Written by: Pam Boquentin ET, CWOCN, Nightingale Medical.
Edited by: Michayla WolfeNightingale Medical nurse

1. To receive pre-surgical teaching and/or marking for a planned ostomy creation.
Many hospitals have Ostomy Nurses who will provide these services in a pre-admission clinic before surgery. If this service is not provided in hospital, or you need more advice regarding teaching or marking for a planned ostomy creation, Nightingale Medical's Ostomy Nurses can also provide the service. We can provide ostomy teaching, ensure individualized choice of supplies, and develop a personalized care plan to promote independence, self-confidence, and improved quality of life.

2. 2-3 weeks after discharge from hospital
A few weeks after discharge, many find that the ostomy products that worked in the hospital no longer function correctly. Reasons for this change can include: changes to the stoma size and shape due to a decrease in swelling, weight gain or loss, and an increase in activity once out of the hospital. To resolve any of these issues you should make an appointment.

3. If experiencing issues with leakage/reduced wear-time (length of time you wear your pouching system).

Most ostomy appliances are designed for a three-day minimum wear-time, during which leaking should not be experienced.  However, there are many reasons why an ostomate may experience reduced wear-time. These issues can be evaluated and assessed in-clinic in order to achieve a longer wear-time.

4. If experiencing breakdown to the skin around the stoma, not limited to but including excoriation/ulcers (sores)/ itching/ redness burning etc. Your skin under your ostomy pouching system should look like the skin on the opposite side of your body.

There are many kinds of peristomal skin problems that may occur: some in relation to the application of the pouching system, changes in abdomen or stoma shape and size, a reaction to ostomy products or to an immune disorder.  Regardless of the cause, all of these conditions can be treated. Peristomal skin breakdown can worsen quickly if left untreated, leading to discomfort and leaking due to reduced sticking of the ostomy appliance.

5. When experiencing changes to the stoma size or shape that are reducing the effectiveness of your ostomy appliance.
Sudden changes to a stoma can occur, even when the stoma has been well established for a long period of time. Provided that the stoma remains functional, and is normal in appearance ie. pink, warm, and moist, these changes are usually not a reason for concern. However, a sudden change in size or shape of a stoma can reduce the success of your current appliance.

6. Prevention or management of a parastomal hernia
Prevention of a parastomal hernia requires an exercise regime and a hernia belt that is customized for you. If a parastomal hernia occurs, it may not be possible to obtain a surgical revision. A hernia belt may help to support the weight of the hernia, as well as prevent complications from developing. Scheduling an appointment with your ET nurse can address these concerns.

7. Three months after creation of a new stoma, to be considered for a pre-cut appliance.
After the creation of a new stoma, it is normal for the stoma to change size and shape over a three-month period. This requires measuring of the stoma and cutting of the flange during appliance changes. Pre-cut appliances make changing an appliance easier and quicker. Therefore, at three months, your stoma should have an established size and shape that may allow it to be fitted for one. Pre-cut appliances usually are only available in a round shape.

8. Three months after creation of a colostomy, to be assessed for possibility of stimulated bowel movements via daily ostomy irrigation.
Colostomy irrigation can provide greater control over bowel movements. Those who are candidates for stimulated bowel movements may not have to wear a bag; instead they can wear a small stoma cap with a filter for escaping gas.


Nightingale Medical's ET nurses can provide you with:

• personalized care plans
• education on peristomal skin health
• hernia prevention exercises
• hernia belt fitting
• colostomy irrigation assessment
• answer questions e.g. can I swim, travelling with an ostomy

If you are experiencing any of the above issues or have concerns, please book an appointment at Nightingale Medical with an Ostomy (ET) Nurse.