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Colostomy care

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was reviewed on June 9, 2022.

Caring for your skin and changing your bag are important parts of your colostomy care. Here are some helpful instructions:

Caring for your colostomy stoma

The skin on your stoma, or opening in the abdomen, will look redder than the rest of the skin around it. It’s even normal for it to bleed for a few minutes occasionally because the skin is so delicate, but it shouldn’t be painful or itchy. Sometimes the output from your colostomy makes the skin of your stoma sore. To keep the skin of your stoma as healthy as possible:

Clean your stoma with water. You don’t need to use soap or sterile supplies. Be sure to dry the stoma completely.

Be gentle. Having a colostomy doesn’t need to stop you from doing your daily activities—including exercise. However, when you’re changing your colostomy bag, be gentle when pulling the pouch away from the skin. The skin of your stoma and around it will always be delicate.

Use the appropriately sized supplies. Both the pouch and the skin barrier opening should be the appropriate size for your stoma. If the opening is too small, it may constrict the stoma, and if the opening is too big, the bag may leak. Your stoma size may change as it heals, or it may change for other reasons. Ask your care team whether you need help finding supplies that are the appropriate size for you.

Change your pouch regularly. How often you’ll need to change your pouch depends on the kind of system you use. Make sure you know how often to change it.

Watch for allergies. You may develop an allergy to the materials in your supplies at any time, even after having your colostomy for years. If you have an allergic reaction to the pouch, adhesive or tape, you may notice irritated or itchy skin. If you do notice irritation, try changing brands or using a pouch cover to separate the pouch and your skin.

Watch for infection. Your skin may also be itchy and irritated due to an infection. If you notice wet, itchy, bumpy or painful skin on or near your stoma, call your care team right away. These may be signs of an infection.

Colostomy irrigation

Irrigating your colostomy is a personal choice. When you irrigate your colostomy, you run water through your stoma and into your colon. Doing this at the same time every day may help you develop a more predictable routine for bowel movements that your body will get used to.

Many people with colostomies used to irrigate them to manage their bowel movements, but colostomy supplies have improved in recent years, so some now opt not to irrigate.

Ask your care team for more information, and if you choose to irrigate, ask them for specific instructions that may help you get into a routine.

Irrigation is only used for descending or sigmoid colostomies, not transverse colostomies.

The right time to irrigate tends to be after eating or having a hot beverage. It may work well to choose a time when you typically used to have bowel movements before your colostomy. The process may take about an hour, so choose a time when you’ll have access to a bathroom for the whole time.

To irrigate your colostomy:

  • Gather all your supplies and have them nearby.
  • Add about 1 quart of lukewarm water to the irrigating container and keep it clamped closed, so it doesn’t run through the tubing yet. You may need to use less than 1 quart, depending on your body. But don’t use more than 1 quart.
  • Hang the irrigating container so that the bottom is about the height of your shoulder when you’re sitting.
  • Sit on the toilet, or on a chair next to it.
  • Attach the irrigating sleeve to your skin barrier.
  • Put the bottom end of the irrigation sleeve in the toilet bowl.
  • Insert the cone at the end of the irrigation container tubing into your stoma. Wet it first with water or a water-soluble lubricant, and remove air bubbles by opening the clamp briefly and letting a bit of water run into the sleeve.
  • Start the irrigation process by slowly opening the clamp and letting water flow into the stoma. Take about five minutes to let all the water in the irrigation container flow in.
  • Keep the cone in place for about 10 seconds after the water flow has ended.
  • Remove the cone and irrigation tube.
  • Over the next 45 minutes or so, stool will come out of the stoma in spurts. You may feel some light cramping during this time.

With time and practice, you’ll notice your body’s signs that the process is done. The stoma may look inactive, or you may notice some gas that signals that your body is done with the irrigation process. When all the stool is out, remove the irrigation sleeve, reattach your regular pouch, rinse your irrigation supplies and hang them to dry out.

