Stoma Size: Importance of Pouch Opening?

Had surgery 2 years ago. Still wear the same size pouch opening. I've heard the stoma shrinks in time after surgery. Wear 1 1/8" opening. Seems there is more space around stoma with this size opening. How critical is the pouch opening in relation to stoma size? Should I get pouches with a 1" opening?

Sounds like you may need a 1" but I bet you will probably have to trim it to fit if you are between a 1 1/8 inch and a 1". I like my opening to be close to the stoma so my skin doesn't get sore or damaged. I'm definitely a cut-to-fit girl!!

Yeah. The pouches I'm wearing now are 1 1/4-inch opening instead of 1 1/8. So I am probably between. I used a cut-to-fit the other day and cut it for 1" and it seemed to fit.

Hi, if you have a lot of flanges/pouches left, then I'd suggest trying the mouldable barrier rings (instead of paste)...my flange is also 1 1/8" and I'm now down to where I could use the 1"...but because I have so many supplies of the 1 1/8", I use the barrier rings and they seem to close up the "gap" once they melt/mould. So, if you're in the same boat as me, try them and I think you'll be pleasantly surprised. Hope this helps!

Thank you.

I have a question. I'm pretty new here. I've been thinking about getting pre-cut wafers. I've been cutting my own. Should I get some that are tighter around my stoma or looser? My output is pretty moist/liquid and my skin gets raw. When I cut it tighter, my stoma seemed to hurt/sting when passing fluids. I've been using Coloplast SenSura Xpro Click Non-Convex Extended Wear Barriers.

Hi, I'd call around to different medical suppliers and ask them for free samples of (1) the same size pre-cut wafer opening that you currently have, (2) ones where the wafer openings are 1/8" and 1/4" smaller than your current ones, (3) either way, I'd try wafers that are "convex" which would stop some of the liquid from running under the wafer to irritate surrounding skin, (4) Also ask for barrier ring samples (not the pastes) which are moldable and you mold it around your stoma and then apply the wafer over that. The ring will expand even further and make a softer/tighter fit no matter what size hole you decide to get. I use these and have an irregular shaped stoma - a portion of it is flat against surrounding skin - and the other side protrudes, so before I found these barrier rings, I used to leak more frequently. I find with the barrier rings and a convex wafer, that I hardly ever leak anymore. Just some suggestions and let us know how you do with new wafers, etc. Good luck!!

Thanks. I will.

Hi Casey George and welcome to the site, I think our Green Eyed Lady pretty well covered most of the major answers for you. There is one small thing I would add, most of our suppliers have cards with measured holes and sizes marked, they are good for a start to getting the exact size you should strive for, I have found with my Ileostomy that a slight squeeze of 1/32 inch is ideal and with the seals backing that up its harder to find a better fit than that, and the card with the holes will shorten your quest for the best size, and if George starts misbehaving stick your finger in his eye, Ed

Thank you. Does yours change size? When mine is relaxed, it is 2" x 1 1/2" and burps a lot. (I am teaching him to play trumpet.) When it is producing, it is a tight knob and a 30mm circle would fit over. I was debating between a precut 1 1/8 (30mm) and a 1 3/8 (35mm) barrier. The problem is I am very fluid and leak, even wearing an extended-wear barrier with paste. My midline incision is under the adhesive part. I constantly get skin issues because of fluid under the barrier. They say there should be 1/8 to 1/4" around the stoma, so that's why I was wondering if I should go tighter or looser. I empty him about 6 times a day at least...not to mention burping.

Should have asked sooner, have you got an Ileostomy or a colonoscopy? In any event if you are having a lot of liquid output then you don't want any skin showing after you have a new wafer on, it doesn't take much to have liquid get under the flange and at that point your flange it finished. With the seals/rings if you can get right up to the stoma and even a slight squeeze will help keep you dry and get a longer lasting flange and just change the pouches every two or three days. Now this will require a bit of practise but in the end it will be worth it. Just don't go slapping the shit out of George if he misbehaves, patience, patience, Ed

PS: When I finally got some seals/rings, the opening on my flange was 1" and my stoma was 7/8, so with the rings all you had to do was slap that flange on and as close to being centered as you can and the rings will keep anything from getting by.

Thanks for the reply. I have an ileostomy. I wear a one-piece pouch. I think the smaller opening will help matters, plus changing suppliers from Convatech to Coloplast. I stopped using the adhesive remover wipes and preheat the adhesive ring. That has helped a lot. Convatech has quality control issues based on what I have personally experienced. Some pouches work pretty well and some only last a few hours.

I have a colostomy, although a previous bowel resection makes it very fluid like an ileostomy. I tried a convex one-piece bag and it didn't last 24 hours without leaking. Today I'm trying an Eakin moldable barrier with my normal Coloplast 2-piece drainable bag. I'm thinking this is the way to go. Thanks to Green Eyed Lady and Gutenberg for suggesting it. It might be a whole new ballgame.

On another note...in the 9 hours since I woke this morning, I have emptied my pouch 4 times, burped it twice, and farted audibly 24 times. Talk about high output! I guess my OCD is kicking in. I start back to work next week, so it should be exciting. I work at an elementary school...not looking forward to being a fart joke.

Holy S#!t, and you start back to work next week, I hope you get in a good supply of Beano or Gasx early tomorrow and try to get ahead of the Evil Wind That Blows No Good.
But seriously we wish you the best of luck, so take care, Ed

Casey & George, I also read that there should be about 1/8" of skin around the stoma.  I believe that's totally wrong!  Any bare skin between the stoma and the wafer will get damaged if the discharge touches it.  The seal or paste is provided so no skin is contacted by the output.  That's my understanding and, if there are other opinions, I'm eager to learn.  Wish you the best.  Mike.

Hi iMacG5, I just gotta agree with you on the no skin showing because if it does it makes it much easier for liquid to seep under the flange and if you get some air mixed in with liquid and put any pressure on the pouch it will find a way under the flange. Nice conversing with you Mike, Ed.

What is the difference between an ileostomy and a colostomy?

Hey Ed, thanks for the acknowledgement.  I think it's so important for us "ostomates" to get and give the most accurate information and I believe we do.  I've experienced bad info from doctors, nurses and other healthcare professionals.  Stoma Nurses know so much more than the three previously mentioned practitioners.  I think we "ostomates" are doing a good job in sharing our successes.

Also, I think we can tell tim1948 that the terms refer to the ileum for an ileostomy and colon for a  colostomy.  

Thanks again Ed.  Sincerely, Mike