A stoma is a surgically created opening on the abdomen that allows a portion of the bowel or urinary tract to exit the body, diverting waste into an external pouch. A stoma prolapse is a complication where the bowel segment telescopes outward through the abdominal opening, causing it to lengthen significantly. This extension of the intestinal tissue can be alarming, but understanding the visual differences between a healthy stoma and a prolapsed one is the first step toward appropriate management. While concerning, this condition does not always represent an immediate medical crisis.
Visual Differences Between Normal and Prolapsed Stomas
A healthy, functioning stoma should appear moist, shiny, and similar in color to the inside of the mouth, typically a beefy pink or red. This color indicates a robust blood supply to the intestinal tissue, which should also feel warm to the touch. Most stomas are designed to protrude slightly from the skin, with an ideal projection of about two centimeters, helping to direct output into the collection pouch. The size of a normal stoma usually ranges between 25 and 45 millimeters in diameter and can naturally fluctuate slightly throughout the day.
In contrast, a prolapsed stoma is defined by its substantial increase in length, often projecting far beyond its typical size. This telescoping effect makes the stoma look like a sausage-like projection, sometimes doubling or tripling its original length, with protrusions ranging up to ten centimeters. The prolapse may also appear swollen and enlarged in diameter due to the extra tissue extending outward.
The prolapse may be positional, meaning it is more apparent when standing or straining and may spontaneously reduce when lying down, which lessens internal abdominal pressure. The most concerning visual sign is a change in color, which suggests the blood supply to the extended bowel is restricted, a condition known as strangulation. An emergency exists if the stoma turns a dark red, purple, brown, or black color, or if it feels unusually cool to the touch. These color changes signal tissue ischemia, meaning the exposed bowel tissue is not receiving adequate oxygen, and require immediate medical attention.
Common Reasons for Stoma Prolapse
Stoma prolapse occurs when the internal segment of the bowel is not securely fixed within the abdominal wall, allowing it to move out through the surgical opening. The primary mechanical factor contributing to this complication is increased intra-abdominal pressure. Activities that raise this pressure, such as forceful coughing, sneezing, straining during bowel movements, or heavy lifting, can push the bowel segment outward.
Certain physical conditions also predispose an individual to prolapse, including obesity or significant weight gain, which places strain on the abdominal structures. Weakness in the abdominal muscles, whether due to poor muscle tone or surgical disruption, reduces the support needed to keep the stoma segment in place. Pregnancy can also be a factor due to the prolonged increase in abdominal pressure it causes.
The initial surgical technique plays a role, particularly if the opening created in the abdominal wall was too large, providing insufficient constriction around the stoma. Prolapse is also statistically more common in patients with a loop colostomy compared to those with an end colostomy, likely because a loop stoma involves bringing a mobile segment of the bowel through the opening.
Immediate Response and Treatment Options
Upon noticing a stoma prolapse, the first step is to remain calm and immediately contact a stoma care nurse or other healthcare provider for guidance. Immediate actions are focused on reducing the prolapse and preventing complications, especially if the stoma appears swollen. A person should lie down flat on their back for approximately 20 minutes, which helps to relax the abdominal muscles and lower the internal pressure, sometimes allowing for a spontaneous reduction of the bowel.
If the stoma remains prolapsed, gentle, continuous pressure may be applied to the end of the bowel to encourage it to slide back into the abdomen, but this should only be done if instructed by a healthcare professional. Applying a cold compress, such as ice wrapped in a towel, to the swollen stoma for short periods can help reduce the swelling. Granulated table sugar can also be applied directly to the prolapsed tissue, as its high concentration draws fluid out of the swollen tissue, aiding in reduction.
It is important to check the stoma for any signs of restricted blood flow, which necessitates an emergency room visit. If the stoma changes color to purple or black, feels cool, or if the person experiences persistent abdominal pain, vomiting, or no output, these are signs of strangulation or obstruction. For a long-term prolapse that can be managed conservatively, adjusting the ostomy appliance is necessary; the opening of the flange must be enlarged to accommodate the stoma’s new size, preventing the edge from rubbing and causing trauma to the bowel. Surgical intervention, such as stoma revision or relocation, is generally reserved for cases that cannot be managed conservatively or where complications like strangulation are present.