Ostomy care FAQ

An ostomy is a surgically created opening on the abdomen (belly) that allows bodily waste—either stool or urine—to leave the body. This opening is called a stoma. According to the National Institutes of Health (NIH), there are three primary types of ostomies, depending on which organ is involved:

• Colostomy: A surgery where a portion of the large intestine (colon) is brought to the surface of the abdomen. The output from a colostomy is typically solid or semi-formed stool.
• Ileostomy: A surgery where the lower part of the small intestine (the ileum) is routed through the abdomen. Because the food bypasses the large intestine, the output is usually liquid or paste-like and contains active digestive enzymes.
• Urostomy: A surgery that diverts urine away from a diseased or damaged bladder. The surgeon uses a small piece of the bowel to create a passageway, allowing urine to flow out through the stoma.

Each type of ostomy requires specific care routines and specialized pouches to collect waste safely and comfortably.

The frequency of changing your ostomy system depends on the type of ostomy you have, the type of pouching system you use, and your individual body chemistry. The Wound, Ostomy, and Continence Nurses Society (WOCN) generally recommends the following guidelines:

• One-Piece Systems: These are typically changed every 3 to 5 days, though some users prefer to change them more frequently.
• Two-Piece Systems: The skin barrier (the part that sticks to your skin) can often stay in place for 3 to 7 days, while the pouch itself can be emptied or changed as needed.
• Drainable Pouches: These should be emptied when they are one-third to one-half full of waste or gas. Leaving them to fill completely can put pressure on the adhesive seal, leading to leaks.
• Urostomy Pouches: These are typically connected to a night drainage system at bedtime and changed every 3 to 5 days.

If you experience itching, burning, or discomfort under your skin barrier, you should change your pouch immediately to inspect your skin, regardless of how long it has been since your last change.

Keeping the skin around your stoma—known as the peristomal skin—healthy is one of the most important aspects of ostomy care. Healthy skin should look just like the skin on the rest of your abdomen. To protect your peristomal skin, follow these consensus guidelines from the United Ostomy Associations of America (UOAA):

• Keep it clean: Wash the skin around your stoma with warm water. You do not need to use soap. If you prefer to use soap, choose a mild, plain soap that is free of moisturizers, oils, perfumes, or deodorants, as these can leave a residue that prevents your pouch from sticking.
• Dry thoroughly: Ensure your skin is completely dry before applying a new skin barrier. Wet skin will prevent the adhesive from bonding properly, which can lead to leaks.
• Measure your stoma regularly: Your stoma can change size and shape, especially in the first 6 to 8 weeks after surgery. Measure your stoma with each pouch change to ensure the opening of your skin barrier fits snugly—leaving only about a 1/16-inch gap around the stoma to prevent waste from touching your skin.
• Avoid harsh chemicals: Do not use alcohol, baby wipes, or household skin cleansers, which can dry out or irritate the skin.

A healthy stoma is pink or red, moist, and warm to the touch—similar to the inside of your cheek. Because the stoma has many blood vessels close to the surface, it is completely normal to see a small amount of bleeding when you clean or wipe it. The stoma does not have nerve endings, so touching it should not cause pain.

According to the UOAA, you should contact your healthcare provider or a Wound, Ostomy, and Continence (WOC) nurse if you notice any of the following changes:

• The stoma turns dark red, purple, blue, or black (which may indicate a lack of blood flow).
• The stoma swells significantly or shrinks excessively.
• The stoma begins to pull back below skin level (retraction) or push out further than usual (prolapse).
• You experience severe, persistent bleeding from the stoma or the opening where it meets the skin.

Choosing the right supplies depends on your lifestyle, your ostomy type, and the contour of your abdomen. Ostomy systems generally fall into two categories:

• One-Piece Systems: The skin barrier and the pouch are permanently attached as a single unit. Many users prefer this option because it is highly flexible, low-profile, and easy to apply.
• Two-Piece Systems: The skin barrier and the pouch are separate components that snap or stick together. This allows you to change the pouch (for example, switching to a smaller pouch for exercise) without removing the skin barrier from your body, which helps protect sensitive skin.

