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Changing a colostomy bag, step by step | CION Cancer Clinics
To change a colostomy bag you peel the old one off from the top down, clean and dry the skin with plain water, check the hole in the new bag matches the stoma, and press it on with a warm hand. It takes a few minutes once learnt. This page walks through each step, the problems that cause leaks and sore skin, and the signs that mean you should stop and call. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- How do you change a colostomy bag?
- The change, from old bag off to new bag on
- The four problems people ring the nurse about
- Words on the packaging, in plain language
- Three things families tell us about bag changes, and what is actually true
- What this page cannot tell you, and when to stop and call
- Common questions about changing a colostomy bag
The short answer
How do you change a colostomy bag?
You peel the old bag off from the top down, clean and dry the skin with plain water, check that the hole in the new bag matches the stoma, and press the new bag on with a warm hand. Once learnt, the whole change takes about as long as a cup of tea.
When to change it
Change a closed bag when it is about a third full, usually once or twice a day. A drainable bag is emptied several times a day and changed every couple of days, or sooner if the seal lifts. First thing in the morning, before food or drink, is the quietest time. Do not wait until the bag is heavy. Weight pulls at the seal, and that is what causes leaks.
Who should be doing it
The person with the stoma, wherever possible. A son, daughter or spouse should learn alongside them so someone can step in during illness, but the routine belongs to the patient. Someone who cannot see well, cannot use both hands or is confused after surgery will need help for now. Tell the stoma nurse before discharge, so the teaching goes to the right person.
Do not go home until you have done one full change yourself with the nurse watching.Step by step
The change, from old bag off to new bag on
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Wash your hands and stand in front of a mirror
Have everything in reach. Gloves are not needed at home.
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Peel the old bag off, top to bottom
Hold the skin down with one hand and peel the base away with the other, starting at the top so the contents stay in the bag. Go slowly. Pulling fast tears skin.
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Clean with plain warm water
Wipe away any stool with a soft cloth. Do not scrub. Scented soap, oils, spirit, Dettol and baby wipes all leave a film that stops the next bag sticking.
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Dry fully, then look
Pat until dry to touch. The stoma should be pink or red and moist, like the inside of your cheek. The skin around it should look like the rest of your belly.
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Measure and cut, if you cut your own
Hold the guide over the stoma and pick the hole that fits with only a sliver of gap. Trace it on the back of the bag and cut. A hole that is too big leaves skin exposed to stool, the commonest cause of sore skin.
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Warm the bag and press it on
Remove the backing paper and hold the bag between your palms for a few moments. Line the hole up with the bottom of the stoma, smooth it upwards and outwards, and hold a flat hand over it for a minute.
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Dispose and wash up
Wrap the old bag in newspaper and put it in household waste. Never flush a bag.
Not sure whether this applies to you?
Ask an oncologistWhen it does not go to plan
The four problems people ring the nurse about
Almost every early problem comes down to the hole, the skin or the seal.
The bag keeps leaking
Usually the hole is too large, the skin was damp, or a crease in the belly breaks the seal. Re-measure, dry longer, and ask your nurse about a barrier ring or a convex bag.
The skin is red, raw or weeping
Stool has been sitting on skin. Fix the hole size first. Stoma powder, dusted off, then a barrier film lets a bag stick over damaged skin while it heals. Ordinary creams stop it sticking.
The bag will not stick
Something is on the skin: soap film, oil, hair or sweat in hot weather. Clean with water only, clip hair, dry thoroughly and warm the bag longer. Store bags out of the sun.
The stoma bled when wiped
The surface of a stoma is like the lining of the mouth and bleeds lightly when rubbed. It stops with gentle pressure. Blood from inside the stoma, or bleeding that does not stop, needs a call the same day.
On the box
Words on the packaging, in plain language
- Flange, wafer or baseplate
- Three names for the sticky disc that goes on the skin. The hole in the middle is cut or moulded to fit the stoma.
- One-piece and two-piece
- In a one-piece the bag and disc change together. In a two-piece the disc stays on for a few days and only the bag clicks off and on.
- Closed and drainable
- A closed bag is thrown away when full. A drainable bag opens at the bottom to empty, then folds or clips shut.
- Pre-cut and cut-to-fit
- Pre-cut bags come with the hole already made. With cut-to-fit bags you cut the hole yourself, which suits a stoma that is still shrinking or not round.
