporting the skin with your other hand. This slow approach prevents skin stripping, which is the removal of the top skin layers with the adhesive.
If the adhesive is strong, an adhesive remover wipe or spray can dissolve the bond, making removal more comfortable. As the pouch is removed, gently fold it in half to contain output and minimize odor. Have a disposal bag open for immediate, hygienic disposal.
During removal, some output may occur. Have a tissue or gauze ready to manage this. Avoid scrubbing or aggressively pulling the skin, as this can lead to irritation and compromise skin integrity.
Caring for Your Stoma and Surrounding Skin
After removing the pouch, clean the stoma and surrounding peristomal skin. Use warm water and a soft, lint-free cloth or paper towel to gently wipe away stool or residue. Avoid soaps with oils, perfumes, or deodorants, as they can leave residue that interferes with new pouch adhesion.
The stoma may bleed slightly when cleaned, which is normal due to many small blood vessels. Stoma tissue should be pink or red, similar to the inside of your mouth, and should not cause pain as it has no nerve endings. After cleaning, thoroughly pat the skin dry. Completely dry skin is important for the new adhesive to form a secure seal.
Inspect the peristomal skin for signs of irritation, redness, or breakdown. Healthy peristomal skin should look similar to skin on other body parts. Persistent redness, weeping, or discomfort may indicate a need to adjust your care routine or pouching system. Applying a skin barrier wipe or spray to clean, dry skin before applying the new pouch provides additional protection against digestive enzymes.
Applying the New Pouch
Applying a new ileostomy pouch requires precise measurement and careful application to ensure a secure, leak-proof seal. Use a stoma measuring guide to determine your stoma’s exact size and shape. The new skin barrier opening should be cut to fit snugly around the stoma, allowing about 1-2 millimeters of clearance.
Once the barrier is cut, apply accessory products like stoma paste or a barrier ring, if needed. Stoma paste fills uneven skin surfaces or scars around the stoma, creating a flatter area for adhesion. Barrier rings provide additional protection and enhance the seal, especially for irregular stomas.
After preparing the barrier, peel the protective backing from the adhesive. Carefully center the opening over your stoma, ensuring it protrudes without touching the adhesive. Press the adhesive firmly onto the skin, starting from the stoma and working outwards, smoothing out wrinkles or air bubbles. Gentle, even pressure creates a strong bond.
Ensure the pouch is properly aligned and secured, with the bottom facing downwards. If using a two-piece system, securely snap or lock the pouch onto the flange. A well-applied pouch should feel comfortable and provide a reliable seal, protecting the skin from output.
Troubleshooting and When to Seek Help
Despite careful technique, minor issues can sometimes arise during or after a pouch change. If you notice a small leak immediately after applying a new pouch, gently pressing around the affected area may help improve the seal. Sometimes, a slight adjustment in posture or a few minutes of warmth from your hand can help the adhesive conform better to the skin.
Skin irritation around the stoma can occur even with proper care. If you observe mild redness or itching right after a change, ensure the skin was completely dry before application and that the barrier opening is sized correctly. An improperly sized opening, either too large or too small, can lead to skin exposure and irritation. Hair growth under the barrier can also cause irritation; carefully trimming or shaving this area away from the stoma can help.
You should contact a healthcare professional, such as an ostomy nurse, if you experience persistent leakage, severe skin irritation that does not improve, or significant changes in your stoma’s appearance. Signs that warrant professional attention include a stoma that changes color, swells noticeably, or bleeds excessively. If you have difficulty achieving a good seal consistently, or if you suspect an allergic reaction to a product, seeking guidance from a healthcare provider can help identify the cause and recommend appropriate solutions.