Understanding Stoma Protrusion
A stoma is a surgically created opening on the abdomen that allows waste to exit the body into an external pouch. Observing changes in its appearance, such as protrusion, can be concerning. This article explains why a stoma might protrude and what actions to take.
Stoma protrusion refers to the stoma extending further out from the abdominal surface than usual. Minor, temporary protrusion can be normal during activities that increase abdominal pressure, like coughing or straining. This temporary extension usually resolves once the pressure subsides. However, a significant, persistent, or newly developed protrusion indicates a change in the stoma’s state, requiring proper management.
Common Reasons for Protrusion
One common factor contributing to stoma protrusion is increased pressure within the abdominal cavity. Activities such as forceful coughing, sneezing, straining during bowel movements, vomiting, or lifting heavy objects can exert outward pressure on the abdominal wall. This pressure can temporarily push the stoma outwards, making it appear more prominent than usual. While often transient, chronic or repeated instances of high abdominal pressure can contribute to more persistent protrusion over time.
A parastomal hernia represents a frequent complication where a portion of the intestine or other abdominal contents bulges through the weakened abdominal wall surrounding the stoma. This bulging creates a lump or swelling around the stoma, which can cause the stoma itself to protrude further. The hernia develops due to the surgical opening weakening the abdominal muscles and fascia, allowing internal organs to push outwards adjacent to the stoma. This condition is distinct from the stoma itself prolapsing.
Stoma prolapse occurs when the bowel segment forming the stoma telescopes outwards through the stoma opening, appearing longer and more extended than its typical length. This can result in a significant increase in the stoma’s visible size, sometimes appearing several inches long. Unlike a parastomal hernia, which involves tissue bulging around the stoma, a prolapse involves the stoma’s bowel segment moving through its own opening. The exact cause is not always clear, but factors like increased abdominal pressure, obesity, and the size of the abdominal opening can play a role.
Localized swelling or inflammation around the stoma can make it appear more prominent or protruded. This swelling might be due to irritation from the ostomy appliance, an infection, or other localized tissue reactions. Such inflammation can cause the surrounding tissues to expand, indirectly making the stoma appear to extend further from the body. Monitoring any signs of redness, warmth, or pain alongside swelling is important to identify potential underlying issues.
When to Seek Medical Attention
Seek prompt medical attention if the stoma undergoes concerning color changes. A healthy stoma should appear pink or red, similar to the inside of the mouth. If the stoma turns dark purple, black, pale white, or blue, it may indicate compromised blood flow. These color changes suggest that the stoma tissue may not be receiving adequate oxygen.
Severe or increasing pain at the stoma site or within the abdomen warrants immediate professional consultation. Pain can signal underlying complications such as obstruction, infection, or tissue damage. A complete lack of stoma output, especially when accompanied by nausea, vomiting, or abdominal distention, suggests a potential blockage requiring urgent evaluation. This combination of symptoms can indicate an intestinal obstruction.
The presence of fever or other signs of infection, such as redness, warmth, or pus around the stoma, also necessitates medical assessment. Infections can spread and lead to more severe health issues if left untreated. If a healthcare professional has previously instructed on gentle reduction techniques for a prolapsed stoma, and the stoma cannot be reduced using these methods, medical help should be sought. However, individuals should never attempt to reduce a stoma without prior specific guidance from a medical professional. A sudden, significant increase in the size of the protrusion also requires prompt medical evaluation to determine the cause and appropriate course of action.
Managing and Preventing Protrusion
Employing techniques to minimize abdominal pressure can help manage and potentially prevent stoma protrusion. This includes proper lifting methods, like bending at the knees and keeping objects close to the body. Managing chronic coughs and preventing constipation and straining during bowel movements also lessen outward force on the abdominal wall.
Specialized support garments, such as ostomy belts or binders, provide external support. These garments offer gentle compression, which may help contain mild protrusion and reduce the risk of further prolapse or hernia development. Consult an ostomy nurse or healthcare provider to determine the most appropriate support garment.
Maintaining a healthy weight also reduces pressure on the abdominal wall. Excess abdominal fat can increase intra-abdominal pressure, potentially contributing to stoma protrusion. Gradual weight management strategies can be beneficial long-term.
Ensuring a proper ostomy appliance fit is important for stoma care. A well-fitting appliance provides a secure seal, preventing leakage and skin irritation. While not directly preventing protrusion, a good fit can offer subtle support. Regular medical follow-ups with an ostomy nurse or surgeon are crucial to discuss any changes and receive personalized advice.