When to change: Frequency and benefits

It seems like we know everything there is to know about our stomas, the appliance and all that needs to be done and when. Yet it wasn't that long ago that we didn't know the difference, or if there was one, between barriers, barrier rings, barrier film or spray, wafer, base plate, etc. I mention this because there may be questions asked by newer folks and we (or I) need to slow down before throwing out stuff that was a mystery a short time ago. One of the real hazards for folks like us is not asking enough questions.

I'm not new to this but I'm still learning and would like to know your thoughts on some basic concepts starting with when to change the appliance. What constitutes too often or not often enough? Are there benefits to less frequent changes? 

Respectfully,

Mike

Mike, under ideal circumstances we would change 5 seconds before it leaks...that would give us the most service for the money spent.

A more logical method would be based on prior experience: how long does it normally last with a reliable seal? Subtract from this 1 day and here is your "fail safe" number.

I think the main benefit from stretching your wear time to the maximum while still being reliable is less stress on the skin from peeling off a well stuck flange.

Regards, MMSH

Great answer, mmsh.  You covered the economy, efficiency and skin care issues.  Thanks for the input.

Sincerely,

Mike

Hello Mike.

Good post! Maybe we ought to have a list of ostomy definitions. or Frequently Asked Questions, or both.

Best wishes

Bill

I'm not long into this, coming up on one year since the takedown, so the only experience I have is my own. When I was released from the hospital...I was pretty much left on my own to figure out what, when, and how. I was led to believe that Hollister was the preferred supplier and that's what I needed to use. I could get about 3 days max from the barrier, so I just changed it every 3 days. I look back now and realize how misinformed I really was. But thanks to this site and the experiences of all who post here, things became clearer. It was harder on my skin to change so often and if I went a little longer, the barrier was easier to remove and the skin was healthier. I tried every product I could get my hands on, trying to extend the change time and have no leaks. I did learn that I can tell if it's too long, the skin beneath becomes irritated and starts to itch, then I know it's time for a change for sure. Through trial and error, I now change once a week and have no problems...just my 2 cents worth

Hey Bill, good idea.  Thanks for the suggestion.

Letsrock, your 2 cents is quite valuable.  You really learned the hard way and you must have been determined to succeed and you did.  There is so much help here and, unfortunately, some folks don't ask questions.  Together we can make each other's ostomy situations way better.

Respectfully,

Mike

Hello Mike

I've now had my stoma for 11 years. Like you, I left the hospital with very little instruction on how to maintain my pouch, preserve the skin, etc. However, after picking up a lot of information here from other folks on this and other sites, I now have everything under control. I can wear my appliance for as long as 10 days without any leakage. There are several factors for you to consider. 1. Skin condition around the stoma is very important. I do everything to keep the skin from getting irritated and weeping. 2. I use a Hollister 7805 Barrier Ring. The key here is to form a good seal around the stoma. Although I can wear the appliance for as long as 10-15 days, I change it every 10 days or if I feel itching of the skin around the stoma. I wipe the skin with a no-sting barrier wipe before applying the Barrier Ring and appliance. If I see any sign of skin irritation when changing, I apply Stoma powder before attaching the appliance. This hopefully will give you an idea of what you can do. Hard knocks and information you get from this site is a good learning tool if you don't get good initial advice from nurses and doctors.

Best wishes.

Bob S

I appreciate your comments. I too have questions about how often to change my pouch, what about drinking wine, and how to avoid gaining weight with all the potatoes I eat. I was told to avoid vegetables, so I seem to be eating a lot of carbs. I have had my ileostomy for 4 months and I can't seem to eat or drink properly.

Hi Lucky Legs

I don't drink because of the medication I take daily. I stay away from any vegetable that may accumulate a potential fiber blockage. Just be careful. Weight hasn't been a problem. I eat just about anything I want to eat. If I do get the urge to eat any heavy fiber vegetable, I just remember to CHEW CHEW CHEW. Knock on wood, but in 11 years, I've yet to have a blockage. I have a friend that has a blockage and ends up in the hospital at least twice a year, but he eats everything he wants. Best wishes, life is good!

