Changes to the Size/Shape of Stomas
My Stoma Seems to be Changing Size/Shape. Is This Normal?
Changes to the size and shape of a stoma can occur with both new and established stomas. Multiple factors can contribute to these alterations.
Changes to the size and shape of a new stoma are normal during the post-operative period. Initially, after surgery, stomas are swollen (edematous). The swelling will gradually subside over a period of about 6 weeks after surgery. No one will be able to tell you exactly how large your stoma will be right after surgery, nor how much smaller it will be as the swelling settles. Regular measuring of the base of your stoma is important during this 6-week period so that you can maintain correct sizing of the opening of the flange/appliance that you are using. The opening of a traditional flange/appliance should be about 1/8th of an inch (3-4 millimeters) larger than the base of your stoma. Correct sizing will help to prevent irritation of the skin around your stoma, as well as prevent irritation (lacerations) to the stoma itself. Moldable flanges do not require this precision.
Changes to the size and shape of an established stoma can also occur over time. Most commonly, these changes result from weight gain. In general, weight gain of ten pounds (4.5 kilograms) or more can cause a stoma to "pull-in" and to become more flush with the surrounding skin. Weight gain may also change the contours of the skin surrounding your stoma. Consequently, your "usual" pouching system may no longer be appropriate, particularly if you are experiencing frequent leaks or the usual wear-time has decreased. If your weight has increased by more than 10 pounds since your ostomy surgery, you may benefit from contacting an Enterostomal Therapy Nurse (ET) to re-evaluate your pouching system. Equally, dramatic weight loss can impact stoma size and skin contours, also requiring re-evaluation of pouching systems.
For women who have stomas and who become pregnant, regular re-evaluation of the stoma and pouching system is recommended throughout the pregnancy. The weight gain experienced during pregnancy (particularly in the second and third trimesters) can cause the stoma to become flush, or even retracted during the later stages. Maintaining regular contact with an ET will help to determine appropriate changes to the pouching system as the pregnancy progresses.
A lengthening (or prolapse) of the stoma can occur. While peristalsis will normally cause minor changes to the length of the stoma, the stoma may also excessively lengthen. You may notice that the stoma lengthens (or prolapses) while standing or after coughing, then may return to normal (reduce) after you lie down. If you notice that your stoma is prolapsing, you should contact an ET for re-evaluation of your pouching and management of the prolapse.
Some people may develop hernias around the stoma (peristomal hernias), causing a bulging of the skin. Again, this bulging may cause significant changes to the size and shape of your stoma. An ET will be able to help you reassess your pouching as well as assist with the evaluation and management of the hernia.
Lastly, changes can result simply from aging. As muscle and skin lose strength and tone, changes to the stoma and the contours of the surrounding skin may require alterations to the size and type of pouching used. Generally, it is recommended that people with established stomas have their care re-evaluated annually by an Enterostomal Therapy Nurse.