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Which spot is best for a stoma relocation?

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Fri May 08, 2020 9:53 pm

Hello everyone, I hope you all are doing well!

I’m having my stoma relocated to the other side in a few days because of a hernia. I am wondering what your guys opinions are if higher or lower is better. Currently mines kinda in the middle of my right side but was placed in a bad spot from my original surgery. Is higher or lower better and why?

Thank you,

Carter

Fri May 08, 2020 10:17 pm

Great question! I had mine marked by an ostomy nurse before I went into surgery. Do you have that option? Mine is to the left and below my navel, and I don't have any problems resulting from the location. It doesn't interfere with my waistband or when I bend over. I had 2 spots marked for my surgeon, and this was my preferred choice. If you can have a couple of choices, that would be best, in case your surgeon isn't able to go with your first choice because of adhesions or other issues. Good luck!

Fri May 08, 2020 10:42 pm

So here goes ... I think it all comes down to where your belt-line is.  I confided in a male friend who has an ostomy who said, "At least 3-4 inches above your belt-line and to the left." Just saying:)K

Fri May 08, 2020 10:45 pm

Hi cc,

  As usual..........it depends.  You've got Crohn's and you're young.  Crohn's is unoffically classifed by severity, with 1 being the mildest and 3 being the nasty fistulizing kind that will require you to have multiple surgeries over your lifetime.  So....if you have 1 or 2 and you currently have a straight ileo....meaning they disconnected your colon but didn't chop off any of your small bowel........and just re-routed it and stuck it thru your abdominal wall......you might want to have your new soma placed below your belt line. This way your bag is always concealed in your pants or shorts and you can take your shirt off without feeling like an alien.  But......there's always a butt.......if you have already lost some small bowel and your Crohn's is the more aggressive type.......you might want your stoma above your belt line.  The reason being you'll be emptying your bag more frequently (as they keep removing more and more small bowel over the years) and if it's above the belt line it's just easier to dump your bag out.  And no dropping trou every time....just pickup your shirt.....empty and go.  But you'll have to get used to wearing shirts that don't tuck in...or plan on wearing them very baggy fitting (which looks like crap if it's a dress shirt or such). Think shirts for plumbers butt....but in reverse.  

  So my advice to you is to have a candid chat with your Gastro and ask how aggressive your Crohn's is.  They can tell, trust me.  They will tell you that even if you have an aggressive form that there are new meds coming out........and more will continue to do so over your life.  I won't comment on that other than to say that's what they told me back in the 80's and I'm down to a little less than 4 feet of small bowel left.  Maybe you have more faith in modern medicine than I do.....so that's up to you.  I'd also schedule a little talk with the surgeon doing the operation, if he hasn't spoken to you already.  Not to rant too much......but it always surprises me when people who are having non-emergency surgery don't talk to their surgeons BEFORE he cuts you open.  I can't wrap my head around that.  People will get 3, 4 or 5 estimates to have new windows or a roof put on their house.......but they never get other opinions or even talk to the guy who's about to cut their guts out.  Fascinating.  

  Anyway.......I'm sure others will chime in with other things to consider.....so consider what I just said one piece of the puzzle for your decision.  But best of luck to you and let us know how it goes.......and what you decide.

 

regards,

bob

 

PS  A team will visit you pre-op to mark you stoma location on your abs.  They will mark 2 locations....a Primary and a Secondary location.  Make sure you like BOTH locations, because there can be a million reasons why the surgeon likes the Secondary location more than the Primary location once he gets in there.....and his main focus is on a successful outcome from the surgical perspective, not how well you'll look in in a pair of Birdie Birdwells at the beach. So make sure you like each location equally.    

Sat May 09, 2020 3:38 am

Hello Carter. 

I think that most things have already been said, but here goes with my own perspective:

I spent a while with the stoma nurses discussing the location options and preferences. My main consideration was the beltline, which I did not want to be interfering with the stoma. I opted for a couple of inches below the beltline for that reason. However, what I found in practice was that, over the day, my trousers  tended to drift downwards, ending up as hipsters, which rather defeated the choice of placement. At first,  I resolved this by wearing braces to keep my beltline in the right place,but it still posed problems when I was bending over and the belt dragged across the stoma. Eventually, I decided that the best option was to wear one-piece overalls (what we call 'boiler-suits') which do not need a beltline at all. These work very well for me and have the added advantage of making it look as if I work for a living! They are also useful in terms of getting free access to the stoma for changing appliances without having to disrobe. 

I have designed for myself, a proper suit with a waistcoat, which attaches to the trousers and thus holds them in the 'right' position. However, as I rarely have any need for such a thing, it has never been made, so I don't really know if it would work in practice! 

If I had to choose a different place for my stoma, I do believe that I would have just as much trouble deciding now, as I did at the beginning.

Sorry if this is no help to you whatsoever, but it does indicate that you are not alone in struggling with making these sorts of choices. 

Best wishes

Bill 

Sat May 09, 2020 8:22 am

i had a relocate hernia repair about 5 years ago, my surgeon was a younger fellow who strongly suggested the the stoma be located in the "rectus" muscle, now i dont know if that the correct spelling but i would at least ask about that location. its higher up than i would have preferred but the surgeon said the repain was way more likely to suceed in that location, so far he was right. i would add that a large percent of hernia repairs fail, each time you cut the ab muscles you weaken the whole area...i wanted the higest chance i wouldnt have to do it again. good luck

Sat May 09, 2020 9:13 am

Hi all i had resection surgery 2yrs. ago and my stoma is to the left and slightly lower than my belly button, thats the way it was on the right side, for me that works good as it makes it easier for draining the pouch as it hangs down into the toilet and there is less splashing of poo.  good luck 

Sat May 09, 2020 10:25 am

For me higher my stoma is same height as my belly button so I can wear trousers without waistband on them cutting bag in half lasted me over 30 years without any problems....just a personel choice I know most prefer stoma to be lower 

Sat May 09, 2020 11:04 am

Speaking from personal experience, I would suggest having your new stoma placed just below your beltline.

Under emergency circumstances, my original stoma was placed above my beltline, which caused many leaks and other related problems. 

Feel free to write back if you need further clarification or have additional questions.

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