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Stoma siting: why the mark is made before your operation | CION Cancer Clinics
The mark drawn on your belly before surgery shows the surgeon where the stoma will be easiest for you to see, reach and keep a bag stuck to. It is chosen while you are awake, sitting and bending, so skin folds and waistbands can be avoided. A well-placed stoma usually leaks less. This page explains what happens and what to tell the nurse. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- Why is a mark drawn on your belly before stoma surgery?
- What does the nurse look for when choosing the spot?
- What happens when the site is marked?
- What should you tell the nurse, and why?
- What do people believe about the mark that is not true?
- What do the siting words mean?
- What if there is no time to mark the site?
- Common questions about stoma siting
The short answer
Why is a mark drawn on your belly before stoma surgery?
The mark shows the surgeon where the stoma will be easiest for you to see, reach and keep a bag stuck to. A well-placed stoma leaks less, makes the skin less sore and makes life after surgery simpler.
Why it cannot be decided on the operating table
During surgery you are lying flat and asleep. Skin folds, the belt line and the way your belly changes when you sit or bend are hidden. A spot that looks perfect on a flat belly can disappear into a crease the moment you sit up. Marking is done while you are awake and moving, so these things can be seen.
Who does the marking
Siting is usually done by a stoma nurse or by the surgical team, a day or a few hours before the operation. Ask your centre who will do it and when. It is worth asking even if you are told a stoma is only a possibility, because a site marked "just in case" costs nothing if it is not used.
Siting is a planning step. It does not decide whether you need a stoma. That is decided by your operation.Choosing the spot
What does the nurse look for when choosing the spot?
The aim is a flat, visible patch of skin that stays flat in the positions you live in.
Flat skin away from folds
The bag needs a smooth area to stick to. Creases, the belly button, old scars and the hip bone all break the seal.
Where you can see it
You must be able to look down and see the stoma to change the bag yourself. For a larger belly this often means placing it higher.
Away from waistbands
A belt, a trouser waist, or the drawstring of a petticoat or lungi can press on the bag and cause leaks.
Tell the nurse how you dress
- Where you tie your saree or dhoti
- Whether you wear a belt for work
Within the belly muscle
The stoma is usually placed through the strap muscle running down the front of the belly, which is thought to give it better support.
Not sure whether this applies to you?
Ask an oncologistAt the appointment
What happens when the site is marked?
A short conversation
The nurse asks about your work, clothes, hobbies, eyesight, hand strength and daily routine. Mention if you sit on the floor, squat, pray kneeling or drive long distances.
Looking at the belly
You lie down, then sit, stand and bend forward. The nurse watches where creases and folds appear in each position and feels for the belly muscle.
Trying a bag
Sometimes a bag or baseplate is placed on the chosen spot so you can see it, move around and check it does not catch on a waistband.
Making the mark
A skin marker is used, and it may be covered with a clear dressing so it survives your bath. Do not scrub it off before surgery.
Before marking
What should you tell the nurse, and why?
Tell the nurse
Why it matters
How you tie your saree, dhoti or trousers
The stoma should sit clear of the waistband
If your eyesight or hands are weak
The site may be moved higher so it is easier to see and reach
If you sit cross-legged or kneel often
New folds appear in those positions
Any wheelchair use or back brace
The bag must not be pressed or hidden while seated
Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
Commonly believed
What do people believe about the mark that is not true?
"If they have marked me, I will definitely get a stoma."
Not always. Many people are marked because a stoma is possible, not certain. The final decision is often made during the operation. Ask your surgeon how likely it is in your case.
"The surgeon will put it wherever suits the operation."
The surgeon aims for the marked spot. Occasionally what is found during surgery means it has to be placed elsewhere, but the mark gives the team a clear target to work towards.
"Siting is only for fat or elderly people."
Everyone's belly changes shape when they sit and bend. Slim and young patients benefit too, and so do people who expect to gain weight back after treatment.
"It is a small detail. Skipping it saves time."
