Medical Oncologist
CION Cancer Clinics
When a stoma pushes out, sinks or narrows | CION Cancer Clinics
Stoma prolapse, retraction and stenosis are three changes in a stoma's shape. A prolapse pushes out further than usual, a retraction sinks to or below the skin, and stenosis narrows the opening. The first sign is often a leak or a bag that fits badly. Most are managed with a better-fitted bag and support wear. A dark or black stoma needs hospital care today. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What are stoma prolapse, retraction and stenosis?
- How do the three problems look, and what usually helps?
- What do the words the stoma nurse writes mean?
- What can you do when the stoma suddenly looks longer?
- When is surgery considered, and who might it not suit?
- What do families believe about these problems that is not true?
- Common questions about stoma prolapse, retraction and stenosis
The short answer
What are stoma prolapse, retraction and stenosis?
They are three changes in the shape of a stoma. A prolapse is a stoma that pushes out further than usual, a retraction is one that sinks down to or below the skin, and stenosis is an opening that narrows. Most are managed with changes to the bag and support wear, and some need surgery.
Why a stoma changes shape
A stoma is a living piece of bowel, not a fixed fitting. Its size and position shift in the weeks after surgery as swelling goes down, and they can keep changing over the years with weight, pressure inside the tummy and healing of the tissues around it.
Why it matters to you
Each of these changes affects how well the bag seals. The first sign is often a leak, sore skin or a bag that suddenly fits badly. Noticing the change early gives your stoma nurse the chance to fix the fit before the skin breaks down.
What this page cannot do
It cannot tell you which of these you have, or how serious it is. A stoma nurse or surgeon needs to look at the stoma, ideally both lying down and standing up.
Take a photo of your stoma when it is healthy. It makes it far easier to show a nurse what has changed.Side by side
How do the three problems look, and what usually helps?
They can look alarming. Many are managed well without an operation once the fit of the bag is right.
Prolapse
The stoma becomes longer and sticks out further, often when you stand, cough or strain. It may slide back when you lie down. It is more common with a loop stoma.
What usually helps
- A bag with a larger, flexible opening
- A support belt or garment
- Easing it back while lying down, if taught
Retraction
The stoma sinks to skin level or below it, so output runs under the baseplate. It can happen early, from tension on the bowel, or later with weight gain.
What usually helps
- A convex bag that presses the skin down
- Seal rings and a support belt
- Keeping weight steady
Stenosis
The opening narrows, often from scar tissue. Output may become thin like a ribbon, harder to pass or crampy, and blockages become more likely.
What usually helps
- Softer output through diet
- Gentle stretching by a nurse or doctor only
- Surgery to remake the opening
Not sure whether this applies to you?
Ask an oncologistOn your notes
What do the words the stoma nurse writes mean?
- Loop stoma
- A stoma made by bringing a loop of bowel to the surface, often as a temporary stoma. It is more prone to prolapse.
- Convex appliance
- A bag whose baseplate curves outwards, pressing gently on the skin so a flat or sunken stoma sits higher.
- Reducible
- A prolapse that slides back in when you lie down or press gently.
- Mucocutaneous separation
- The stitched join between the stoma and the skin coming apart. It can lead to retraction and needs a nurse's care.
- Dilatation
- Gently stretching a narrow stoma opening. Only a trained nurse or doctor should do it.
- Refashioning
- An operation to remake the stoma.
At home
What can you do when the stoma suddenly looks longer?
Check the colour first
A healthy stoma is moist and red or pink. If it is dark red, purple, grey or black, stop here and go to an emergency department.
Lie down and relax
Lie flat on your back for a while. Many prolapses slide back on their own once the pressure in the tummy drops.
Ease the swelling
A cool, damp cloth over the stoma can reduce swelling. Some stoma nurses teach a method using sugar to draw fluid out. Use it only if you have been shown how.
Refit the bag and call
Cut the baseplate slightly larger so it does not squeeze the stoma. Then tell your stoma nurse, even if it has gone back in.
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When a changed stoma cannot wait
Go to the nearest emergency department today if the stoma turns dark red, purple, grey or black, if a prolapse becomes hard and painful and will not go back, or if output stops with cramps or vomiting. Do not keep pushing a stoma that will not go back. Say that you have a stoma and what has changed.
