A stoma is a surgically created opening on the abdomen that allows waste to exit the body into an external pouch. A prolapsed stoma occurs when the bowel telescopes out through this opening, making it noticeably longer and larger than its usual size. While a prolapse can be alarming, it is often a manageable condition and not a medical emergency, provided the tissue remains healthy. This guidance details steps for safe, at-home management, but it is not a replacement for instruction from a Wound, Ostomy, and Continence (WOC) nurse or physician.
Recognizing Stoma Prolapse
A prolapsed stoma is identified primarily by a visible increase in the length of the exposed bowel, sometimes extending several inches from the abdominal wall. It may also appear swollen and enlarged in diameter. This protrusion is caused by a portion of the intestine pushing through the abdominal opening, often due to increased pressure inside the abdomen from activities like coughing or lifting.
The most important factor to check is the color of the exposed bowel tissue, which should maintain a healthy, beefy red or pink appearance. This color indicates good blood flow, necessary for the tissue to remain viable. Temporary swelling or minor protrusion may occur after physical activity, but a true prolapse will be significantly longer and may not reduce immediately upon rest. Any change in color, particularly to dark red, purple, or black, signals a potential loss of blood supply and requires immediate medical attention.
Essential Steps Before Attempting Reduction
Maintaining a calm demeanor is the first step, as anxiety can increase muscle tension and abdominal pressure, making reduction more difficult. Before any physical manipulation, carefully remove the existing ostomy appliance to avoid further trauma to the enlarged stoma. The stoma’s size makes it susceptible to injury from the rigid edges of an appliance.
Next, assume a position that minimizes intra-abdominal pressure, such as lying flat on your back with your head slightly reclined. Lying down relaxes the abdominal muscles and can sometimes cause the prolapse to spontaneously reduce within 15 to 20 minutes. Gather necessary supplies, including disposable gloves, a water-soluble lubricant, and household granulated sugar, in case a manual attempt is needed. Even if the stoma reduces spontaneously, assess the tissue for any signs of injury or excessive swelling before reapplying a new appliance.
Techniques for Gentle Prolapse Management
If the stoma does not reduce spontaneously after resting in a supine position, gentle non-surgical techniques can be attempted. The prolapsed segment often becomes swollen with fluid (edematous), making manual reduction challenging until this swelling is addressed. The use of cold compresses or a hypertonic solution can help reduce the size of the stoma before manual pressure is applied.
The application of household granulated sugar works by an osmotic effect, drawing excess fluid out of the swollen tissue. To use this method, liberally cover the entire surface of the prolapsed stoma with the sugar and leave it in place for 15 to 30 minutes. As the sugar draws out the fluid, a syrupy liquid will form, which is harmless. This osmotic action shrinks the stoma’s diameter, facilitating a safer manual reduction attempt.
Following the sugar application, or if the stoma is not significantly swollen, manual reduction can be attempted using gentle, sustained pressure. With lubricated, gloved fingers, apply continuous, even pressure to the tip of the prolapsed stoma, directing the bowel inward toward the abdominal wall. The goal is a steady push, not a quick or forceful one, as excessive force can cause injury. If reduction causes a significant increase in pain, or if the stoma does not begin to slide back in easily, the attempt should be stopped immediately.
Warning Signs and When to Contact a Healthcare Provider
While at-home management is often successful, certain signs indicate a serious complication requiring immediate medical attention. The most significant warning sign is a change in the stoma’s color from the expected red or pink to a dark purple, dusky, or black hue. This color change suggests a compromised or cut-off blood supply (ischemia or strangulation), which can lead to tissue death.
Immediate care is also required if the prolapse is accompanied by signs of a potential bowel obstruction, such as severe abdominal pain, nausea, or persistent vomiting. If the prolapse cannot be gently reduced after repeated attempts, including the use of sugar, within 30 minutes, it is considered irreducible and requires professional medical intervention. Even if the prolapse is successfully reduced at home, a follow-up with a WOC nurse is advisable to assess the appliance fit, as the stoma size may have changed, requiring a new pouching system.