A stoma is a surgically created opening on the abdomen that redirects the body’s internal waste elimination process, typically following a colostomy or ileostomy procedure. This opening allows stool or urine to pass out of the body into an external pouching system. While a stoma significantly improves quality of life for many, it is not without potential complications. One common issue that can arise is a stoma prolapse, where a section of the bowel telescopes outward through the abdominal opening. Understanding this complication is important for anyone living with an ostomy, as prompt recognition can prevent more serious problems.
Understanding Stoma Prolapse
A stoma prolapse occurs when the bowel protrudes further out from the abdomen than its intended length, essentially turning inside out like a telescope. The amount of bowel protruding can vary significantly, sometimes only a few centimeters and other times extending more than 10 centimeters.
A healthy stoma, even when prolapsed, should maintain a moist, reddish-pink color. It may appear swollen or enlarged, but as long as the color remains healthy and output continues, it is generally not an immediate emergency. Prolapses can be sliding, meaning they occur intermittently, often with increased abdominal pressure, or fixed, where the protrusion is constant. A change in color to a dusky, purple, or black shade indicates a lack of blood flow (ischemia or necrosis), which requires immediate medical attention.
Factors That Increase Prolapse Risk
The underlying cause of a stoma prolapse is typically an area of weakness in the abdominal wall surrounding the stoma coupled with increased internal pressure. Elevated intra-abdominal pressure, which can occur from activities like excessive straining, persistent coughing, or heavy lifting, is a major contributing factor.
Patient factors also increase risk. Obesity or significant weight gain following stoma surgery increases pressure on the abdominal contents. Pregnancy also represents a period of dramatically increased intra-abdominal pressure. Prolapse is seen more frequently in certain stoma types, such as loop colostomies. Surgical technique, including creating an overly large opening or inadequate fixation of the bowel to the abdominal wall, can also predispose a person to prolapse.
Immediate Care and When to Seek Help
Upon noticing a stoma prolapse, the first step is to remain calm and immediately assess the stoma’s color and function. If the stoma is pink or red and is still passing stool or gas, it is not an emergency, but you should contact your stoma care nurse. If the prolapse is accompanied by swelling, lying down flat for about 20 minutes can often reduce the intra-abdominal pressure and allow the stoma to slide back in naturally. When lying down, it is important to keep the head back to avoid tensing the abdominal muscles.
If swelling prevents the stoma from reducing, a temporary technique may involve using an osmotic agent like table sugar. Table sugar or icing sugar can be applied directly to the prolapsed tissue for 20 to 30 minutes to draw fluid out of the swollen tissue. Applying a cold compress, like ice wrapped in a towel for no more than five minutes, can also help reduce the edema before attempting gentle manual reduction. If the stoma remains prolapsed, the pouch aperture must be enlarged to accommodate the swollen tissue and prevent trauma or constriction.
Emergency indicators require immediate attention and a trip to the emergency room. These signs include a change in stoma color to dark purple or black, which suggests the blood supply is compromised. Other serious symptoms are severe abdominal pain, excessive bleeding, or a complete lack of output for several hours accompanied by nausea and vomiting, which may indicate a bowel obstruction. In these cases, the prolapse is considered incarcerated or strangulated, demanding urgent surgical review.
Treatment Options for Prolapsed Stomas
For minor or intermittent prolapses, the initial approach is typically conservative management, focusing on observation and changes to the ostomy appliance. This involves regular monitoring by a stoma care nurse and adjusting the pouching system to ensure the enlarged stoma fits without causing friction or trauma. Specialized convex flanges, support belts, or garments can be used to apply gentle pressure to the area, supporting the abdominal wall and reducing the risk of the stoma protruding further.
Surgical intervention becomes necessary when the prolapse is fixed, recurrent, or causes complications like obstruction, persistent pain, or tissue death. One surgical option is a local stoma revision, where the excess bowel is trimmed and the remaining stoma is re-sutured to the abdominal wall to prevent future telescoping. Stoma relocation is a more extensive option, where the original stoma is closed and a new stoma is created at a different site on the abdomen. Techniques to prevent recurrence include fixing the bowel to the internal abdominal wall or ensuring the opening through the muscle is appropriately sized.