The Importance of Stoma Site Marking (w/ video)

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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.

Introduction

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.

Video

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.

Ideal stoma placement
Notice how this stoma is placed towards the center of the muscle?

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.

Closing Words

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.

QUESTION: Did you have your stoma site marked? How was your experience?

Sources

  1. 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.
  2. 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.
  3. A Multicenter, Retrospective Study to Evaluate the Effect of Preoperative Stoma Site Marking on Stomal and Peristomal Complications. Ostomy Wound Management
  4. 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
  5. Ostomate Bill of Rights, UOAA
  6. 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.
  7. An assessment of surgeons‘ abilites to site colostomies accurately. Macdonald A, Chung D, Fell S, Pickford I. Surgeon. 2003 Dec;1(6):347-9.
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Erica

Well I had a loop ileostomy and now have a permanent ileostomy. For my permanent ileostomy my surgeon did mark me but it ended up being next to my belly button. Unfortunately for me my belly looks weird due to having major surgeries. So I feel my surgeon did what she could when it comes to stoma placement. My old surgeon didn’t even give me the choice of stoma placement for my loop ileostomy. She said she might be able to remove my colon and hook up j pouch in 1 step but it turned out to be a 2 step surgery. My loop ileostomy was placed in a bad spot. It was lower than my permanent one and I hated it. I had so many leaks but with my permanent ileostomy I haven’t had many leaks.My old surgeon got sued for malpractice but she moved away. Luckily I have a really good surgeon and now have a colorectal surgeon.

Member
Neal

Hi Eric,

Great article. This is valuable information for anyone going for surgery and I like that you include references.
As an ostomy nurse it is very important to be very thorough in doing the pre-op marking. Some additional factors that we consider is the person’s ability to see the stoma to make pouch application and removal easier. So a person with a larger abdominal circumference may need to have the stoma site marked above the line of the navel. Placing a mark in this area is also common for a person who is wheelchair confined to make pouch management easier.
We may also place a one piece pouch or the flange of a two piece appliance as a guide on the abdomen to get a sense of the best place to mark. In some cases we may ask a person to wear a pouch prior to surgery for a couple of days to see if that location would be comfortable for them.
Another factor I take into account is if the surgical consent states an ostomy may be a possibility. For example, when the diagnosis is cancer or Crohn’s disease I may need to mark two locations for either an ileostomy or colostomy. During the course of an operation a surgeon may plan to do one type of ostomy but out of necessity needs to create a different type. In cases where we are concerned that the best possible site may be problematic for management, we will contact the surgeon to let them know.

Member
Ngaire

I did have mine marked (colostomy) before the operation. And 9 years on all is good. Maybe I was lucky, as I did not know that I should have the position marked before the operation. The right nurse on the right day ?? In NZ I am told this is standard procedure. Good article as I am sure a lot of people do not know about this. Thanks.

Sydneychic
Member

I had my site marked with three possibilities. I preferred one of them but the surgeon used another. I have no issues with my stoma but the placing of it is parallel to my navel and I have great trouble with pant waistlines. I don’t like the feeling of the waistline under my bag so I have gradually changed my wardrobe to maternity pants. They are not ideal but much better than ordinary waistlines. Even the so called high waisted jeans are not high enough and want to sit right across my stoma. Last week I had a parastomal hernia removed, very painful still, and I asked the surgeon if he could reposition the stoma but he said no. Any lower and it would interfere with my hip and higher would be on a rib.

Member
Maggi

I had my stoma site marked and the nurse was very meticulous. One year on and I ve had hardly any problems with leaks and my bag sits neatly under my knicker line!!

Member
Nh556677889900nmh

16 years ago I had my permanent ileostomy going in on March 15th for revisions my bag has never fit correctly I go through 5 bags and night how should I have them mark it no one has even offered me two pre- Mark me

Member
Millie

Great article, I’m sure it will benefit those who are fortunate enough to find it before they have the surgery. I didn’t know about this but part of my health care team was a Stoma Nurse and she did all of the above. I feel like she must have read your article. :o) If you are going for surgery and feel uncomfortable discussing this with your health care team, print out this article and take it with you.

Songbringer
Member
Songbringer

Great information! This is quite possible why I have had so many issues with my stoma.