This topic is about managing a recessed, stenosed stoma that keeps closing. A stoma is an opening created during surgery to allow waste to leave the body, and sometimes it can become narrowed or recessed, causing discomfort and complications. Here are some insights and advice for dealing with this situation:

- Eleven weeks after surgery, the stoma opening has narrowed significantly, causing painful cramping and thin output. Regular self-dilation hasn't been effective in stopping the narrowing.

- The surgeon suggested an outpatient procedure to enlarge the opening, but the patient is unsure about this approach and is seeking advice from others with similar experiences.

- After a manual dilation by the surgeon, the cramps stopped, and the output returned to normal, leading to the cancellation of the scheduled revision. The patient is now looking for clearer guidance on self-dilation techniques.

- The patient has found that using a Coloplast "Convex Click" wafer provides a better seal and reduces leaks. They are also hoping to regain strength and return to swimming, while looking for long-term strategies to prevent the stoma from narrowing again.

Here are some helpful tips and insights:

1. Consider seeking a second opinion from another colorectal or ostomy surgeon if you're not confident in the current plan.

2. Small, skin-level stomas can work well, but if enlargement is needed, discuss whether a flat stoma is suitable for your lifestyle, such as swimming.

3. For self-dilation:
- Use finger cots or finger condoms with Vaseline for gentle insertion during appliance changes.
- Some nurses recommend using a stainless-steel Hager dilator set, gradually moving to larger sizes.
- Be prepared for a learning curve; firm, steady pressure may be needed to pass the tight muscle ring.

4. Keep the stool or output thin to reduce pressure and cramping. Adjust your diet and hydration until the stoma opening is larger.

5. For recessed or stenosed stomas, consider using deep convex or firm convex barriers from major brands. The Coloplast Convex Click has been reported to improve wear time and reduce leaks.

6. Non-surgical options that might help include:
- Modest weight loss to reduce abdominal fat.
- Visceral massage or physical therapy to loosen scar tissue and adhesions.
- Pain management consultation if muscle tightness is causing retraction.

7. Long-term dilation may be necessary for chronic conditions. Sticking to a dilation schedule is important to prevent the stoma from narrowing again.

8. Use neutral terms like "stool," "output," or "feces" if it makes discussions easier. Adding humor, like naming the stoma, can also help with coping.