This topic is about managing a transverse colostomy that presents some unique challenges, such as prolapsing, retraction, and skin protection issues. The person dealing with this situation has a stoma that frequently changes size, making it difficult to manage. Here are some helpful insights and advice for handling these challenges:

- The stoma, affectionately called "Beastie," can retract to just below skin level or prolapse significantly, with its size varying from about 33 mm to 42 mm in diameter.

- The output is consistently liquid or porridge-like and acidic. Due to dietary restrictions, thickening the output is challenging, with pork or chicken gelatin providing only partial help.

- Current management routine includes:
- Using barrier rings like Dansac or Eakin, which are hand-cut to fit the stoma's changing size.
- Employing one-piece soft-convex pouches such as Convatec Esteem drainable or Coloplast Charter high-output, both cut to 40 mm and feathered for expansion.
- Utilizing pouch belts and a support belt, with an average wear-time of 24 hours due to leaks and stinging.
- Trying water washouts and adding a pinch of bicarbonate in the pouch to reduce stinging.
- Maintaining a high-volume diet of non-starchy fruits and vegetables, nuts, eggs, meat, and fish, leading to about five pouch empties per day.

- The person has three main questions:
1. Are there convex pouches or systems that can better handle the stoma's rapid size changes? Would a two-piece system be beneficial?
2. With 40% of the stoma circumference separated from the peristomal skin, how should this be managed? Is holding off or opting for surgery better?
3. Do others with transverse-colon ostomies experience such dramatic shape-shifting of their stoma?

Additional advice and insights include:

- For thickening output:
- Consider using Metamucil (psyllium) to firm up the output, as many colostomates find it effective.
- Gel-sachets or absorbing beads like "Pearls" can help, though multiple sachets may be needed due to frequent emptying.

- For appliances that accommodate large, fluctuating diameters:
- Convatec Moldable Technology wafers allow you to adjust the opening to the stoma's exact size, expanding and contracting without cutting. Request samples from Convatec.
- Explore other generic moldable base plate products that work on the same principle.

- For medical follow-up:
- The separation between the stoma and skin might allow more freedom for prolapsing or retracting. If possible, see a surgeon promptly to assess and potentially re-anchor or revise the stoma.

- For general support:
- Other members with transverse or sigmoid colostomies report only minor size changes, so this level of variability is unusual. Sharing detailed measurements and photos with a stoma nurse or surgeon can help tailor a solution.