Bob

It depends on your "output consistency" regarding how often you need to change your bag. Colostomies often have a thicker output, which can present its own problems, but ileostomies often have a very fluid output, and it hence makes it far more likely that you are going to get a leak, because the watery output can quickly find a way out under barrier rings, wafers - and leave you in a mess. I thought the law of gravity dictated that liquid flows downwards? Not so with me, my leaks have mainly been from the side of the appliance.

I shower naked and change daily. I can't stand the smell, even with drops, perfume, M9 etc. etc. etc. The bags smell. I have had no skin problems.

Peace

I've had my colostomy for 13 years and am still learning. Changing the appliance depends on the type of output. Firm or paste-like can go longer. Water or diarrhea needs close attention and like someone said gravity has no effect, and if you disagree with that just let some air out of the bag when you feel there is too much and you'll get too much of what you don't want coming out; that's for sure. I find 4 days and as of lately I may have to change that to 3 because of such a liquidy output. Some veggies give me blockage so I drink some V8 juice to make up for the vitamins or minerals my body needs. Like bes0642 said, life is good!!!!!!!!!!!!! Woohoo

Hello great conversation. I change daily or every other day. I just can't take it any longer than that. My skin has been good. I am grateful because my insurance assures me a wafer daily and the pouch also. I do, however, wash the pouch out while I have it on during the day. This depends on output but, I change it daily. Best of luck guys. Maybe I can get used to having it on longer but for now I change.

Lol, I think most of us do!

MMS - meaning no bag, from most posts, I'm gathering that most people use the same bag for two, three, four, etc. days.

Peace.

Hi, I can't use the pouch for 3-4 days because my filter clogs and will not work. Also, if the filter gets clogged, there is a chance for some leakage and odor - which happened before. I try to change my pouch every day or every other. I also use an ostomy deodorant to control the smells. It helps, is not perfect, but helps. Take care. LH

Ladyhope, I'm with you, the filter is inefficient and clogs almost immediately depending on what was eaten. I can't stand the smell, feel, and even just the thought of having dirty underwear on for days at a time. I find it extremely offensive that some unseen authority decides when we get to change our underwear. My mother always told me to make sure my underwear was clean as you never knew.... LOL

Hey ;--where in Pa.? 20 years ago, after we sold our restaurant on LBI in NJ we moved up to Gouldsboro, in the Pocono Mountains; for a couple of years. We opened two restaurants in the Lake Harmony area as consultants for two different owners. Loved the area, tough to find any worthwhile employment and we had decided we were too young to stay retired, so we moved south to the triangle area of NC where employment was booming. Now with both retired again, thinking of another move, but probably west, Colorado or California as we have opportunities being offered in both places. Just curious

Peace

Nancy

Ladyhope--OK, I just backed up and read your profile, Philadelphia area. You're probably better acquainted with the Jersey Shore area where we had our restaurant than where we moved to in the Poconos. I was just curious, or nosy .......

Nancy

When I got my ileostomy (almost two years ago), I was very disappointed that the hospital only gave me one time for learning, and then I was sent to a nursing home for three weeks. That was a horrible experience as they could not get my bags to work - one day they changed the bag 13 times - I was almost screaming from the pain. Finally, they took me to the ER and had a wound nurse help me. She helped a lot, but after being discharged from the nursing home, I got dehydrated again and was rushed to the hospital. The wound nurse at this hospital was wonderful - finally got the bags to fit right. I had thought that I didn't want to live like this if it was going to be this difficult. Now, finally, I can last almost a week with one bag - sometimes all week - but have decided on my own to change it two times a week. Now I have a large hernia which is going to be removed this Friday; it is interfering with my bag sticking. All in all, I have accepted this bag and am doing good.

I told my insurance company I change it every 3-6 days depending on my skin's condition. Right now, I'm battling a skin ulcer so I'm lucky to make it 3 days. The ostomy nurse told me to let it stay on until it was hurting, leaking, or slipping. She basically recommended letting it stay on until it comes off. Saving your skin is very important, so if I suspect it is leaking, Crohn's flare-ups, watery stools, I definitely change it more frequently.

This topic is of great interest to me because I have heard of changing practices that go from one extreme to another. I have a permanent ileostomy and I'm still learning after two years.

