Quite a few factors influence whether someone’s stoma will have a tendency to be problematic or not, and a well-placed stoma is at the top of the list of things that can help.
As patients, we don’t have a great deal of control over whether or not our stoma will work as expected.
We know that certain things like maintaining an ideal weight, being sure that our illness (if any) is being managed properly, or quitting smoking are in our control and they can have a profound effect on our recovery and surgical outcomes.
For those of us who have the luxury of preparing for our surgery in advance, we should make sure that we’re doing everything we can to facilitate the best outcome possible.
Depending on the hospital you’ll be having your surgery at, you may be given all the information up front and won’t need to worry about too much.
But there is something that we should insist on having done, and that is to have our stoma site marked.
This video will give you a crash course in stoma site marking (for patients), but the article that follows has more information.
What Does It Mean to Have a Stoma Site Marked?
Your stoma can’t just be placed anywhere, and some spots are better than others.
As a general rule, you tend to see people with a colostomy have a stoma on the left side of their abdomen, while ileostomates and urostomates tend to have theirs on the right side (although, I have seen exceptions to this rule).
Stoma site marking, if done correctly, will help to make sure that your stoma is in the right place for your body shape, clothing preferences, your range of movement, and abdominal muscle structure.
The “gold standard” is to have a trained stoma nurse do the marking. There is evidence which suggests that a colorectal surgeon will have similar results compared to that of a stoma nurse. However, general surgeons don’t seem to mark stoma sites as well as the specialty surgeons or stoma nurses (8).
What Happens When Your Stoma Site Is Marked?
The exact process may vary between stoma nurses or hospitals, but many times your nurse may do the following :
- You will likely be asked to sit, stand, and lay down so the nurse can see how your skin reacts to gravity.
- You may be also asked to bend (from various positions) so the nurse can see where your skin naturally folds.
- The nurse will look for an area that is relatively smooth and free of any scars, dips, or folds.
- Existing hernias will be noted.
- Your nurse will assess what placement will give you easy access to your appliance.
- Your abdominal muscle structure will be looked at.
Your nurse is trying to use all of these factors to help determine the best placement on your body.
It’s been known for quite some time that a stoma should be placed through the rectus abdominis muscle (4), which is why it’s easier to mark the stoma on someone who’s slimmer.
Once your nurse had determined the best home for your stoma, they will mark the skin (usually with some kind of marker) so that the surgeon knows where the stoma is to be placed.
Benefits of Having a Well-Placed Stoma
The benefits of stoma site marking have been studied for many years, and nearly every stoma nurse that I’ve ever come across has advocated for it. Even the UOAA (United Ostomy Associations of America, Inc.) has listed site marking as a fundamental patient right (5).
- Minimizes hernia risk.
- Improves the seal under the appliance.
- Makes it easier to be independent (i.e. less likely that you’ll need someone to help change your appliance).
- Can make things like emptying the pouch or changing the appliance easier on a day-to-day basis.
- Improves a patient’s range of motion.
- Reduces the need for follow-up surgeries.
- Can reduce the likelihood of leaks.
I’ve known people who’ve had a poorly placed stoma and they suffered for many months or years before finally having it revised. Before their revision, they would have their stoma nurse properly mark the new site and the resulting stoma ends up being far better for them. It’s unfortunate that it took a revision to correct the initial surgery, but I’m glad the option exists for patients who cannot manage with their original stoma.
If you feel that the placement of your stoma was not the best it could be, consult with your surgeon to see if a revision might be worth looking into.
It’s also important to mention that while all efforts to have your stoma placed where it was marked will be made, there’s no 100% guarantee that it’ll be done once your surgeon has opened you up (or gone in laparoscopically). Sometimes, a surgeon may discover something that’s not very apparent from an external exam so they may decide to place the stoma at a different site.
I hope that this article has given you enough information to understand the importance of stoma site marking.
As a patient, you have the right to ask for your stoma to be marked, and you will be better off with one that’s been carefully placed to suit your lifestyle and body shape.
I would encourage you to speak with your surgeon and stoma nurse during a pre-op appointment so that they can share more details about the process and benefits.
- Person B, Ifargan R, Lachter J, Duek SD, Kluger Y, Assalia A. The impact of preoperative stoma site marking on the incidence of complications, quality of life, and patient’s independence. Dis Colon Rectum. 2012;55(7):783-7.
- Mckenna LS, Taggart E, Stoelting J, Kirkbride G, Forbes GB. The Impact of Preoperative Stoma Marking on Health-Related Quality of Life: A Comparison Cohort Study. J Wound Ostomy Continence Nurs. 2016;43(1):57-61.
- A Multicenter, Retrospective Study to Evaluate the Effect of Preoperative Stoma Site Marking on Stomal and Peristomal Complications. Ostomy Wound Management
- Sjödahl, R., Anderberg, B. and Bolin, T. (1988), Parastomal hernia in relation to site of the abdominal stoma. Br J Surg, 75: 339–341. doi:10.1002/bjs.1800750414
- Ostomate Bill of Rights, UOAA
- McKenna LS, Taggart E, Stoelting J, Kirkbride G, Forbes GB. The Impact of Preoperative Stoma Marking on Health-Related Quality of Life: A Comparison Cohort Study. J Wound Ostomy Continence Nurs. 2016 Jan-Feb;43(1):57-61.
- An assessment of surgeons‘ abilites to site colostomies accurately. Macdonald A, Chung D, Fell S, Pickford I. Surgeon. 2003 Dec;1(6):347-9.