When you get a stoma this does not change much in your personal hygiene, although it will take some more time at first, but with experience you will get faster.
Getting used to it in the beginning is not easy, but soon(ear or later) it will become a habit and feel natural, it’s just something you do and you hardly think about it.
You can take a shower as you always did, with or without a bag. You can even take a bath if you like.
Hygiene is important for everyone; you don’t have to wash yourself more often now that you have a stoma. You can care for your body the same way as before.
It is advisable to show or teach the stoma care-routine to a person close to you. If you ever are unable to do it yourself (for instance by a broken wrist) this person can then help you.
What do you need for the daily routine?
Wet and dry wipes
A disposal bag
A pen and template to draw the stoma template onto your new bag or flange (if it is not pre-cut)
A fresh bag and, if you have to change the wafer, a fresh wafer
A scissors with rounded ends or a nail-scissors
A piece of cloth or an absorbent layer, to protect your clothes
Many other remedies exist, for example a adhesive-remover, a stoma-ring, creams, tape to stick around the wafer etcetera. On
you can find more information about these and other remedies.
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Where do you change the appliances?
When you just got your stoma, it takes some thinking to find out what is the best place to look after your stoma. You can do it in the toilet, but any other place is an option, as long as there is some room and some (running) water. You can do it while sitting down, or while standing up, and some people prefer to do it while lying down. It is handy to have a mirror nearby in order to see the lower side of your stoma.
When you are travelling, you are advised to use the toilet for handicapped, it gives you more space since most public toilets have no sink and no waste-basket.
Sometimes you have to be creative to find the most comfortable solutions for yourself. Here you see the stoma-cupboard my father made for me. I change my wafer sitting on the toilet lid, exactly in front of the hanging mirror. Everything I need for my stoma care is in the cupboard and when it opens it folds out to make a shelf on which I can to put my stuff.
Jan Brinks sent me an email containing this photo, it is a home-made triplex case with room for all his stoma care appliances and even with a mirror.
A factory-made stoma-sink is also available:
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How to change the wafer?
What is the right time to change your wafer depends on your personal preferences. Often the morning will prove to be appropriate because you have not yet been eating and the production of the stoma is low.
First you put everything you need together. Then you cut the right shape for your stoma in the new wafer, using your template. Most wafers contain a pre-cut hole already but a stoma is never perfectly round and every stoma has a distinct shape. this cutting is not necessary when you use a pre-cut wafer with a flexible hole, that fits snugly around
It is important to cut the opening to the right shape in order to protect the skin around the stoma. If the hole is too wide, the stool or urine gets into contact with the skin, which can cause irritation of the skin. If the opening is too narrow, the wafer can cut into the mucous membrane of your stoma, which can cause bleeding or swelling. A too narrow opening can also cause leakage, when the stool pushes the wafer away from the skin.
The hole in the wafer must be about two millimetre wider than the circumference of the stoma, but not more.
To make cutting the hole in the right shape easier you can make a template from a piece of cardboard, or ask your stoma-nurse to do this for you. Using this template you then draw the right shape on your wafer.
Then you cut that shape along the drawn line. When you use a one-piece system you must be careful not to cut into the bag, so hold the bag away from the scissors.
After cutting the opening you control the smoothness by moving your finger along the edge of the hole. Sharp corners might hurt you stoma, so try to prevent them.
There are also special stoma punches on the market. Herewith you do not have to cut the opening yourself. This is only possible if you have a stoma that has a regular and constant diameter and primarily for use with a two piece system.
When you use a drainable bag, and you have not yet closed the outlet, do that now.
Before you go on, put the wafer in a warm spot, for instance in between you legs, because at that temperature the wafer is most supple and the adhesive power is the greatest.
Now you put the protective layer over your clothes and start peeling off the old wafer. You start peeling on top and work carefully downwards. Never pull the wafer away with force, but slowly push your skin down from the wafer, to prevent skin damage.
After removing the old wafer put a wipe on your stoma to catch discharge that might come out. If the stoma is producing a lot you might use a mini-tampon. This you take out again just before putting on the new wafer. Another possibility is to fold a wipe into a small hollow tube and to stick this around your stoma, to catch the output.
Source of this last advice and picture: Combicare nieuws
Before throwing away the old wafer, you should study the backside to find out if any discharge has crept under it. Then you can put it into the special disposal bag.
