A stoma is a surgically created opening on the abdomen, typically following a colostomy or ileostomy, that allows waste to pass into an external pouch. A stoma prolapse occurs when the segment of intestine forming the stoma telescopes outward through the abdominal wall opening, causing it to lengthen and protrude abnormally. While prolapse is a common complication, its severity ranges from a manageable inconvenience to a medical emergency, depending on specific physical signs.
Recognizing the Physical Characteristics of Prolapse
The most recognizable sign of a stoma prolapse is a noticeable increase in the stoma’s length and size, often making it look like the bowel has “telescoped” out of itself. This protrusion can range from a few centimeters to over ten centimeters in length. The prolapsed segment of the bowel will still appear as the moist, pinkish-red mucosal tissue that is typical of a healthy stoma.
The prolapse may not be constant; it can sometimes appear when a person is standing or straining and then spontaneously reduce or disappear when they lie down. When prolapsed, the stoma tissue frequently becomes swollen, or edematous, due to gravity and the restriction at the abdominal wall opening. This swelling can make it difficult to properly fit the ostomy appliance, leading to leakage or skin irritation around the site. The condition often develops as a late complication following the ostomy surgery, and it is more common in certain types, such as loop ostomies.
Assessing the Urgency: When Prolapse Becomes an Emergency
A simple, reducible stoma prolapse, where the tissue remains pink and healthy, does not typically constitute an emergency. Urgency arises when the prolapse becomes complicated, indicating a restriction of blood flow to the tissue, a condition known as strangulation or ischemia. This distinction dictates an immediate trip to the emergency room.
The most concerning sign is a significant change in the stoma’s color to dark red, purple, brown, or black. This discoloration signals that the blood supply is compromised, which can lead to tissue death, or necrosis. Another emergency indicator is the onset of severe, sudden, or persistent abdominal pain, which may suggest that the portion of the bowel trapped inside the abdomen is also being affected. Furthermore, if the stoma output significantly decreases or stops completely, accompanied by nausea or vomiting, it suggests a bowel obstruction, which is a life-threatening complication. A prolapse that has been present for more than an hour and cannot be gently reduced also requires urgent medical evaluation.
Immediate Response and First Aid Protocol
If a prolapse occurs but the stoma color remains a healthy pink or red, the initial response should focus on gentle, at-home reduction techniques. The patient should lie down on their back for about 20 minutes to relax the abdominal muscles and reduce intra-abdominal pressure. Gentle, continuous pressure can then be applied to the prolapsed tissue with the palm of the hand to help the bowel slide back into the abdominal cavity.
If the prolapsed stoma is swollen, applying a cold compress may help reduce the edema before attempting reduction. Wrap ice in a towel and place it over the bagged stoma for no more than five minutes at a time. Alternatively, granulated table sugar can be applied liberally to the stoma for 20 to 30 minutes, as its osmotic properties draw fluid out of the swollen tissue.
If these gentle measures are successful, the patient should still contact their ostomy nurse or physician for follow-up and appliance adjustment. If the stoma exhibits signs of strangulation—such as dark color, severe pain, or absent output—all attempts at reduction must cease immediately. The patient should call emergency services or go to the nearest emergency department without delay, as attempting to push a strangulated bowel back can cause further damage.
Long-Term Medical Management Options
Once the immediate threat is managed, the long-term approach involves both conservative and potential surgical strategies. Conservative management begins with adjusting the ostomy pouching system to accommodate the increased stoma size. This often involves cutting a larger opening in the wafer to prevent tissue constriction and using a flexible appliance system, since rigid flanges can injure the prolapsed segment.
For recurrent or persistent prolapses, specialized support garments, such as hernia belts with a prolapse cover, can be used to hold the stoma in place and minimize further protrusion. If conservative measures are insufficient, symptomatic, or if the prolapse cannot be reduced, surgical intervention is considered. Options include stoma revision, which re-secures the bowel to the abdominal wall, or in some cases, excising the prolapsed segment or relocating the stoma entirely.