Stoma Changing Size: When It Pushes Out or Pulls In

This video explains two common changes in stoma size: prolapse and retraction. Stoma prolapse occurs when the bowel pushes out and the stoma appears longer. It is significantly more common in loop stomas (up to 47%) than in end stomas (up to 8%). Stoma retraction is the opposite, where the stoma pulls back in, sitting flat or below the skin, making a leak-proof seal difficult and risking skin irritation. Causes for both conditions are often related to anatomy or increased internal abdominal pressure (e.g., from coughing or lifting). Initial management focuses on home care. Retraction can often be managed with a convex pouching system, which gently pushes the stoma out. Prolapse can be managed with a support belt, and sometimes gently guided back in (reduced). Patients must call a doctor immediately if a prolapsed stoma appears dark, purplish, pale, cool, or very swollen and cannot be pushed back in, as this suggests a compromised blood supply. Surgery is considered the next step if home care fails or if the change causes blockages, pain, or major pouching problems.