Treatment
When is surgery considered, and who might it not suit?
Surgery is usually considered when the change cannot be managed with bags and support wear, when leaks keep damaging the skin, when blockages keep coming back, or when the blood supply to the stoma is at risk.
What the operation may involve
For a prolapse, the surgeon may shorten the stoma or fix it more firmly. For retraction or stenosis, the stoma may be remade or moved to a new spot. If the stoma was meant to be temporary, the team may discuss whether an earlier reversal is possible instead. Ask your centre which of these it offers and why.
Who it might not suit
Another operation carries its own risks. For someone who is frail, has serious heart or lung disease, or is in the middle of cancer treatment, the team may feel that careful bag fitting is the safer path. That decision is made with you, not for you.
Questions to take to the appointment
Ask what is causing the change, whether it is likely to get worse, what happens if you wait, and how the bag and daily routine will change after any operation.
Commonly believed
What do families believe about these problems that is not true?
"A stoma that sticks out further will burst."
A prolapse looks frightening but is usually not dangerous on its own. What matters is the colour, whether it goes back, and whether output continues. Those are the signs to watch.
"The stoma is sinking, so it has stopped working."
A retracted stoma usually still works. The trouble is the seal. A convex bag and a belt often put that right, so call your stoma nurse before assuming anything more.
"We can stretch a narrow opening with a finger at home."
Stretching a stoma without training can tear it and cause bleeding or scarring that makes the narrowing worse. Leave this to a nurse or doctor.
"These changes mean the cancer is back."
They are almost always caused by the mechanics of the stoma, weight and pressure. If your team has any concern, they will explain what tests they want and why.
Questions we are asked
Common questions about stoma prolapse, retraction and stenosis
Is it normal for a new stoma to shrink?
Yes. A stoma is swollen after surgery and gets smaller over the following weeks. That is not retraction. Measure it every time you change the bag during this period, and cut the baseplate to the new size so the seal stays snug.
Can I push a prolapsed stoma back in myself?
Only if your stoma nurse has shown you how and it goes back easily while you lie down. Never force it. If it will not go back, is painful or changes colour, go to hospital instead of trying again.
Why does my bag keep leaking after I gained weight?
Extra weight around the tummy can pull the skin up around the stoma so it sits lower, which is a form of retraction. A convex bag or a seal ring often helps. See your stoma nurse and ask them to check the fit standing and sitting.
My output has become thin like a ribbon. What does that mean?
It can be a sign that the stoma opening is narrowing. It is worth telling your stoma nurse or surgeon soon, before a blockage happens. They may examine the opening and suggest ways to keep the output softer.
Does a prolapse mean the stoma needs reversing now?
Not necessarily. Reversal depends on the reason the stoma was made, your cancer treatment and your recovery. A prolapse may be one of the things your team weighs, but it does not decide the timing on its own.
Can a support belt help with a prolapse?
Often, yes. A belt or support garment with an opening or soft cover over the stoma can keep a prolapse from sliding out as far. Ask your stoma nurse to measure you, as a tight belt pressing on the stoma can do harm.
Which foods help if the opening is narrow?
Foods that keep output soft usually help, with enough fluid through the day. Fibrous foods such as raw coconut, corn and fruit skins are more likely to get stuck. A dietitian can adjust this to your own stoma and treatment.
Is any of this caused by something we did wrong?
Rarely. These changes happen after careful surgery and careful care at home. Heavy lifting and weight gain can add to them, but most families have done nothing wrong. The useful step now is getting the fit checked.
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Sources
- NHS — Colostomy
- NHS — Ileostomy
- American Cancer Society — Ostomies
- Macmillan Cancer Support — Cancer information and support
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
What a Healthy Stoma Looks LikeThe normal colour and size to compare againstMeasuring and Cutting the BaseplateRefitting the bag as the stoma changesParastomal Hernia: Prevention and TreatmentA bulge beside the stoma rather than in itStoma Reversal: What to ExpectIf your stoma was meant to be temporary
Talk to us
Has the stoma changed shape?
Call the helpline and describe what you are seeing. We will help you reach the right surgical team. One helpline serves every CION centre.