Basically, I was told that I would be able to go for at least five days without changing my pouch, but that has not worked out. Interestingly, my husband heard this from the ostomy nurses in the hospital and he wonders why I can't accomplish this? I know that he means well, but let's face it, only those of us living with the results of this type of surgery can truly appreciate what works for us!

My question is this... lately I have been dealing with my stoma retracting while I sleep at night. I have been trying to sleep in more of an upright position, thinking that my stoma is retracting because I am laying on my back (gravity?). But, that doesn't seem to help. Unfortunately, when my stoma retracts, the output gets under the barrier ring and then I need to change my appliance that morning.

Does this happen to anyone else, and if so, have you found ways to stop this from happening? My changing routine usually lasts about three days, which is fine with me. The skin around the stoma is still sensitive so I use the prescription powder that seems to keep the irritation and redness from getting too bad.

I am amazed that some people can go for over a week without changing, and more power to them!! Maybe someday I will have a more predictable routine, but so far each day is a surprise.

Lavern,

I am about a year out since my takedown surgery for cancer, and have a permanent colostomy. Just wondering if you're wearing a belt of some type? It may help during the night to keep the barrier tighter...

Yes, I do wear a belt constantly. It feels more comfortable and gives me a little more feeling of security. Not sure how much it does, but it's become part of my regular routine.

I'm wondering about two things. First, does it matter what I eat for dinner and does it matter if I eat late at night or close to when I go to bed? Generally, it takes about 3-4 hours for food that I eat to result in output. Does the stoma have to work harder to push out certain foods, therefore, causing it to retract at night?

Maybe I will just have to get used to this?

  I was always told to eat as close to the same time daily if you want any kind of schedule and at least 3 hours before bedtime. What you eat may have an impact on output as some foods take longer to digest and pass through the system. I started a diary of what I ate daily & the time of output, that at least gave some clue of what/when to expect something. I don't know as far as the stoma working harder on certain foods as they processed before they get there. I would imagine that the foods that are harder to digest, or lack fluid may be more difficult to pass. My guess as you sleep you become more relaxed and the wall that holds the stoma relaxes as well causing the stoma site to settle. That's why I was asking about a belt, it should hold the barrier tighter than not wearing one.

The stoma that I have is uneven and one side is barely above the skin level, if I don't pay attention or keep everything tight it will get under the barrier and try to push it off. We all are different in this way but share in the same problems. Through trial and error we develop the best procedures and appliances that work best for our situation. Don't give up on anything, try different products until you're satisfied and you will get the best results for your situation.

I really appreciate your help.

I think I will follow your idea of keeping a diary just so it can give me a better picture of what is happening and maybe help me develop a routine that works for me.

One of the most difficult parts of living with an illeostomy is how unpredictable it can be, and anything that can give me some sense of control sounds good to me!

Hey LH, from what I read filters are not that reliable.  I use the EZ vents and just burp the pouch when needed. I also use ostomy deoderants.  I think colostomates can go a lot longer than ileostomates between changes.  

When you mention changing every day or two, does that include the wafer?

Mike 

Thanks so much bes0642 for the info you supplied.  Obviously you have a colostomy and we get longer wear than those with ileostomies. You provided great advice!

Sincerely,

Mike

Hey Bettyjoe, do you change the wafer each time you change the pouch?  I ask because I thought frequent wafer changes could be harmful to the surrounding skin.  

Lots of wisdom comes from New Jersey;  Edison, Einstein, Primeboy, Dabnabbit to name a few.  Just sayin'.

Respectfully,

Mike

Hi Carlomcq.

I can't imagine changing anything 13 times in one day. I think you're blessed to be where you are considering where you were. Great job!

Respectfully,

Mike

Hi Lavern and Letsrock. I always wore one of those one-inch wide belts that clip onto the pouch flange. I'm not sure I needed it but it had psychological advantages. Now, about three years down the road, I wear a hernia belt. It fits over the pouch flange perfectly and seems to hold the whole thing precisely where it belongs. I'm wondering if this type of device might mitigate retraction of the stoma. I think it certainly helps maintain a very good seal between the wafer and the skin. NU HOPE LABORATORIES does a great job with their belts and mine were covered by insurance.

Respectfully,

Mike