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What is a well-placed stoma

Posts: 125
Joined: May 2012

Good morning, all. I've been doing some reading and planning for my surgery on August 2nd (Stage III rectal, post chemo/radiation). I'm hoping the treatments have been so successful that I won't need a temporary colostomy, but I know I probably will so I've been reading up on them to be prepared. Here's a question that needs an experienced answer: everyone says "make sure it's a well-placed stoma" but they never tell me what the considerations are. What factors should I consider for a well-placed stoma? (Note - I'll see my surgeon two weeks pre-op for a planning session, so I'll ask about a stoma nurse then.)


Kenny H.'s picture
Kenny H.
Posts: 503
Joined: Aug 2010

Mine is to my left of belly button about 2in. Slightly downward. But mines permanant, seems to be doing well in that location. Use 2-piece holister system. Like them the best.

Lovekitties's picture
Posts: 3366
Joined: Jan 2010

First let me compliment you on your 'just in case' research. Many don't have that opportunity and have to come to terms with it after the fact.

As to the question of what is a well placed stoma. I would say for a colostomy it is approx. 2 inches to the patient's left of mid-line and 2 inches down, which keeps it out of the natural belt line. That being said it might have to be relocated based on what is found at surgery or other anatomical issues. Whatever is marked by the stoma nurse should be optimum based on what is known before surgery.

Certainly the placement of a stoma for an ilio would be different.

Pre-planning with a stoma nurse is the key to hopefully getting a 'well placed stoma'.

Best wishes for successful surgery and recovery,

Marie who loves kitties

John23's picture
Posts: 2140
Joined: Jan 2007

You can read some info on my "blog", here on this forum:

The idea of a stoma being "well placed", is to have it where it
easiest to maintain, and where it won't interfere with the clothes
you normally wear and how you wear them.

There is a "4x4" rule that most surgeons will use when preoperative
planning did not take place. The "4x4" indicates that the stoma
will be 4" to the side of the naval, and 4" below the belt line.

It's usually preferable to have it below your waistline, so you can
continue wearing what you presently wear. If it's too high, you'll
have problems with both outer wear and underwear. Too low,
and you'll be tripping over it. (just kidding)

If it's an Ileostomy, it's best to have it placed so the pouch will
be aiming down the front of your leg. Sitting on the toilet, the
pouch will fall naturally between your legs for emptying.

The stoma nurse (WOCN) can be of great assistance in helping
with the placement. Some even place an appliance on your skin
at the location that's been marked. They'll fill it with some sort of
stuff (usually applesauce) (seriously) and let you wear it to see how
it feels. (It feels like a bag of applesauce! what else would it feel like?)

Having spots marked for both a Colostomy and an Ileostomy
isn't a bad idea. All too often a surgeon will find some reason for
the need for something other that what was originally planned!
It's happened to me twice, so I feel it was worth mentioning.
Surprises are nice, except when it's a pregnancy or an ostomy;
both change your life.... ya'know?

Best wishes,


Posts: 125
Joined: May 2012

Applesauce? Really? Too funny. (But someone seems like the perfect filler...). Thanks!

RickMurtagh's picture
Posts: 586
Joined: Feb 2010

The perfectly placed stoma is on someone else.

Posts: 125
Joined: May 2012

We've got a bunch of comedians on here! Very funny. And very true. :-)

dmj101's picture
Posts: 527
Joined: Nov 2011

everyone is correct...
mine is a permanent stoma.. to left of belly button@ 2 inched..
about the size of a quarter.. little smaller.. sort looks like a rosebud...not at all as ugly as the pics in the sites you will see.. I would take a pic of it if I didn't think that was obscene.. I am really happy with it..
works well with Holister 2 piece system..
Though I think if it was slightly lower it would be prefect..

Posts: 125
Joined: May 2012

The thought of a colostomy is not quite so awful the more I learn. I had been reading about one piece vs two piece zystems so that recommendation is helpful. John - your blog on stoma care is a huge help.
Who would have know i'd ever be having this conversation. Damn cancer.

dmj101's picture
Posts: 527
Joined: Nov 2011

I know.. it sounds silly..
but there are some real life people discussing care for their stoma's on you tube.. search colostomy .. you will be delighted to see young people showing how they care for themselves. I found them really helpful and they filled me with hope that this was manageable. they may not be cancer but colostomies are done for more than cancer..
their comments and videos are much easier to follow than any of the manufacturers sites.
Good luck to you..
PM if you need any personal guidances..

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