How to Change a Leaky Ileostomy Bag
My dad had a complicated ileostomy that was double barreled, and would leak very often. At some points, it leaked multiple times a day. Other times, it would last one day or three to four days. When the skin was irritated (from unresponsive and poorly trained nurses) I resorted to changing the bag myself (even when my dad was in the hospital or rehabs) because only then would it last long enough for the skin around it to heal. In my experience, the below method worked best for me. But please note that this may be different for each person.
What you will need: Disposable Gloves, Ostomy Scissors, Ostomy Bag (I will demonstrate with a two-piece bag that is cut to size), Stomahesive Paste, Adhesive Remover Wipes, Paper Towels (warm wet ones, and dry ones), a Plastic Bag.
If you are using a two part cut to size bag, one part will be the wafer and one part will be the bag that simply clicks into the wafer. Use the ostomy scissors to cut a hole in the wafer as close to the stoma size as possible. This will ensure the best seal for the ostomy bag. Close the bottom of the ostomy bag and put it aside. The ones that I preferred for my dad were the ones that closed with a suction (they are actually meant to drain into a catheter but you can use them even if you self-drain). Other ones you may have may have a flap that you have to fold. The flap must be dried very well each time you drain it or it will lose its stickiness.
Next, you must remove the old bag. It is easiest to drain the old bag before removing it, so as to avoid a mess. Then, use the adhesive remover wipes to slowly work off the sticky part of the old bag. Be gentle and push the wipes under the sticky part little by little with one hand, while pulling the sticky part off slowly with your other hand. Next, use the warm (wet) paper towels to clean around the stoma. This is extremely important to protect the skin around the stoma. Place a dry paper towel over the stoma to catch any drainage that comes out during the process. If it leaks, clean around the stoma again to be sure it is completely sanitary before placing the new wafer on. Undo the backing of the wafer and place it down sticky side up to use in a moment. If you are using stomahesive paste, squeeze the paste around the stoma (as close as possible but not on the actual stoma) so that it forms a circle around it. Place the wafer on gently and smooth the sticky part onto the abdomen, from the inside (closest to the stoma) out. Click in the bag (and be sure the bottom is closed to avoid a mess). If there is leakage during the process, you must start over because allowing the secretion to remain on the skin will one: irritate it and two: not allow the bag to hold a proper seal.
After ensuring the wafer and bag are properly sealed on, the process is complete. This should be replaced if there is leakage under the wafer or one to two times per week. It is important to note that sometimes, the actual bag will leak from pressure while draining it. If this is the case, or if the bag gets clogged, you may have to replace only the bag and not the wafer part (this is only for two part ostomy bags). To replace just the bag, have paper towels handy to catch any drainage and slowly remove the bag from the wafer by unclicking it. Click in another bag and you are done!
It is essential to note that there are several ways to change an ostomy bag, and one way may work better for some and not for others. Some people prefer one piece bags. In my experience however, the seal around the stoma was difficult to hold and I felt as though the two piece ostomy bags worked better. Along with this, since my father had a double barrel stoma, the cut to size wafer worked much better so that the sizing was near perfect and that is what allowed it to hold its seal. For less tricky stomas, such as regular one barreled or smaller stomas in which the stoma is small enough to fit into a standard sized wafer, you may not have to cut the wafer at all which may make the process easier. Experiment with different products, ask for samples from different companies--you can get both supply samples and bag samples to determine what works best for you. Trial and error are key in this process, and something that works one time may not work another. It depends on the size of the stoma (which can change a little overtime), the irritation around the skin, and the amount of drainage that is occurring at that time.
It is important to change a leaky ostomy bag as soon as it begins to leak. The longer it remains on the skin, the more irritation will occur. The more irritation, the more uncomfortable you/your loved one is and the harder it will be for the wafer to stick. So as soon as you feel the bag leaking, take measures to change it right away. If you go out, be sure to always take an extra bag and supplies with you, even if it is only for a short while. This will avoid an embarrassing situation. Most people do not even know what an ostomy is, so if it does leak and you are embarrassed you can just say you spilled something on you and they will have no idea. It is nothing to be ashamed of however, so the more honest you are the more comfortable you will feel with it yourself. This ileostomy most likely saved your life, or at least made your life much more comfortable. Keep that in mind when you feel yourself getting frustrated or upset.
It can be overwhelming to hold a seal at times. In fact sometimes, when my dad would come home from rehab or the hospital, his skin would be severely irritated. When it was this bad, it was due to nurses who did not change the bag quickly enough (sometimes he would be left for over an hour!) or they were simply not skilled enough to secure a good seal which would in turn make it leak over and over again and cause severe irritation. At those times, he would wake me up two-three times a night to change the bag since his skin was so damaged. I hated that he was in pain, and that I could not do something more permanent for him. But the fact that was when his skin was in the worst condition, even a few hours with the bag would help heal his skin long enough for the next bag to stick. We had countless ostomy nurses visit the house, and several in the hospitals and rehabs as well to try to help us. But the only thing that actually helped was trial and error. I learned what worked best for his specific stoma, and for his specific needs (especially when they made it worse and I had to change it myself). So when you are feeling frustrated, do not fret. Remember, it can sometimes be a challenge but there will always be a way. Do not be afraid to try different approaches, and different products. It may take some time, but you will find the best way for your specific needs and it will get easier!
I would love to know which approach(es) work best for your specific needs. There are endless possibilities with endless products that you can try. Which products do you use? What type of ostomy do you have and what methods work best for you?
Ostomy Bag (wafer and bag, or a one piece bag/wafer combo)
Ostomy Scissors (usually curved to make it easier to cut a circle in the wafer but they don't have to be)
Wet Warm Paper Towels
Dry Paper Towels
Adhesive Remover Wipes
Plastic Bag (for disposal)