This topic is about concerns related to the movement of a stoma and the potential risk of it being constricted by an undersized wafer. The main worry is that if the wafer opening is too small, it might "strangulate" or constrict the stoma. There's also a question about whether constant stoma movement is normal.

Here are some helpful insights and advice:

- A wafer opening that is too tight can indeed constrict the stoma, which might lead to injury, darkening, bleeding, or pain. The stoma should maintain a healthy rosy-red color.

- It's normal for the stoma to change size and shape. It can expand in the warm, moist environment of the pouch and contract when exposed to air, with gas, output, or changes in weight. Therefore, it's important to leave some clearance around the stoma.

- A general rule for sizing is to cut the wafer about 1/8 inch (approximately 2–3 mm) larger than the stoma.

- To fill the gap and prevent leaks while allowing for expansion, you can use a moldable or elastic barrier ring or sealing washer. Some recommended options include:
1. Coloplast Brava Protective Seal
2. ConvaTec Eakin Cohesive Slims
3. Hollister Adapt Barrier Ring
4. Salts (aloe-infused) barrier rings, which are readily available in Canada

- A procedure that many find successful involves:
1. Cutting the wafer hole slightly larger than the stoma.
2. Stretching or molding the barrier ring to fit snugly around the stoma.
3. Applying the wafer over the ring and adding an ostomy belt only if it doesn’t increase tightness on the stoma.

- Be aware of warning signs that the wafer hole is too small, such as a purple or dark stoma, blood on the stoma, pain, or a "slip-knot" tightening sensation under the wafer. If you notice these signs, change the wafer immediately and recut it larger.

- It's normal to go through some trial and error during the first few months. Be patient, keep an eye on your stoma’s color and comfort, and adjust the hole size and accessories as needed.