Aside from the light cramping, you shouldn’t feel pain, cramps or nausea. Tell your care team if you do. Discomfort may mean that there’s too much water or that it’s too cold.

Remember that your care team will walk you through exactly how you should irrigate your colostomy if you choose to do so. Learning to irrigate is probably a new skill for you, so be sure to ask your care team any questions you have along the way.

Emptying the colostomy bag

To prevent problems like bulging or leaking, empty your colostomy bag when it’s about a third to half full. Over time, you’ll be able to tell how often you’ll need to do this. To empty your colostomy bag:

  • Sit on a chair facing the toilet, or as far back on the toilet seat as you can.
  • Hold the pouch up and open the clip that holds the bottom (tail) closed.
  • Unroll the tail of the pouch.
  • Empty the contents into the toilet. (Putting some toilet paper in the toilet beforehand may prevent splashing.)
  • Wipe the inside and outside of the tail with toilet paper.
  • Roll up the tail and clip it closed.

Changing the colostomy bag

Make a planned routine for changing your colostomy bag. Different pouch systems need to be changed more often than others. Some should be changed daily, while others may only need to be changed once a week.

Your care team will let you know how to change your type of colostomy bag. Refer to these instructions as general guidance:

  • Make a schedule. Find a time of day that works best for you. Many people find the morning, before they eat or drink anything, to be a good time because your GI system isn’t experiencing as much digestive activity.
  • Wash your hands before and after changing your pouch. Changing your pouch with clean hands is important in helping to prevent infections.
  • Remove the old pouch. Carefully pull the skin barrier and seal (if you use one) off of your skin. Dispose of the old pouch in the trash, but keep the clip.
  • Check the stoma. It should be pink or red. Call your care team if it’s blue, purple or black.
  • Wipe around the stoma. Gently wipe any stool or adhesive from around the stoma and let the area dry.
  • Attach the new pouch. Use the supplies you need for your body and your pouching system. You may choose to use a ring seal, stoma powder or paste. Clip the end of the pouch closed.

Living with a colostomy bag

Life with a colostomy bag can be a lot to get used to. As the weeks go by after your colostomy, you’ll get more comfortable with your colostomy bag and the ways to manage it. You’ll start learning your body’s new habits and get into the swing of life with this new tool. Even after you’re well versed in managing life with a colostomy bag, it’s a good idea to have your supplies on you at all times.

Diet

The food you eat will affect the stool and gas you produce. It may determine whether your stool is more liquid or solid. How much you eat and when you eat may also affect the output in your pouch.

You may need to pay special attention to how your body reacts to the foods you eat. Over time, you’ll get used to the new rhythms of your digestion. You may find that it’s helpful to plan your meals in advance and eat at certain times of the day.

Just as before your colostomy, you may experience gas, diarrhea or constipation. Keeping a record of the food you eat and how your body processes it may help you figure out the foods that help you feel your best.

Odor

Just like life before your colostomy, your stool will likely still have an odor. This is due to the bacteria that work to digest your food, and it’s normal. The good news is that colostomy pouches trap bad smells with an odor-barrier film. You may smell an odor when emptying the pouch, but you shouldn’t smell one otherwise.

Certain brands of pouching systems may also offer the following odor-eliminating options to give you extra peace of mind:

  • Drops
  • Gels
  • Tablets
  • Sprays
  • Sachets

Some foods cause more odorous stool than others. You may be able to decrease the odor of your stool by limiting certain foods, such as:

  • Asparagus
  • Broccoli
  • Cabbage
  • Cauliflower
  • Eggs
  • Garlic
  • Beans
  • Onion

Bathing and swimming

You can shower and bathe with your colostomy bag, and you don’t need to remove it. In fact, your care team may recommend that you leave it in place while you shower or take a bath.

While soap isn’t bad for the skin on or around your stoma, using it may loosen the skin barrier or make it less likely to stick. So only use water to clean around your stoma, and rinse your skin well if you do use soap.

Likewise, you can leave your colostomy bag attached if you swim. If you prefer, you can buy swimwear that covers your colostomy bag.

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