How To Apply a Two-Piece Ostomy Pouch

A two-piece ostomy bag or pouch is a convenient system in which the pouch can be detached from the skin barrier. This means you can change the ostomy bag without having to remove and replace the skin barrier every time. A two-piece ostomy pouch can be a good choice if you want to reduce skin irritation or change pouches rapidly.

Applying a two-piece ostomy pouch for the first time may be challenging, but the process will get easier. Your ostomy bag should be emptied when it’s about one-third to one-half full and changed every two to four days (or as often as your healthcare provider recommends.) Replace the skin barrier once or twice per week.

This quick guide will show you how to apply a two-piece ostomy pouch.

Step 1: Collect your ostomy supplies

In addition to a new two-piece pouch, you may need:

A disposal bag for the old one
Lubricating deodorant
A washcloth or paper towel
A stoma measuring guide and a pen
Scissors specifically for ostomy barriers
Stoma paste or a barrier ring
Stoma powder

Step 2: Remove the used pouching system

Wash your hands, then lift the edge of the adhesive and pull downward, gently separating it from the skin. Place the used pouch and skin barrier in the disposal bag (do not flush.) Some pouches can be washed with soap and water after emptying and reused.

Step 3: Clean and dry the stoma and surrounding skin

Gently clean the stoma with water. A little bleeding is normal when you clean the stoma. Clean the skin as your healthcare provider recommends, either with water or with a gentle soap. Rinse and dry the skin. Don’t use any alcohol, lotions, or oils on your skin.

Step 4: Inspect your stoma and surrounding skin

Your stoma should appear moist, shiny, and pink or red. If the stoma has changed in appearance, or if the skin around the stoma looks raw, irritated, bulging, or discolored, call your healthcare provider. Stoma powder can help heal skin irritation.

Read more: How to Use Stoma Powder

Step 5: Measure your stoma

Stomas shrink over time, so it’s important to make sure the opening of the pouch is the right size for your stoma. Use a stoma measuring guide to find the correct size. There should be no or minimal skin showing between the edge of the guide and the stoma.

(If you’re using a pre-sized barrier opening, skip to step 7.)

Step 6: Trace the opening size onto the skin barrier

With a pen, trace a circle on the skin barrier to indicate the correct size of the opening. Use your scissors to cut along the line, being careful not to cut beyond the line on the release liner.

Step 7: Remove the release liner

First, place the skin barrier over your stoma to make sure it’s the right size. Then, peel off the release liner.

Step 8: Add paste or barrier ring (if needed)

Apply the barrier ring or a ring of stoma paste around the opening of the skin barrier, following the product instructions.

Read more: How to Use an Ostomy Barrier Ring

Read more: How to Use Stoma Paste

Step 9: Apply the skin barrier

Center the skin barrier opening on the stoma in a diamond shape. Gently press it against the skin for a minute. If you’re using a barrier with a tape border, remove the backing and gently press the adhesive against the skin.

Step 10: Attach the pouch to the skin barrier

Align the lower edges of the pouch flange and the skin barrier flange, then press them together. You’ll hear a series of clicks as they attach. No more clicks means the pouch is firmly secured. (Some pouches use an adhesive connection instead.)

Step 11: Close the bottom of the pouch

First add about a teaspoon of lubricating deodorant to the inside of the pouch, if desired. Depending on the type of pouch you’re using, it may close with a clamp, clip, Velcro or other type of seal. Read the product instructions. If you’re using a urostomy pouch, make sure the drain valve is closed and facing the right direction.

Read more: How to Use Ostomy Pouch Lubricating Drops