A stoma is a surgically created abdominal opening for waste diversion. Individuals with a stoma may notice it appears to increase in size. This article discusses normal stoma characteristics, reasons for enlargement, and management guidance.
Normal Stoma Appearance and Variations
A healthy stoma is typically a moist, pinkish-red protrusion, similar to the inside of the mouth. Its appearance varies among individuals due to surgical technique, underlying conditions, and body type. Most stomas settle into their permanent size and shape within six to eight weeks post-surgery as initial swelling subsides.
While a stoma’s size generally stabilizes, minor fluctuations are normal throughout the day or due to activities. These variations can stem from hydration, digestive activity, or changes in body position. Recognizing these variations helps distinguish them from significant changes.
Understanding Stoma Enlargement
Stoma enlargement can result from several distinct conditions, each with specific underlying causes. Identifying the reason for enlargement aids appropriate management. These conditions often involve changes in the abdominal wall or stoma, leading to a noticeable increase in size or protrusion.
Stoma Prolapse
Stoma prolapse occurs when the stoma lengthens or protrudes further from the abdominal wall. This ranges from minor extension to significant outward projection. Increased intra-abdominal pressure (from chronic coughing, straining, or heavy lifting) is a common contributor. Weakness in surrounding abdominal muscles or surgical techniques can also predispose to prolapse.
Parastomal Hernia
A parastomal hernia appears as a bulge or swelling around the stoma, not the stoma itself. This occurs when abdominal wall weakness near the stoma allows intestine or other contents to push through, creating a sac-like protrusion. Factors like obesity, increased abdominal pressure (from straining or coughing), and natural tissue weakening can contribute to its development.
Edema or Swelling
Temporary stoma enlargement can also be caused by edema, swelling from fluid retention or inflammation. This swelling might arise from irritation by an ill-fitting ostomy appliance causing pressure or friction. Infections around the stoma site or allergic reactions to appliance materials can also lead to localized inflammation and swelling. Occasionally, a partial blockage within the stoma can cause back-pressure, leading to swelling.
Other factors can change stoma size. Significant weight gain can alter abdominal contour, potentially affecting its appearance or creating additional pressure. Pregnancy can also cause temporary changes due to increased abdominal pressure and shifting organs.
When to Seek Medical Attention
Certain signs indicate immediate medical evaluation. Consult a healthcare professional (ostomy nurse or doctor) if any of these symptoms appear:
- A change in stoma color (dark red, purple, or black), indicating compromised blood flow.
- Significant, continuous, or profuse stoma bleeding.
- Persistent lack of stoma output, especially with nausea, vomiting, or increasing abdominal distension, signaling possible obstruction.
- Sudden, severe swelling of the stoma or surrounding area, particularly if associated with intense pain.
Living with a Changing Stoma
Adjusting to a changing stoma requires practical strategies and support. Adapting the ostomy appliance is a primary step, as a proper fit is crucial for comfort and preventing skin issues. This may involve exploring different sizes, shapes, or types of bags and wafers to accommodate new stoma dimensions. An ostomy nurse can guide appliance selection and application.
Dietary considerations help manage stoma output and comfort. Modifying food choices for consistent output can reduce straining or irritation. Avoiding activities that significantly increase abdominal pressure (e.g., heavy lifting, strenuous exercise without support) can help prevent exacerbating conditions like prolapse or hernia. Regular follow-up appointments are important for monitoring the stoma’s condition and addressing new concerns.