How to Measure an Irregular Shaped Stoma for a Flange?

Hi everyone,

 

I'm having trouble getting an accurate cut on my flange. My stoma is new and has an irregular shape. When I was in the hospital, the ostomy nurse used a Hollister guide to cut a 44 mm hole for my flange. In reality, my stoma is not circular; it's more like a wide, uneven oval with some bits sticking out toward the surface of my skin. The upshot is the hole I was told to cut was too small, which caused my stoma to be strangled and led to issues with swelling. Going the next size up to 51 mm just leads to a big gap on the top and bottom, and when I try to fill it with the barrier ring, it just melts and leaves a lot of exposed skin. I don't want to hurt my stoma, but I don't want leaks either! I want to try a moldable wafer, but in the meantime, I have to use these cut-to-fit flanges. Do you have a trick for getting accurate measurements? Thanks!

You don't have to use the exact markings on the wafer; you can custom cut it however you want. You could take a heavy piece of paper and press it against your stoma so the moisture leaves an outline to use as a template. Mine isn't perfectly round; I just cut it big enough to not strangle my stoma and let the barrier ring fill in around the edge.

My stoma is not round either, and sounds a lot like yours, an irregular oval. You just need to do the best you can to cut a hole that fits the shape exactly. The template is just a guide, so that you get used to cutting to the same size each time. It doesn't mean you are supposed to cut in the perfectly round shape of the rings on the flange. After 3 1/2 years with this stoma (I had two others previously) I've gotten pretty good at cutting to just the right size. It's like so many other things in life, practice makes perfect, or as good as.

Terry

P.S. If you use a barrier ring, you can be a lot less careful about your cutting job, as the barrier ring molds to your stoma and fills up any gaps there may be.

You can go ahead and order samples of the moldable wafers along with pouches as you continue using the cut-to-fit wafers. ConvaTec and Hollister have moldable wafers, Coloplast does not.

No need to precision cut your wafer. Use a moldable ring. After molding/stretching the ring, fit it to your stoma. There should be no skin showing between the ring and your stoma. You want the ring right up against your stoma. I use Coloplast Brava rings. I can stretch them quite a bit and they don't tear.

My stoma is big and oblong. The ring makes wafer "change day" a breeze.

I should clarify that I'm already using a barrier ring, but I think I must be applying it wrong because it melts and leaves my skin exposed. Right now I'm trying to fit it around the skin on my stoma.

I also use Coloplast Brava rings. In particular, I use the "Brava Protective Seal" -- Coloplast Item# 12035.

The ring leaves behind no residue, which makes cleanup quick.

I didn't mean to reply to just BB, I meant to reply to the topic.

Hi Yearling,

Your stoma sounds a lot like mine before it was revised. The issue you're having is your output is directly impinging on your barrier ring material, which is causing it to erode. Mine did the exact same thing. Normally, a proper stoma sticks out a bit from the skin, so output doesn't hit the barrier ring material directly, and the ring will last the couple of days in between barrier changes. In your case, the ring really doesn't have a fighting chance. So you're right in thinking you need to cut your barrier as close to the shape of your stoma as possible to minimize the amount of space the barrier ring has to fill. The ring material and the barrier material look the same, but they're not... the ring erodes faster. So what you need to do is make a template out of plastic that can be reused each time you cut your new barrier hole. So here's what I used to do. Find a piece of semi-stiff plastic, like what you peel off your barrier before you apply it. The more rigid the better, but even half of a plastic sandwich bag will work. Cut a hole for your stoma that you know is close, but a little bigger... and you don't need to be exact here, just in the ballpark, so even a circular hole will do... it's just a starting point. Hold it over your stoma and tape it to your skin on the outer edge so it stays put for a few seconds. Take some tape... any tape will do as long as it's not super sticky on your skin. Lay pieces of tape along the edge of your stoma until you have it fully encircled, like in the attached pic. The more pieces of tape you use, the closer you can follow the outline of your stoma. When you have its shape fully traced with the tape, simply lift up the plastic with the tape defining your actual stoma shape and lay it on another piece of plastic, and with a marker pen trace the hole your stoma just made on the new plastic sheet. Then just cut out the hole with your scissors and you now have a permanent template to use week after week. Make a second one to keep in your backup kit and you're good to go. Just repeat the process as your stoma changes shape, or tweak your current template if need be and repeat the process.

;O)

My wound care/stoma nurse took food coloring and used a few drops so it would put a light coat on my stoma, press the non-stick side of the barrier lightly to the stoma, then we cut the wafer a tiny bit bigger. Test fit over and over and keep trimming till it's just barely bigger than the stoma. Once that's done, you can put your barrier ring right into the skin and make sure it's right on the edges of the stoma. Or I put it on the wafer so it's just barely smaller than the cut and apply it to the skin. Either way, let the barrier ring take up the extra space and don't worry if it looks like it is overfilling between the wafer. Just be sure your stoma opening isn't covered. Bag lube is a definite help if you get too much of the ring coming through and making your bag stick. If you want a step-by-step as you go through the process, feel free to message and I'll see what I can do.

There are two ways to apply a normal barrier ring. 1) Fit it around the opening of your wafer/bag or 2) fit it around your stoma and then apply your wafer/bag. I've never done moldable rings; I presume you'd put them on your skin first.

These are all great ideas. I'll try them on my next bag change. Thank you all so much!

G-Day Yearling, I like Bob's idea, but you could also try this. Get a length of soft soldering wire or copper wire because it keeps its shape, and gently wrap it around the stoma following the contour of it. Then lift it carefully and mark out the shape on a piece of stiff board or plastic, cut it out, and you now have a shape the same as the stoma. You can repeat this if the stoma changes in shape. Regards, Iggie

Great way to make a template. It seems obvious now, but I would have never thought about it. The simplicity is what I like most because it is easy to explain to someone.

The frustration is real! Getting a proper fit does take some messing around. A mere 1/8 inch of exposed skin is needed around the stoma to give it room to breathe. The opening can be cut, as others said, to conform to your stoma's shape. At your next ostomy care date, have your nurse check to see how your stoma changes when you're in different positions. That can help determine how to cut the opening. Mine is perfectly round when I lie down or stand, but goes flat/oval when I sit. Now I cut a little wider at 3 and 9 o'clock on the flange and it works great. Putting the barrier ring on the flange and molding it to shape was easiest. That small 1/8" gap also leaves space for my "pearls" at 12 o'clock—a couple of little red beads at the stoma's edge that protrude over the skin.

I had a 2-piece Coloplast. I could use the last used adhesive liner and trace it on the new wafer. I could adjust it as needed. I always used a moldable ring and placed it around the wafer hole and placed it on the stoma then. But, this is of course with a 2-piece!