Properly Sizing Your Stoma to Get the Best Fit

December 01,2020 |
Doctor talking to her patient who has a stoma.

If you’ve recently had an ostomy, you’ll need to familiarize yourself with your stoma and how to care for it. One of the best ways to ensure that you’re living a high quality of life is to properly size your stoma and use the right accessories for a tight seal. Since every ostomy is different, there are very few predetermined “one-size fits all” options that actually work. You’ll need to measure your stoma and cut your wafer/skin barrier to make sure that your pouch system works effectively. In this article, we’ll teach you everything you need to know about properly sizing your stoma to get the best fit.


Understanding Your Stoma

A stoma is created through an opening on the abdomen that’s either connected to your digestive or urinary system. This allows waste to be diverted out of your body without exerting stress on certain parts of your intestines. There are many reasons that someone might need an ostomy, which leads to a stoma, and they can be temporary or permanent. To make sure that you stay healthy and avoid any complications, it’s important to take care of your stoma and properly size it for a secure fit to your pouching system.

Initial Swelling

For the first few weeks following your surgery, your stoma will appear swollen. The swelling will make it larger, but it will subside as the weeks pass. During this time, it’s important to regularly measure your stoma and adjust the size of your wafer/skin barrier as it changes. Eventually your stoma will become more static and you won’t have to measure as often. However, changes in size and shape can and do still occur for a number of different reasons.

Changes in Size and Shape

It’s common for stomas to change in shape and size over time—especially during the first 6-8 weeks after surgery. After this period, your stoma may change due to weight gain, weight loss, pregnancy, prolapse or hernias, aging, or other changes to your physical appearance. If you notice that your soma is changing in size, just take new measurements and adjust the size of your wafer/skin barrier. If you’re concerned about the size or shape changes, you can always reach out to your doctor or ostomy nurse for support.


How to Properly Size Your Stoma

To check the size of your stoma, you’ll use a few supplies provided by your doctor and ostomy nurse. Before leaving the hospital, you’ll learn how to size your stoma, change your pouch, and what to do if you notice any signs of a problem. There are a few steps involved in sizing your stoma and while they may seem overwhelming at first, you’ll adapt to the process quickly and efficiently.

  1. Gather Your Supplies

    The first step in sizing your stoma is to gather all of the supplies you’ll need. If you’re using a cut-to-fit skin barrier, you’ll have a box of barriers available. You should also get your stoma measuring guide and special scissors for cutting the wafer/skin barrier. Talk to your doctor about recommendations for the best scissors, but make sure you purchase a pair that are specifically for ostomy barriers. You’ll also need a pen or marker, your wafer, gauze, and a mirror to make things easier.

  2. Prepare Your Stoma

    Next, it’s important to prepare your stoma for the best results. If you currently have a pouching system on, take it off and empty your bag. Proceed to wash your hands thoroughly and clean the area around your stoma. Remove any hair if necessary and avoid using oil-based products or alcohol. Warm water is the best option. Make sure that the skin around your stoma is completely dry before moving on to step three.

  3. Use a Stoma Measuring Guide

    Take your stoma measuring guide and find the closest marker for the size of your stoma. You can start with previous measurements and adjust as needed. Place the stoma measuring guide over your stoma to confirm the correct size. Make sure that your stoma protrudes through the hole completely without too much surrounding skin showing. There should be about a 1.5 – 3mm gap between your stoma and the edge of your measuring guide.

  4. Transfer to Your Wafer/Skin Barrier

    Next, you’ll need to transfer the size to your wafer/skin barrier and cut it accordingly. Simply place your measuring guide onto the wafer/skin barrier and use your pen or marker to trace the hole in the center. Some people need to make the hole a little off-center due to wounds or skin ailments, which is completely fine. Just make sure you remain within the “maximin” cutting area to avoid adhesion problems. Make sure that you use your wafer/skin barrier scissors to avoid damaging to the product.

  5. Test, Adjust, Prep, and Apply

Place the cut barrier over your stoma to test the fit. If you need to make any adjustments do so before removing the plastic backing. If all looks good, continue with your skin care routine and apply the wafer/skin barrier.

There are different types of wafers/skin barriers available to choose from. You can try a few options and see what you like best. Many people have certain preferences or use different products depending on their activity. Some options include convex, accordion, moldable, pre-cut, and cut-to-fit options. To determine which pouching system is right for you, talk to your doctor about testing different options.


Challenges to Sizing Your Stoma

While sizing your stoma seems like it would be a fairly straightforward process, there are a few challenges that can make things difficult. If you have any problems, or need further clarification, always discuss with your doctor or ostomy nurse.

Loop Ostomies

If you have a loop ostomy, measuring your stoma using a pre-sized circular chart can be difficult. Loop ostomies have two different openings, so they can’t be measured easily using printed guides. Some people with loop ostomies suggest using a half circle, rather than a full circle, on the measuring guide to measure each opening of the stoma separately.

Wafer/Skin Barrier Differences

The differences between wafers/skin barriers can also make sizing your stoma a challenge. Sometimes they act differently when they’re worn vs. when you cut them. Certain brands can swell after contact with fluid, requiring a larger size to prevent leakage. If you notice this, try to accommodate about 10cm of space. However, since some barriers fit perfectly with your stoma, only increase the size after you notice these issues.

Stoma Changes

The most common challenge to sizing your stoma is changes in size and shape. This is completely normal, especially in cases of weight gain/loss or changes in physical appearance.


How to Care for the Skin Around Your Stoma

Aside from properly sizing your stoma, one of the best ways to ensure that you have a well-fitting ostomy pouch system is to keep the peristomal skin healthy. By creating a good stoma skin care routine, you’ll keep the surrounding area healthy create a stronger seal. It’s important that the area is clean and completely dry. This helps to improve adhesion to the baseplate. If you have hair on the skin that surrounds your stoma, removing it may help your pouch more securely stay in place.

The best way to care for your skin is to regularly wash it using warm water. Make sure that you avoid any products that contain oil as this can make the attachment difficult, if not impossible. Do not use alcohol-based products as these can dry out your skin and cause irritation. If you need to use anything, just make sure that they are special skin care products designated for stoma care. If you notice any redness, signs of irritation, or dryness, contact your doctor to make sure that you’re addressing the problem before it spreads.

The skin that surrounds your stoma is sensitive and certain supplies can make this sensitivity more intense. If you’re having problems with your products, talk to your doctor about trying something new.


When to Call a Doctor

If you notice any changes to your stoma, it’s important to talk to your doctor as soon as possible. While it’s normal for your stoma to change in size and shape during the first few months, there are certain warning signs to look out for. Call your doctor if your stoma:

  • Is excessively dry
  • Starts to pull away from the skin
  • Has a bad odor
  • Is a dark color (purple, gray, black, etc.)
  • Is flush with your skin
  • Goes deeper into your skin
  • Opens big enough for your intestines to push through
  • Pushes out from your skin
  • Becomes narrower

You should also call your doctor if you notice any severe changes to the skin around your stoma. If it hurts, burns, swells, bleeds, itches, or starts to develop bumps, pustules, or sores, it could be a sign that somethings wrong. When it comes to your ostomy, it’s always better to be safe so err on the side of caution and call your doctor with any alarming changes. To make sure you have a full-range of support, partner with Byram Healthcare for all of your Ostomy needs.