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Swollen stomas: What Causes Them?

22nd November 2020

From time to time your stoma may change shape and size. This is perfectly normal, but it is worth monitoring your stoma to check the size does not cause additional problems such as a poor fitting appliance which may lead to leaks and sore skin. Here are some of the reasons why your stoma may become swollen and some tips to help with managing your stoma whilst it is swollen.

Following surgery:

Initially, stomas are often more swollen following surgery, than any other time. Surgery is traumatic for the body and swelling to the stoma is common. It is often referred to as an “oedematous stoma”. Usually the swelling reduces slowly within the first 10 days of recovery and both the size and shape of the stoma will be closely monitored.  

Constipation:

At times the stoma itself can appear swollen. It may be worth checking you are not constipated or have a blockage. On the other-hand it can shrink and become tight. Increase the amount of fluids you are drinking if you think you are not having a regular bowel movement. If you have an ileostomy it is uncommon for it to stop working. Consult your GP or stoma care nurse should this happen. If you have a colostomy, you may require a gentle laxative, again your stoma care nurse can advise on the most appropriate action. 

Prolapsed stoma:

A prolapsed stoma can be alarming as it can happen fairly quickly. Some prolapses can extend past 6 inches, which can make fitting an appliance very tricky. It can also become debilitating and reduce a person’s quality of life. The prolapse may even be random and at times may shrink back to original size, only to become larger again later. This quick fluctuation in size can make it difficult to measure accurately, so your Stoma Care Nurse will teach you how to measure your stoma yourself and how to make adjustments in your appliance, to accommodate the changes in size. 

Depending on the severity of the prolapse, a referral can be made to the Surgeon for review, but is often not deemed as urgent, unless the prolapsed stoma changes to a very dark/dusky colour, stops functioning or causes pain.  Pain may suggest bowel strangulation which is treated as an emergency.

Weight gain:

If the stoma size has increased in size, it may be worth considering whether you have gained weight recently? If so, this is the most likely reason your stoma has also become larger. This is nothing to worry about, but make sure you measure your stoma size or you could ask your stoma care nurse to help, so you can ensure the aperture is fitting correctly and not too tight around the stoma itself. Remember to check the flange is not resting on new skin folds/creases as well.

 Many people experience dramatic changes in weight following surgery, so it goes without saying your stoma may change with the rest of your body.

Hernia:

Parastomal hernias are caused when part of the bowel pushes through the muscle of the stomach (abdomen). Unfortunately, it can affect a large percentage of ostomates. Hernias can cause a bulge under the skin and as a result, they can then change the shape and size of the stoma making them appear larger and sometimes flatter.

Remember to contact your Stoma Care Nurse, so that they can give you tips to help prevent the stoma and hernia from getting worse. They will also be able to give you advise on a support garment for you to wear, which will help keep the hernia in place during the day time and will also help keeping you  appliance/pouch in place.

If your hernia causes you pain, or causes your stoma to change colour or your stoma stops working you should contact your GP for a review. You can find out more about stoma hernias here

Tips to help with a swollen stoma:

  1. Cold compress – A cold compress can help with swelling of the stoma. Wrap some ice in a towel and place over the stoma and swelling for a maximum of 5minutes. This can be repeated several times. Keep your stoma appliance in place whilst you do this.
  2. Re-sizing the aperture – Make sure you keep an eye on the size of your stoma and especially the measurement of the aperture in your appliance, to check it is still fitting around your stoma correctly. As the stoma swells in size, the aperture will need adjusting to suit the needs of your stoma, to ensure comfort and prevent any sore skin or leaks. It can often become difficult to know what size you are needing, but the template will need to be cut to a larger size for your swollen stoma. Your stoma care nurse can also show you how to adapt the aperture of your appliance (eg: fluting) or use an accessory product such as a seal, to allow for fluctuations in stoma size whilst the appliance is being worn.
  3. Sore skin – to prevent sore skin around your stoma, check the appliance sizing and make sure you are using an appliance which is comfortable and large enough to incorporate swelling for you. This will help reduce any potential issues with the surrounding skin becoming sore.

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