Changing a stoma bag: step by step, how often and what to do about leaks

A bag change has the same basic shape whichever system you use. You remove the used bag, clean and dry the skin around the stoma, look at the stoma and the skin, then fit a new bag or baseplate cut or pre-cut to the size of your stoma. Most people take a few minutes once the routine is familiar, but nobody expects it to feel quick in the first weeks.

The exact details depend on the products you were given. Your stoma nurse will have chosen a bag type to suit the shape of your stoma and your abdomen, and will have watched you do the change yourself before you went home. Treat what follows as a general outline of what UK charities and the NHS describe, not as a replacement for what your nurse taught you.

The NHS explains that there are two main kinds of stoma bag. In a 1-piece bag the sticky back fits around the stoma and has to come off completely at each change. In a 2-piece bag a separate sticky ring, called a baseplate, stays on the skin and the bag clips or sticks onto it, so only the bag comes off at a routine change.

Bags can also be drainable or closed. Crohn's & Colitis UK says drainable bags have a clip or Velcro fastening so you can empty them into the toilet without taking the bag off, and are usually suited to the looser output of an ileostomy. Closed bags are sealed and are replaced when full, which suits the firmer output that typically comes from a colostomy.

Shape matters as well. The charity says a flat bag normally suits a stoma that stands out as a spout, while a stoma that sits flat or pulls inwards may be given a convex bag, whose seal curves toward the stoma. Because convex bags can press on the skin, it advises using them only if a stoma nurse recommends it.

These steps follow the order given by Crohn's & Colitis UK and by the guidance of Salts Healthcare. They apply to a 1-piece system, or to a 2-piece system when you are changing both bag and baseplate.

• Gather what you need: a clean bag, scissors and a template if you cut your own, dry wipes or plain kitchen roll rather than cotton wool or tissues, warm water, a disposal bag and adhesive remover if you use one. Salts suggests washing your hands before and after.

• If you wear a drainable bag, empty it into the toilet first.

• Peel the old adhesive away from the top downwards while supporting the skin with your other hand. A little adhesive remover sprayed as you go can help.

• Fold the used bag over on itself and put it in a disposal sack. Salts says not to flush bags unless they are described as flushable, as they can block the toilet. Crohn's & Colitis UK notes that some areas ask for clinical waste bags, so check with your stoma nurse.

• Clean the skin around the stoma with warm water and dry wipes. Salts says water is adequate, and that if you prefer soap it should be plain, unperfumed and not moisturising, and rinsed off before drying.

• Look at the stoma and the skin. Make sure the skin is completely dry before going on.

• Measure the stoma against the guide supplied with your products and cut the baseplate to the same size and shape. Once the stoma has settled, Crohn's & Colitis UK says you can order baseplates pre-cut.

• Peel off the backing paper. Salts advises folding the top half of the adhesive back, placing the bottom edge around the stoma first and smoothing upwards with your fingers, with no creases, and warming it with your hands so it moulds to the skin.

• Hold the baseplate in place for about 30 seconds, as Crohn's & Colitis UK describes, then attach the bag if you use a 2-piece system and have not already done so.

There is no single correct interval. The NHS says how often you change a bag varies between people and that you find what works for you over time. The figures given by Crohn's & Colitis UK are useful as a rough guide rather than a rule.

• A 1-piece system suits some people who change their bag once a day or less, while someone who needs to change several times a day may find a 2-piece system gentler on the skin, according to the charity.

• Sore or burning skin can be a sign that a bag needs changing, the charity says.

Looking at the skin at every change is the simplest way to catch trouble early. It should look much the same as the skin elsewhere on your abdomen. Crohn's & Colitis UK lists sore or burning skin, itchy red skin that may be a reaction to a product, and skin infection, which a GP can treat.

Leaks are most often down to the seal. The charity explains that a baseplate which does not fit snugly, creases under the adhesive, or a change in the shape of your stoma or in your weight can all let output under the edge. It suggests checking the size of the hole, smoothing out creases and emptying the bag regularly, and says your stoma nurse can suggest seals, rings, collars, filler pastes or a different bag.

Some people notice gas building up in the bag, known as ballooning, or output collecting at the top of a colostomy bag, known as pancaking. Both have practical fixes, such as a different filter or bag, and the advice is to mention them to your stoma nurse if they are regular.

Crohn's & Colitis UK says the stoma may bleed slightly during a change and that this should stop quickly, but blood in the output or in the bag is a reason to contact your stoma nurse. The same applies if you are worried about any change in the stoma or the skin around it.

It also lists reasons for faster action in people with an ileostomy. Signs of a blockage include less output, watery output, feeling sick or bloated, and tummy pain. If the pain gets worse or you are sick, it says to go to your nearest A&E. If output stays high you can become dehydrated, and the charity says to contact your hospital urgently if output is more than 2 litres a day for 3 days or more.

The NHS adds that many medicines are designed to dissolve slowly and may come out in the bag if you have an ileostomy, so it is worth asking your doctor about liquid or powder alternatives rather than stopping anything yourself.

Supplies come on prescription. Crohn's & Colitis UK says prescriptions are free in Scotland, Wales and Northern Ireland, and in England they are free if you have a permanent stoma, which you apply for with a form from your GP surgery or hospital. The NHS says someone with a temporary ileostomy may need to pay for bags.

You can usually choose between a pharmacy and a home-delivery supplier. The charity advises ordering in good time but not stockpiling, since your needs and your stoma can change and unused items would be wasted. If you change product, check with your stoma nurse first.

Teaching on bag changes is normally part of NHS surgical care. A stoma nurse should see you after surgery, help you choose a bag, show you how to change it and make sure you know who to contact before you go home. Follow-up from the nurse continues for the first months at home by home visit, clinic or telephone.

Whether your operation took place in the NHS or privately, the practical details are the same: a named stoma nurse, a supply route through your GP or a supplier, and a contact for problems. If you are unsure who that is, ask the ward or your surgeon's team before discharge.