Stoma Placement and Its Impact on Ostomy Success

I have had my ileostomy since 1986 due to UC. I had a great stoma therapist prior to and after surgery, and I know that has made a HUGE impact on my recovery, acceptance, or whatever you want to call it. Because of her, I am pretty much an open book and have always been willing to help other ileostomates when questions and concerns arise. Which brings me to this posting.

Once again, I have been approached by a person who is suffering from “bag blowouts.” Their confidence is so low they often don't want you to leave the house because of this fear.

Why the problem is the most often asked question. Sadly, I don't have a post-surgery answer for most of them, as I very, very seldom have this problem except when it gets really hot (sweating) or if I push “just one more day” and I'll change it “tomorrow.”

What I see as the most common problem these folks have is where the surgeon has placed the stoma. Seems they do not pay attention to where the belt line is and place it too high so the belt/waist line rides on the stoma, just underneath the stoma, or cuts the pouch. All three of those situations can cause BM waste to build up and pop the wafer. Why can't the surgeons take some time to educate themselves as to where a stoma should be located to ease this problem?

My ostomy therapist spent quite a while judging where my stoma should be located. She made note of my belt line and waist, where my tummy bulged when I bent over, then marked with a pen exactly where my stomach should protrude and be located. The night/day before surgery, the doctor, she, and I met, and she showed him my placement mark. I estimate it to be 3.5 inches lower than my belly button and maybe 3 inches to the right. (Estimation key word)

I know that not all situations allow this step due to some being emergency surgeries (vehicle accident, etc.), but if time allowed, this knowledge that surgeons should know could benefit many ostomy patients.

Just sayin.

I couldn't agree with you more.  I have seen so many people on this site who, it's clear from what they're saying about their stoma, had a surgeon who gave no thought to placement.  I assume that there are valid surgical factors that play into this, but still...  I had a vascular surgeon at my bedside once the day before surgery and I asked if he wanted some back story re my need for his expertise.  No, he said; I'm just a mechanic.  He was a nice fellow but with a very narrow focus.  

Hi Nordakotan... I definitely agree with stoma placement... I was very fortunate that my stoma was placed perfectly... I had a great surgeon... I just celebrated my 1-year stomaversary and am doing great... I went in for exploratory emergency surgery and came out of surgery with my stoma, which, by the way, saved my life! Good luck on your journey!

I couldn't agree more. I was lucky to have a great ostomy nurse who marked me before surgery. At least one of the surgeons did not follow her markings, and the stomas wound up directly in line with each other. But they are still well placed... high on my abdomen, about three inches above the belly button and just inside the rib cage on either side. Any lower, and I'd likely have problems.

But the number of people who come on this site with poorly placed, problematic stomas is concerning.

Nordakotan, your post is going to help so many folks who come on here before their surgeries. They probably never thought about stoma placement before, and now they can have a conversation with their medical team before they get one.

Staying Hydrated with an Ostomy with LeeAnne Hayden | Hollister

When I had my colon removed in 2004, I got a stoma to let the J-Pouch I had get healed enough to reconnect. The stoma was in a bad spot, but I only had 3 months to put up with it. After 18 years, I went back for an ileostomy, but this time my surgeon allowed me to pick where it went. He gave me what's called a skin marker, and I marked a spot 3 inches above my belly button and 2 1/2 inches to the right.

The surgeon got it spot on, and it's perfect for me. I wear my shirt on the outside, and no one knows I have a stoma. When I want to wear my shirt tucked in, I just roll the bottom of the bag up 3 times and put my IGGIE CLIP on. Again, no one knows I have a stoma.

Talk at length with your surgeon and stoma nurse and get it right from the start.

Regards, IGGIE

  

Hi Nordakoan, well said, sir. When I had my pre-surgery visit, the surgeon had me sit and stand, and then marked me with a Sharpie. He asked the nurse if she thought it was a good spot, and she agreed. That was 40 years ago.

Well said, everybody - prior consideration as to position is vital.

However, to give surgeons their due, there are instances whereby, because of other factors - blood flow routes achievable and prior adhesions which may be challenging, can, in some instances, cause the surgeon to allow for the best option to be achieved once they are in theatre..... But when this pertains, there can always have been prior discussion as to whereby the preferred option(s) are - and as such, a detailed understanding of a patient's lifestyle and movement considerations, including special necessities, may be taken into account.

Experience and preplanning are a relevant part of the pre-op process - for all elective surgery.

And, in my humble submission - even where emergency intervention is required - one might imagine that awareness of a patient's body creases, etc., would be evident..... But I also appreciate that within the emergency situation, many priorities are balanced - and in very little time - thus there may be 'intermediate' stomas created, where, in these instances, the surgeons operating on the day will know that there are likely to be subsequent revisions/repairs and further interventions down the line.

I feel to highlight placement consideration is such a valid issue - and I thank you for bringing this to the fore.....

Good positioning and good length/pull through for the small bowel is essential for subsequent ease of management!

Jayne

I agree, my stoma nurse at the time marked the site for the stoma to be placed on the day of surgery opposite where my belly button used to be, so the bottom of the bag is at the same level as my waistband. It's a perfect place for me; I can wear any clothing with no restrictions. Thirty-six years later and going strong, I can't thank my retired stoma nurse enough for choosing the perfect spot. Even when I had my temporary emergency jejunostomy, the stoma surgeon copied it and placed the stoma on the left side at the same level.

One disadvantage to being a small person (I'm 5'2") is that there isn't a lot of choice in stoma placement. There just isn't much space to work with. My first surgery, the colostomy, was an emergency one, but the second, for my ileostomy, wasn't. There just wasn't much of a decision to make, as any lower or higher would be problematic. I can only wear hipster pants, which is challenging. Fashion is constantly changing, and it's pretty much impossible to find hipster anything these days. I have to have new clothes altered. Pain in the butt.

Terry

As a kid, I was usually one of the tallest in the class. I always felt awkward and out of place. I settled at a reasonable 5'8" adult height, but I never lost the childish wish to be shorter. Until now.

Thank you for the kind words. I do hope that it opens dialogue with the patients and their doctors. The tough part (and this is where doctors could improve—if the situation allows it, as another person wrote) is when a patient unknowingly wakes up after surgery with a pouch attached and they have no idea why at the moment.

There is definitely a need to educate surgeons, particularly emergency surgeons.

That would be me! And I still knew nothing when I was discharged... I am blessed to have an RN as a niece, and she walked me through it.

That's funny! Conversely, as a kid, I was always the shortest one in the class. I finally made it up to 5'3" (I've shrunk an inch with age), but for some reason, I always liked being short. Well, maybe not in old-style movie theaters... but in general. Until ostomy!

Terry

My first stoma was in a terrible place. It was in my waistline, and I could not wear a bag successfully. It would fall off. It would not stay on. I had my stoma relocated; it was such a problem. Now I can wear a bag, and I have no problems with my stoma. Placement definitely has something to do with the success of the stoma and of life in general.