A stoma is a surgically created opening on the abdomen that allows waste, either stool or urine, to exit the body into a collection pouch following an ostomy procedure. This opening is formed from a portion of the intestine or urinary tract brought to the surface of the skin. Any noticeable change in stoma size is a common concern for people living with an ostomy. Understanding the difference between expected, temporary changes and those that signal a medical complication is paramount for proper self-care. Persistent or sudden enlargement requires attention to maintain appliance fit and ensure intestinal health.
Understanding Normal Stoma Size Fluctuations
The most significant change in stoma size occurs immediately following surgery due to post-operative swelling (edema). Initially, the stoma tissue is swollen and may appear quite large, but it gradually reduces in size over the first six to eight weeks as the surgical site heals. This shrinking process can continue subtly for up to a year, necessitating regular measuring to ensure the pouching system fits correctly.
Daily life activities can also cause minor, temporary fluctuations in the stoma’s appearance. Increased intra-abdominal pressure from a forceful cough, a sneeze, or straining can cause the stoma to momentarily protrude slightly more. Changes in diet or hydration status may also lead to mild, short-lived swelling of the intestinal tissue. These minor changes are considered normal physiological responses and do not indicate a complication if they resolve quickly.
Body weight shifts are another factor that influences the stoma’s appearance relative to the abdomen. A substantial increase or decrease in body weight (10 pounds or more) can alter the abdominal contour and the position of the stoma. While the stoma tissue size may not have changed, the surrounding skin may develop folds, which can make the stoma appear larger or more retracted. Regular monitoring of the stoma’s size and shape is important for adjusting the appliance to prevent skin irritation.
Identifying Pathological Causes of Enlargement
When a stoma appears persistently larger or is accompanied by a noticeable bulge, it often points to a mechanical complication. The most frequent cause of perceived enlargement is a parastomal hernia, occurring in up to 70% of ostomates, typically within two years of surgery. This condition involves a section of the intestine or other abdominal contents pushing through the weakened abdominal wall muscles adjacent to the stoma opening. The hernia presents as a soft, often reducible bulge around the stoma, which makes the stoma site look distended and can make securing a pouch difficult.
Another distinct cause of true enlargement is a stoma prolapse, where the bowel telescopes out through the stoma opening, causing the stoma to become noticeably longer and sometimes wider. This is a visible extension of the bowel tissue itself, unlike a hernia, which is a bulge next to the stoma. A prolapsed stoma may become more prominent when standing or straining and poses a risk if the blood supply is compressed.
Less common, but potentially serious, is localized swelling caused by an internal complication such as a bowel obstruction or stenosis. An obstruction, often caused by undigested food or scar tissue, leads to a buildup of pressure within the intestine. This pressure can cause the stoma tissue to swell and become firm as the body attempts to push contents past the blockage. Stenosis, or a narrowing of the stoma opening, can similarly impede output and result in tissue swelling above the restricted area.
Immediate Steps and When to Seek Professional Help
The first step when noticing an apparent enlargement is careful monitoring and self-assessment. Measure the stoma’s diameter and length to document the change, and check its color, which should be a healthy pink or beefy red, similar to the inside of your mouth. Also, assess the surrounding skin for any signs of irritation, redness, or pain, as a poor-fitting appliance caused by size changes can lead to skin breakdown.
Certain changes represent medical emergencies that require immediate attention from a healthcare provider or emergency room. These “red flag” indicators include any drastic change in stoma color, such as turning dark blue, purple, or black, which signals compromised blood flow. Other urgent signs are severe abdominal pain, persistent nausea or vomiting, or the absence of any stoma output for several hours, which may suggest a complete bowel obstruction.
Preventative measures and specialized consultation can help manage or prevent further enlargement. Avoiding activities that involve heavy lifting and strenuous core work, especially post-operatively, reduces strain on the abdominal wall. Wearing a prescribed abdominal support garment or binder can provide external support to the muscles around the stoma site. Consulting a Wound, Ostomy, and Continence (WOC) nurse is recommended for proper diagnosis and management, including resizing the appliance or evaluating the need for surgical intervention.