A poorly placed stoma can mean leaks and sore skin every day for years. The marking itself is usually a short appointment, and it is one of the few parts of the operation you can shape yourself.
Words you will hear
What do the siting words mean?
- Siting
- Choosing and marking the place on the belly where the stoma will be made.
- Rectus muscle
- The long strap muscle on each side of the middle of the belly. The stoma is usually brought out through it.
- Baseplate
- The sticky part of the bag system that holds to the skin around the stoma.
- Parastomal hernia
- A bulge next to the stoma where bowel pushes through a weak spot in the belly wall.
Being straight with you
What if there is no time to mark the site?
In emergency surgery, for example for a blocked or torn bowel, there may be no chance to site the stoma first. The surgeon then chooses the spot from experience while you are asleep. Many of these stomas work well. If yours leaks often afterwards, a stoma nurse can usually help with a different bag shape or accessories.
When the mark cannot be followed
The spot may have to move if the bowel will not reach it without tension, or if a problem is found during the operation. This is a decision made for safety. Ask afterwards where the stoma was placed and why, so you understand your own body.
Who siting helps less
Marking cannot solve everything. If the belly has many old scars, a large hernia or very deep folds, there may be no truly flat spot. The nurse then chooses the least difficult place and plans ahead for accessories such as filler paste, rings or a curved baseplate. Knowing this before surgery makes the first weeks less of a surprise.
What this page cannot tell you
It cannot tell you whether you will need a stoma, or where yours will be. Your surgeon and stoma nurse decide that with you. Ask when siting will happen, and bring the family member who will help you at home.
Questions we are asked
Common questions about stoma siting
Does the marking hurt?
No. The nurse only looks at your belly, asks you to move into different positions and draws a small dot or cross with a skin marker. Nothing goes into the skin. Some centres cover the mark with a clear film dressing, which can feel a little tight but comes off after surgery.
Can I bathe after the mark is made?
Usually yes, but do not scrub the area or use oil on it. If the mark fades, tell the ward nurse before you go to theatre so it can be redrawn. If a clear dressing has been put over it, leave the dressing in place until the operation.
Can I choose where my stoma goes?
You have a real say. The nurse suggests spots that work for the bag and the surgery, and your daily life helps choose between them. The surgeon has the final word on safety during the operation. Speak up about how you dress, sit and work.
Why were two marks drawn, one on each side?
When it is not certain which type of stoma will be needed, both sides may be marked. An ileostomy usually goes on the right and a colostomy on the left. The surgeon uses the mark that matches the operation actually done.
Does a good site prevent a hernia?
Placing the stoma through the belly muscle is thought to lower the chance of a hernia, but it does not remove it. Weight, coughing, heavy lifting and the operation itself also play a part. Ask your team about a support belt and when it is safe to lift after surgery.
My belly is large. Will the stoma still work?
Yes. Siting matters even more, because the nurse can find a spot higher on the belly that you can see and that stays flat when you sit. There are bags and baseplates made for curved bellies. Tell the nurse if you are planning to lose weight.
What if I was not marked and I am having planned surgery?
Ask. Say to your surgeon or the ward nurse that you understand a stoma is possible and ask whether siting has been arranged. It is a reasonable question, and families often forget to raise it in the rush before an operation.
Can the stoma be moved later if the spot is bad?
Sometimes, but it needs another operation, so it is only considered when problems cannot be solved another way. Most difficulties with fit improve with a different bag, a curved baseplate, filler paste or a belt. A stoma nurse is the right first person to see.
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Sources
- NHS — Colostomy
- NHS — Ileostomy
- American Cancer Society — Ostomies
- Cancer Research UK — Bowel cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Colostomy, Ileostomy and Urostomy: How They DifferWhy the mark may be on the left, the right, or bothParastomal Hernia: Prevention and TreatmentThe bulge a good site aims to make less likelyThe Days Before Your OperationEverything else to prepare before surgeryClothing, Saree and Dressing With a StomaHow the site and your clothes work together
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