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Sizing the hole in the pouch for an Ileostomy

Posted: Sat Oct 14, 2017 7:26 am

I have recently had an ileostomy for chronic constipation caused by extremely slow transit. I actually ended up having three bouts of surgery in the space of five weeks, but that is by the by.

I know it takes about six weeks for the stoma to settle down to a pretty constant size. The problem I am facing is how 'snug' should a 'snug' fit be? I have had so much conflicting advice from the medical profession. 

It has to fit exactly, it has to have 1mm gap all the way round, it has to be given room to move etc etc. I just want to know what size the hole should be. I have to wear a convex pouch as my stoma has a 'channel' running round most of it. This gets sore very very easily. I also change it twice daily to try to prevent any soreness.

Any answers would be so appreciated.

Posted: Sat Oct 14, 2017 11:03 am

It is more important to have your fing or paste be snug as putout will irritate your skin..I have a colostomy so it is not as much a problem for me. So big enough that it does not cut or scrap your stoma., 1mm approximately. Hopefully others will jump in with advice.

Posted: Sun Oct 15, 2017 2:45 am

Hello Missie.

Thanks for this interesting question. The problem with the conflicting advice is that each opinion is probably valid from differeing perspectives. Many of us find that with experimentation, we find what suits us best and then stick with that until the next time it isn't working quite as well.

I've had a whole lot of problems with wafers in the past so have made my own to suit my own needs. That's not to say that they always work but it does give me an insight into why these things are so difficult to get precisely right. One of the best and most comfortable manufactured devices that I found was the Conseal stoma collar, which is made of very soft and flexible rubber and is a bit like an Elizabethan collar for the stoma. It doesn't stop at skin level but protrudes up along the stoma sides. this not only protects the stoma but it tends to direct most of the output away from the skin. I found them to be a great idea and a comfortable fit so I would recommend them as something to try.

I am convinced that no one product is going to suit everybody and it is a pity that there isn't a company out there that would make bespoke devices for stoma patients. (perhaps with computerised device making in mind) However. as this has not happened yet, we are left with experimenting with whatever is available. The manufacturers are quite willing to send out samples, so get your requests in and see what there is out there that might suit your needs.

Best wishes


Posted: Fri Oct 20, 2017 10:52 am

Hello Missie,


I would say a 1mm space around your stoma would be about right, but as yours is new be prepared for your stoma to alter in size until it has settled.   For the channel around part of your stoma you could put some paste (I use Adapt paste) around the base of your stoma before you apply your bag.  It will squeeze up around your stoma when you put the bag on and just may fill in the channel.   I use the paste just on about 1/2" to make things more secure as the hole in my stoma is low just there.

Hope this helps:)



Posted: Mon Oct 23, 2017 5:51 pm

Thank you for the post as there is always some discussion regarding what size to cut the wafer.  At one of the UOAA conferences, a wound care nurse said to allow approximately 1/8 inch from the wafe to the stoma to allow some "wiggle" room.  As we all know now, the bowel moves and grows and shrinks up when it is processing food hence the term BM.   If you cute the wafe too small it could harm the stoma and too large could allow the effulent to get on the skin causing irratation.  Also, don't forget to use a good barrier/skin protectant.  It is helpful in the event some leakage occurs. Take care and good luck. Sincerely, LadyHope

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