- Convex
- A base that curves inwards so a flat or sunken stoma stands up into the bag. Used for stubborn leaks, on a nurse's advice only, because it can bruise the skin.
Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
Commonly believed
Three things families tell us about bag changes, and what is actually true
"It must be done in a sterile way, with gloves and antiseptic."
A stoma is not a wound. It is bowel lining, and the bowel has never been sterile. Clean hands, plain water and a dry cloth are all that is needed at home. Antiseptic makes things worse, because it dries the skin and stops the bag sticking.
"Changing it more often keeps it cleaner."
Every change pulls at the skin. Changing a bag that is still sealed and not full strips a little of the top layer each time, and after a few weeks the skin becomes sore. Change when it is a third full or when the seal lifts, not on a fixed clock.
"An elderly parent cannot learn this."
Most do, including people who cannot read and people in their eighties. What they need is repetition with the nurse in the first week and a family member who watches rather than takes over. Doing it for someone who could do it themselves takes away the one part of this they can control.
Being straight with you
What this page cannot tell you, and when to stop and call
This page describes a standard change on a settled colostomy. It cannot tell you which bag suits your stoma, what size to cut, or whether the problem you are looking at is minor. Those need a stoma nurse to see the stoma itself, and a photograph on WhatsApp is often enough.
Call the stoma nurse for these
Leaks more than once in a few days. Skin that stays raw after you have fixed the hole size. A stoma sinking below the skin or pushing out further than before. A bulge beside the stoma when you cough. None of these needs a night-time trip, and all are easier to sort out early.
Go to an emergency department the same day for these
A stoma that has turned dark purple or black, which can mean its blood supply is cut off. Bleeding from inside the stoma that does not stop with pressure. No output at all while the belly swells and you vomit, which can mean a blockage. Say at the door that you have a colostomy.
Take a spare bag to any hospital visit. Emergency departments rarely stock stoma supplies.Questions we are asked
Common questions about changing a colostomy bag
Can I change the bag while I bathe?
Yes, and many people find it the easiest way. Take the old bag off, bathe as normal with the stoma uncovered, then pat the skin fully dry before the new bag goes on. Keep scented soap and oil away from the skin around the stoma.
What if the stoma starts working during the change?
Hold a folded tissue over it, wait a moment, then clean and dry again and carry on. It happens to everyone. Changing before breakfast, when the bowel is quietest, makes it less likely.
Can I reuse a bag to save money?
A closed bag is single use. Washing it out damages the adhesive and the filter. A drainable bag is designed to be emptied and worn for a couple of days, which is why many people on a tight budget switch to drainable bags. Ask your nurse which suits your output.
Is it normal for the hole size to keep changing?
In the first couple of months, yes. The stoma shrinks as swelling settles, so a hole that fitted at discharge may be too big a few weeks later. Measure weekly until it stays the same for three checks in a row, then order pre-cut bags in that size.
How do I dispose of used bags in a flat or a village?
Empty solid contents into the toilet if you can, wrap the bag in newspaper, tie it and put it with household waste. Never flush a bag, even one marked flushable, because drains block. Where there is no toilet, bury contents away from water sources.
Do I need to shave the hair around the stoma?
Hair under the base stops it sticking and hurts when the bag comes off. Clip it short with scissors or a trimmer, roughly weekly. Do not use a razor or hair removal cream on this skin, because nicks and chemical burns under a bag heal slowly.
Can I use talc, coconut oil or turmeric on the skin?
Not under the bag. Anything oily, powdery or coloured leaves a layer the adhesive cannot grip, and turmeric stains the base so the nurse cannot see the skin. If the skin is sore, stoma powder and a barrier film are the products made for this.
Who teaches me if I am discharged before I feel ready?
Tell the ward you are not ready and ask for one more supervised change before you leave. After discharge, the stoma nurse at your centre can see you in clinic or over a video call. If you cannot reach anyone, call the helpline.
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Sources
- NHS — Colostomy
- Macmillan Cancer Support — Colostomy
- American Cancer Society — Ostomies
- Cancer Research UK — Surgery for bowel cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
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Talk to us
Bag keeps leaking, or the skin looks wrong?
Send a photo of the stoma and the skin around it, or call the helpline. A stoma nurse will tell you what to change and whether you need to be seen. One helpline serves every CION centre.