Every ostomy is unique, and so is the care each stoma deserves. Getting to know how to care for and live with a stoma is an important factor to help the transition period and maintain quality of life after ostomy surgery.Properly sizing your stoma and knowing which accessories are suitable to use is vital in securing the best fit and avoiding irritation and leakage. Understand your stoma size better and equip yourself with everything you need to know about proper stoma sizing. 

Understanding your stoma size

A stoma is an opening made on the abdomen linked to your digestive or urinary system. It is a passage that allows waste to exit your body without stressing certain parts of your intestines. There are various reasons why people undergo ostomy surgery, and having a stoma can be permanent or temporary.  Correctly size your stoma to achieve a perfect-fitting pouching system and avoid any complications for optimal health. 

Post-ostomy inflammation

Your stoma may appear swollen a few weeks after your surgery. During this period, it will be essential to regularly measuring your stoma and adjusting the size of your wafer/skin barrier as the stoma changesl. As time passes, your stoma size will stabilize and frequent measurement may not be necessary. However, changes in stoma size and shape can still occur for several different reasons.

Stoma size and shape changes

During the first 6-8 weeks after surgery, your stoma may change shape and size. Different factors will change your stoma, including weight gain and loss, pregnancy, prolapse or hernia, aging, and other changes in your physical appearance. If you notice that your stoma size is changing, take new measurements and resize your wafer/skin barrier as needed. If you’re concerned about the stoma size or shape changes, consult your doctor or ostomy nurse.

Steps to proper stoma size

Before leaving the hospital, you need to familiarize yourself with your stoma. You’ll learn how to measure your stoma, change your pouching system, and what to do if you notice any signs of infection. 

Step 1: Get your ostomy care supplies

Gathering all of the supplies you’ll need is the initial step in sizing your stoma. You may need a stoma measuring guide and a pair of scissors used specifically for cutting the skin barrier. Other materials may include a pen or marker, your wafer, gauze, and a mirror.

Step 2: Prep your stoma

Stoma preparation is essential to ensure the best results. If you’re wearing a pouching system, remove it and empty the bag. After that, thoroughly wash your hands and clean the peristomal skin. Make sure to avoid using oil-based or alcohol products and, if necessary, remove any hair from the skin. Using warm water is your best option. Completely dry the peristomal skin before moving to the next step.

Step 3: Use a stoma size measuring tool

Put the stoma measuring guide on your stoma to mark the correct size. Ensure that your stoma goes through the hole entirely without showing too much surrounding skin. Observe a 1.5mm – 3mm gap between the stoma and the edge of the measuring guide. To help you with sizing, you may use your previous measurements and make changes as needed. 

Step 4: Transfer the size to your wafer/skin barrier

Once you’re done measuring your stoma, transfer the size to your skin barrier and cut accordingly. Put your measuring guide on the skin barrier and use a pen to trace the hole in the middle. You might need to make the hole a little skewed due to lesions or skin ailments. Make sure to make the cut within the allowed area to avoid adhesion issues. Use only the ostomy scissors with a blunt end to avoid damaging the wafer.

Step 5: Test, alter, and apply

Test the fit of the cut barrier by placing it over your stoma. Before removing the plastic backing, Test the fit of the cut barrier by placing it over your stoma, and make all the necessary adjustments before removing the plastic backing.. Once completed,proceed with your skincare routine and apply the wafer/skin barrier.

Possible challenges in determining stoma size

Loop ostomies

For patients with loop ostomies, measuring the stoma using a standard stoma measuring guide can be a challenge. Loop ostomies have two various openings, so they can’t be easily measured using a printed guide. Some people with loop ostomies prefer using a half-circle on the measuring guide in sizing each stoma opening instead of using a whole circle.

Differences in skin barrier

Variances between skin barriers can also make stoma sizing difficult, as they sometimes act differently when they’re worn compared to when they’re cut. Certain types can swell after contact with fluids, which requires a larger wafer to prevent leakage. 

Stoma changes

Changes in stoma size and shape are the most common challenge when sizing your stoma. These changes are expected, especially in weight gain/loss or changes in physical appearance.

When to consult your healthcare provider

While it’s typical for your stoma to change in shape and size a few months after surgery, there are some warning signs to look out for. Contact your healthcare provider as soon as possible if your stoma:

  • Becomes narrower
  • Sinks deeper into your skin
  • Smells bad
  • Appears darker in color (purple, gray, black, etc.)
  • Is drier than usual
  • Is flush with your skin
  • Opens big enough for your guts to push through
  • Pushes out from your skin
  • Starts to pull away from the skin
  • New onset or sudden increase in severe pain 

Consult your doctor if you notice any severe changes to your peristomal skin. If the area is painful, swelling, bleeding, itchy, or is developing bumps, blemishes, or sores, there must be a problem. It’s always better to be safe, so don’t think twice about calling your doctor with any changes you observe. Contact Better Health to learn more about the importance of correct stoma size and ways of maintaining your ostomy’s optimal health. Visit https://joinbetter.com/ or call 415-475-8444 today.

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