When preparing for surgery to create a permanent colostomy or ileostomy, choosing the best spot for the stoma is crucial for comfort and ease of living. Here are some helpful tips and insights to consider:

1. Consult with an ostomy or wound care nurse to mark the potential stoma site before surgery. If possible, try wearing a practice wafer or pouch for a day to see how it feels.

2. Choose a flat area on your abdomen that is free of folds or creases. This helps the flange stick better and reduces the chance of leaks.

3. If your anatomy allows, position the stoma below the waist or belt line:
- This way, the waistband can sit over the pouch, keeping it hidden and preventing the belt from pressing on the flange.
- It also allows stool or urine to drop into the lower part of the bag without being blocked by clothing.
- Seat-belt issues can often be resolved with simple padding if the stoma is positioned low.

4. Ensure the stoma is placed far enough from the main surgical incision to promote better healing. If they overlap, the incision can still heal under a barrier.

5. If your abdomen has uneven contours, consider using moldable rings, barrier rings, or a convex flange for a more secure fit. For example, a Convatec convex moldable flange might be helpful.

6. Aim for the stoma to protrude at least 1 inch to help reduce skin problems.

7. Be aware that surgeons might sometimes override the nurse's markings. Make sure to be involved in the decision-making process.

8. Relocating an established stoma is a complex procedure that may increase the risk of hernias and should only be done if it is clearly beneficial.

9. People with stomas at the belt line often find it challenging to return to wearing normal clothes, such as switching from yoga or pajama pants to regular street wear.

10. Urostomy wearers with belt-line stomas might consider moving the stoma slightly above or below the belt. The same principles of choosing a flat surface and considering clothing apply.