When you have removed the base plate you can clean the skin around the stoma with damp gauze. Avoid as much as possible the use of soap, oil, body lotion etc on the skin where the base plate sits, because the primarily fat based constituents of these products reduces the adhesion properties of the base plate. If you do want to use soap, then use a PH neutral soap (for example: Eucerin PH5 or Dermolin). You can also use an adhesive dissolver to remove the sticky remainder. It does not matter if you leave the sticky remainders on the skin, as this is better than scrubbing the skin clean. There are all sorts of products to clean the skin around the stoma:
Left: Skin lotion and tissues from Dansac at the middle: Adhesive remover tissues from Welland
then: Citrus Fresh removertissues from Pelican and right: de Stomareiniger from Heltiq
If the stoma bleeds whilst you are cleaning it, do not worry. A stoma consists of a well blood fed mucus membrane. This happens more often with people who use anti clotting agents and people undergoing chemotherapy. Normally it is sufficient to dab the stoma with a cold damp gauze. When the skin around the stoma is clean, then dab it dry with a dry gauze.
You can use special creams to protect the skin. Take care to only use a tiny bit, a match head amount is enough. Wipe it well in before you attach the base plate. In larger problems such as a spotty skin, leakages etc, look at this page. Look here also if you are interested in other aids for caring for the stoma.
Left: Ultra skin protection cream from Pelican Middle: Skin cream from Dansac
Right: Skin protection cream from Welland
Now remove the plastic or paper layer that is stuck on the adhesive side of the new wafer. Take off the wipe or the tampon that covers the stoma. You are now ready to stick the new wafer on.
It is important for the skin to be held as flat as possible, because folds in the skin allow the discharge to leak.
When you use a one-piece system you fold the bag-and-wafer in two, so that the bend is along the middle of the hole. Then you hold the underside of the hole against the underside of your stoma and you stick it in place. Then you let the bag unfold and stick the rest of the wafer as well. The folding is necessary, because otherwise you cannot see where you stick the bag.
When you use a two-part system you can see the stoma while sticking it on, but here also start sticking from the bottom upwards.
Right photo thanks to Cock!
Press on the wafer, starting from the centre and hold your warm hand (or another warm object) against it, to make sure it sticks on well. Take some time to do this, because it helps prevent leakage.
With a two-piece system, now attach a clean bag. While attaching the bag to the wafer you have to give a bit of counter pressure by tightening the stomach-muscles or by blowing on your hand. The “Tupperware” fitting can sometimes be rather tight and hard to close. A touch of soap or Vaseline along the edge of the ring will help to make it easier.
Always check if the bag is well fastened by pulling the bag a little.
Sometimes you need to stick extra adhesive tape around the wafer. A variety of sizes and brands can be found on
If you are worried about smells from your stoma (which is unnecessary) you can put a bit of perfume on the bag.
Sometimes the upper part of a bag bends double, which is unpleasant if you wear a tight top. To prevent this
you can use three pieces of double tape to fix the bag to the wafer in that area. In
our experience the double tape from Sellotape works best, for sale in any stationers
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What to do when the bag is full?
With every kind of stoma the rule is not to let the bag get too full. A full bag is heavy and can pull the wafer from the skin, so with a full bag the chance of a leakage is greater. So try to make it a habit to empty or change your bag before you go out, before sports, and before you go to bed. At night a full bag mostly will wake you up and if you don’t feel sure about that, set you alarm. Sometimes at night
or and during the day you get an “airbag effect” , the bag is full of air and puffs up. The cause is probably a blocked-up filter, since the discharge reaches the filter more quickly when you are lying down. So the air cannot escape and the bag balloons.
You can try using a bigger-size bag for the nights.
For the urostomy there are also night bags available which you connect to your urostomy bag. Then you can sleep a little easier. To prevent a vacuum it is advisable to leave a little urine in your urostomy bag. Naturally the night bag must hang lower than the mattress. You can hang it is a bucket. If the urine does not flow well, you can put a little water in the night bag, before you connect it. When you rinse out your night bag well, for example using water and vinegar, then you can use it for a maximum of one week. For extra freedom of movement you can attach an extension tube.
When you use closed bags, (with a colostomy) you have to change the bag when it is half full. This happens from
3 to 6 times every 24 hours, depending on your eating habits and your bowel-movements.When you use a drainable bag (mostly with an ileostomy) you can empty the bag in the toilet when it is nearly full. Better is to empty it when it is one-third full or less, because if the discharge reaches the filter this stops working.
What is the best way for you of emptying the bag is a matter of trial.
You can sit on the toilet seat and empty it in between you legs.
Or you can squat in front of the toilet and then empty it .
Other possibilities are: sitting backward on the toilet seat, put a stool near the toilet or put an old bucket in the sink and empty the bag into that first.