Additionally, you will need to choose between flat barriers (best for flat abdominal surfaces) and convex barriers (which curve inward to help push a recessed or flush stoma outward, preventing leaks). Consulting a WOC nurse is the best way to determine the ideal combination of ostomy pouches and accessories for your unique body shape.

Yes, absolutely. Modern ostomy pouches are designed to be completely waterproof. You can take a shower, take a bath, or go swimming with your pouching system securely in place. The adhesive is water-resistant and will not wash off.

If you prefer, you can also shower with your pouch off, as water and mild soap will not harm your stoma. However, keep in mind that you cannot control when your stoma will output waste, especially if you have an ileostomy. Many people find it easiest and cleanest to shower with their pouch on and simply pat the pouch dry with a towel afterward, or use a hair dryer on a cool setting.

It is a common worry for new ostomy patients, but modern ostomy systems are made of odor-proof plastics that prevent odor from escaping the pouch. You should only experience odor when you are emptying or changing your pouch. To manage odor effectively, consider these tips recommended by ostomy care professionals:

• Check for leaks: If you smell odor while the pouch is closed, check for a small leak or a failing adhesive seal.
• Use pouch deodorants: Liquid or tablet deodorants can be placed directly inside your pouch during changes or after emptying. These neutralize odors rather than just masking them.
• Choose pouches with integrated filters: Many modern pouches feature active charcoal filters that slowly release deodorized gas, preventing the pouch from ballooning.
• Dietary adjustments: Certain foods, such as onions, garlic, fish, eggs, and cruciferous vegetables (like broccoli and cabbage), can cause stronger odors. You do not have to avoid these foods entirely, but being mindful of when you eat them can help you manage output odor.

In the first few weeks following your surgery, your bowel will be swollen and healing. Your doctor or dietitian will likely recommend a low-fiber diet to prevent blockages. Over time, most people can slowly reintroduce their favorite foods. The NIH and UOAA suggest these general nutritional practices:

• Chew your food thoroughly: Chewing food to a paste-like consistency is crucial, especially for those with an ileostomy, to prevent food blockages.
• Stay hydrated: Because the large intestine absorbs water, individuals with an ileostomy or colostomy lose more fluids and electrolytes than normal. Aim to drink plenty of water and electrolyte-rich fluids daily.
• Introduce foods slowly: Add new foods back into your diet one at a time and in small quantities to see how your digestive system reacts.
• Be cautious with high-fiber foods: Foods like nuts, seeds, popcorn, coconut, celery, and raw vegetables can be difficult to digest and may cause a blockage. Eat these in very small portions and chew them carefully.

A food blockage occurs when poorly digested food gets stuck in the intestine, preventing waste from passing. This is most common in individuals with an ileostomy. Signs of a blockage include:

• A sudden decrease or complete stop in stoma output.
• Abdominal cramping, pain, or swelling.
• Nausea or vomiting.
• Swelling of the stoma itself.

If you suspect a partial blockage (you are still passing some liquid or gas), stop eating solid foods, drink warm liquids like tea, gently massage the abdomen around your stoma, or take a warm bath to help relax your abdominal muscles. Never take a laxative. If you stop passing output entirely, begin vomiting, or experience severe pain, seek emergency medical care immediately.

While managing an ostomy becomes routine over time, certain symptoms require professional medical evaluation. According to the WOCN, you should contact your doctor or ostomy nurse if you experience:

• Severe skin irritation, redness, open sores, or weeping skin under your barrier.
• A persistent leak that requires you to change your pouching system more than once a day.
• A change in stoma color (pale, blue, purple, or black).
• Persistent watery diarrhea lasting more than 24 hours, which can quickly lead to severe dehydration.
• Fever, chills, or unusual drainage from around the stoma.

Your healthcare team is there to support you, adjust your appliance fit, and ensure your recovery is on the right track.