Properly cutting the flange: Ensuring the right fit?

Hello all,

This is my first post. I am 6 weeks post-ileostomy and I changed my bag for the first time myself today (nurses had helped previously). I measured and cut, but I'm worried it is too small. I think this is just anxiety, but how do you know if the fit is too snug? My ostomy nurse said the stoma could be strangled if the fit is too tight, but since the stoma doesn't have sensations, what are the signs if it is too tight?

Many thanks for any help!

Dilia

On my ileostomy, I cut mine about 1/8-1/4 away from my stomach. I do use a convex appliance with a protective ring underneath to absorb the moisture from my high output. The ring gets placed slightly away from my stoma as the stoma is always moist.

Don't stress....relax and if all else fails, don't let the sides of your appliance touch your stoma.

Ritz

Typo... not stomach... stoma! After cutting, those ridges can cut your stoma, so be careful. I stand to change mine without a mirror... it's easier. Coloplast makes special scissors to easily cut for about 4-. I bought 2. If you need any info, don't hesitate to post... we're all here to learn, help, and laugh. nbsp
Ritz... keep us posted. nbsp

Hello Deedee 42.

Yes! the curved scissors are really handy. However, If you ask the manufacturers of the bags, they nearly all have stoma ring templates , that you can put over your stoma to see what size you need the hole. Then, when you know the size, you can simply place the template over the baseplate and cut the required hole, before placing the bag in position.

I hope this helps.

Best wishes

Bill

If you haven't got any measuring guides to hand, use the backing plate you pull off the base before sticking the base to the stomach to put around the stoma so you can see if it's a nice fit with just a small gap around the edge of the stoma.

Don't worry about strangling the stoma. The hole would have to be extremely small to do that. You would have difficulty even getting the base over your stoma and have constant leakages, so you would know yourself long before that there was a problem.

Hi DeeDee,

You need to make yourself a template that you can use over and over each time you cut your new barrier opening. Once you have the template, then every time you cut a barrier... the clear plastic part you peel off before you stick it will be a copy of that template... so you'll never have to make another, unless your stoma changes shape. So to start, just get some thin cardboard or clear rigid plastic. Start with a small hole in the center and keep cutting it larger and larger until you get to the size you need. You can even cut the cardboard or plastic in half and cut just half your stoma in each. Then, with both halves around your stoma in the proper position, just tape the two pieces together. Then remove and transfer your hole to either a barrier (if you're ready to apply it) or another piece of plastic for a permanent template. If your barrier is convex, then peel the clear plastic cover off it and make the template out of that. Easy peasy!!

How tight around your stoma is your choice, but the less of a gap between the barrier and the stoma, the better. I use a ring (and highly recommend them), and what I do is cut the hole really snug for my stoma to fit through, but I also put my ring on my barrier before I apply them as one piece... and I squeeze the inner diameter of the ring to exactly match the hole in my barrier. Once they match perfectly, I pinch them together to make sure there's a good bond between them... and then apply. Then just finish with whichever ritual you prefer to help the barrier stick to your skin, be it pressure or heating up the area first... and you're good to go.

Regards,

Bob

Dee dee,

You have gotten some great advice here. I use a two-piece pouch system, so the barrier comes in a package that you peel back the top paper. I have cut the hole with that paper still attached, and when I pull it off, I keep it, and it is my template. The next time, I tear the top paper off and place the one that I cut the previous time onto the barrier and draw the outline of the hole with a pen onto the back of the barrier. Then I cut it with scissors, and it fits perfectly every time. I keep the one and use it over and over. Your stoma may change shape after it heals. Mine went from a perfect little round stone to a slightly oblong stoma. So don't be afraid to adjust for that. I keep all I need, scissors, pen, and template in the box the barriers come

in. I also write the date I change my barrier on the top of the box. Nice to keep track. Sometimes I just forget to change it, and unless something happens like a leak or coming loose, I will wear a barrier on average 10 days. I have gone 18 days just to see if I could! Lol

Glad you found this site! It is so helpful!
puppyluv

18 days??? I'd forget I had an ostomy if I could go half that time between changes! That's amazing!!! Not to mention what a mess my skin under my barrier would look like.........YIKES! Good for you!

Regards,

Bob

I use Hollister supplies and there is always a template in the box of wafers for different sizes. I really just cut mine along the lines on the wafer. Best wishes and stay safe.

Hi Deedee, I use Convatec pouches and there's a template for sizing your stoma in every box of the wafers. After I had resection surgery, my new stoma was considerably larger than the old one, plus it was swollen from the surgery. So, I had to use different size templates as my new stoma shrunk down to its current size. Like others said, I put the template on the back side of the new wafer and draw the circle, then cut it out. It's about an 1/8 inch larger than my stoma. After I peel the paper off, I run my finger around the edge I just cut to blunt it so there are no sharp edges.

Thank you very much to everyone who responded. I feel a little better getting all this advice. I was nervous yesterday that I did it too tight, so I changed it today again to a little looser with the 1/8 inch larger than my stoma. I'll see how that works. There seems to be a tiny space of skin showing, so hopefully that's okay and nothing will leak there. Live and learn, I guess. If it does leak, I'm sure everyone with an ostomy has had that issue at one point. Many thanks again!

Hi Deedee! I'm not so ambitious about managing my ostomy as most of these folks here. I use a precut convex ring (Convatec two-piece) and under that, I use an Eakin seal that you can stretch to the size you require. I make it just slightly larger than my stoma. If you are changing standing up as I do, you can hold a mirror in one hand and the seal or gasket in the other, you can easily see where to place them. Just be patient and breathe. Take care!

When you cut the hole in the barrier, set it over the stoma before removing the clear protective layer, just in order to check the fit. You should see a 1/16" gap between your stoma and the barrier all the way around the stoma. That is enough.

Bob's idea to create a template is good for mature stomas. When your stoma is new, it will typically change size (getting smaller over the first few weeks to months). For this reason, it should be measured at each pouch change until you note over several pouch changes that the size is no longer changing. At that point, you can use a template and precut several barriers at a time or order precut for most systems.

I can only go 2-3 days without changing 

It is easy to forget. I prefer to do the 10-day thing, but because I do forget to change it, I have to check my dates and it is usually 11 or 12 days! LOL

Pup

Can you go that long because you use irrigation? Best wishes and stay safe.

I have gone that long with a drainable pouch and not irrigating. The Convatec two-piece I use just seems to work well for me. No skin problems. The Coloplast worked that well for me too, but I don't like that click system they use for the pouches to latch onto the flange. I sure like their pouches better, other than the click. Irrigation is probably why I can get 18 days out of a barrier. I still have output. And water from irrigation gets under the flange around the stoma. Even though irrigation has made my life so much easier, I am not one of the lucky ones that have no output in between irrigations. It is my own fault because I will always eat what I want and pay the price versus depriving myself for the sake of not having to poo! Lol

Pup

I forgot to mention that if you prefer to cut your own ring size, you can also get a cutter with whatever ring size you need. I have a cutter that is 1-1/8" for times when I can't get a precut ring. They make all sizes and they last a very long time.

Oops... STOMA!