After emptying the bag, clean the opening with a piece of toilet paper or a wipe, in order to remove bits of discharge, then you can close the opening by pressing, rolling en securing the end.
How often you need to empty a drainable bag depends on the amount of discharge you produce, it is mostly between 6 and 10 times in 24 hours.
People with an urine stoma have a drainable bag with a little tap, to make the emptying easier. How often you need to empty an urine-bag depends on the amount of urine you produce, it is mostly between 8 and 10 times in 24 hours.
For people in a wheelchair with an ileostomy, a tip from Christiaan: “I searched for a solution to independent emptying of the bag. The leg bag is normally chosen. In my personal case, because I can push myself forwards in the wheelchair, I considered the option of the long high flow ileo bag with button closing (which makes the bag a bit longer) by BBraun Almarys Twin+. As far as I am aware this is the only make which offers a long bag with a button closure. For me this works excellently, aided by the fact that thanks to the electrical height adjustment of my wheelchair, I can reach well above the toilet. The advantage of this bag with button closure is that it is possible to add a night bag via tubing, which can be a solution for bedridden people. “
A good advice especially for ileostomy is to put some toilet paper in the bowl before emptying the bag, to prevent splashes jumping back.
Another advice is to carry a sealable container, in case there is no (clean enough) toilet around, in emergencies you can empty the bag into this container.
While changing or emptying the bag smells emerge. You can use an air freshener or light a match to get rid of these smells. But remember also people without a stoma produce smells. On
this page you can read more about smell-reducing products.
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Depilation around the stoma.
It is important to have no hair on the skin around the stoma, because the wafer will not adhere well on a skin with hairs (and removing the wafer will hurt a lot!) So, if there are hairs, get rid of them. Cutting them off is better than shaving, because a shorn hair can grow into the skin, when the skin is covered by the wafer, and ingrown hairs can cause infections. If you prefer shaving, then be sure to shave with the direction the hairs grow, and not against it.
Never shave more than twice a week and protect your stoma with gauze or wipe. After shaving you can use a skin protector.
Do not use a shaving cream; this can affect the adhesive power of the wafer.
Studies are being held about permanent depilation around the stoma by way of laser. It seems this is a safe and effective treatment. It may take 5 to 7 treatments to work and it does not work on blond or grey hair, because these contain not enough pigment. The treatment is nearly painless, the laser releases some warmth and it feels as if an elastic band touches the skin.
The results are promising, but more research is needed. If more information reaches us, we will let you know.
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Taking a shower?
When you have a stoma you can take a shower just like before, with or without the bag. The bag is meant to be water-resistant and the filter can be closed by a sticker that comes with the bags. A fabric layer will stay moist for some time, a reason why many people prefer changing the bag after a shower. An added advantage of this routine is that the wafer is easier to remove after a shower.
Showering without bag or wafer is also possible; it’s just what you yourself prefer. Water has a purifying effect, so it is even advisable to shower without having anything stuck on your stoma. The stoma closes itself, so you don’t have to be afraid of water getting inside. Be prepared for some output though, this happens less often with a colostomy.
Shampoo and douche gel are okay to use and do not damage the stoma. It is better to use no bath oil or body lotion, for they can be the cause of the wafer fastening less well to the skin.
Try to prevent the full force of a shower on your stoma, or shift the water force to a lower
setting. All of the above also holds true for taking bath.
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What do you always carry with you in your bag?
Be sure always to carry an emergency set, even when you go out for only a short time.
What do you need to take?
To start: a toilet bag. Take some time to select a suitable type. Several compartments to fit different materials is a pro. The rest is a matter of taste. I personally like a bag with a cooling function, for the warm weather. The bags that are specially made for keeping insulin are handy. (See example on the photo).
Other women use a normal handbag or shoulder bag with many compartments and reserve a couple for their stoma materials.
For men it is probably less feasible to carry a handbag, they might consider putting their stoma material in a camera bag.
White Rose collection
Ik ga op reis
It can be handy if you have a bag with a cooling function for during the hot summer. There are for example bags which are designed to store insulin, which are ideal. A handy bag wherein you can put a number of base plates is the one from Frio. We have tested a number of models, and the expedition model is the most suitable. You place the inner bag in water for 10 minutes, whereby it congeals and keeps your base plates cool for a minimum of 48 hours.
And what goes into this bag?
To this you might add:
Flannel or prepacked wet wipes
Air fresheners or matches
Bottle of water
Salt or salt tablets
Crackers or a bag of chips
Check occasionally that your emergency set is still complete!