Ostomy Tips

Prolapsed Stoma: What You Should Know

What is a Prolapsed Stoma?

A prolapsed stoma is when the intestine protrudes through the stomal opening more than it should. It means the stoma looks more extended than usual, varying from 2-3cm to more than 10cm. It may frighten you at first, but usually, it is not serious. Many times, this can be managed at home with conservative treatments. Stoma prolapse becomes problematic when blood flow is compromised, or blockages form in the stoma.

Stoma prolapse is a common complications after the ileostomy or colostomy surgery, and it may occur in as many as 16% of ostomy patients.

What Causes a Prolapsed Stoma?

A stoma prolapse is more common after colostomies than ileostomies and more likely after a loop colostomy than an end colostomy. During a loop colostomy, the intestinal loop is pulled through the opening in the abdominal wall and then cut open and stitched to the skin to create a stoma. If the loop is not well secured inside the body, it can pop through the opening and stick out more. The most common causes of stoma prolapse include:

• Excessive weight gain following surgery.
• Poorly developed abdominal muscular support (commonly seen in infants).
• Increased abdominal pressure due to constipation, pregnancy, tumor, coughing, and sneezing.
• Excessive exertion, such as lifting heavy objects or extensive core exercises.
• A larger hole created during surgery.

How to  take care of a Prolapsed Stoma

As long as the stoma functions normally, it is not too concerning if it remains a healthy reddish color.  You also don’t have to worry if the prolapse naturally reduces in size when you are lying down or can be gently pushed back into place.

If you experience a prolapse, consult your doctor or stoma nurse for advice and support. They can explain how to care for your prolapsed stoma and recommend products to minimize discomfort. They can also tell you what you should look for that may require immediate medical attention.  

A prolapsed stoma will require a few changes to your routine care, such as:

• You may need a larger or longer pouch to accommodate both the prolapse and the usual volume of waste. Also, it is recommended to use a flexible pouching system since those with convex barriers, and rigid flanges can cause stoma injury.
• If the stoma is swollen, you may need to adjust the opening of the flange to incorporate swelling and prevent leaks, sore skin, and ulcerations.
• Consider trying a moldable wafer that will not hurt your stoma if the prolapse slides in and out, depending on your position (lying down or standing up).
• If the skin has become sore due to leakage, you may need to use skin barrier paste or wipes until the skin has healed and is more comfortable. In addition, an adhesive remover can help minimize any skin stripping and discomfort while changing your pouch.
• You may need to drain or change the pouch more often. 
• It is essential to protect the prolapse from external trauma. Therefore, you must avoid activities and daily habits that can cause stoma bruising. Stoma guards, protectors, and ostomy support belts with prolapse straps may work for you, depending on your stoma size.
• You may need to adjust your clothing to prevent them from rubbing against the prolapse and causing injury. 

How to reduce a prolapsed stoma at home

Here are some things you can try at home to fix a prolapsed stoma:

• Try lying flat on your back for 20 minutes.
  • This position can relax your abdominal muscles and reduce pressure on the area, and the stoma may go back into place.
  • Lay flat, and do not attempt to look at the stoma.
  • Doing so can put pressure on abdominal muscles.      
• While lying down - 
  • Apply gentle downward pressure to the end of the stoma to push it back into its usual position.
  • The stoma should slide back into the opening if it is not swollen.
  • Your stoma nurse can guide you on how to do this safely.
  • Before trying this, ensure you have clean hands.
• To reduce stoma swelling -
  • Apply a cold compress to the stoma with the pouch on for no longer than 5 minutes at once.
  • You can also use sugar to reduce swelling.
  • Put a generous amount of granulated sugar onto the stoma and leave it there for 20 to 30 minutes.
  • Sugar draws fluids out of the stoma, which helps reduce swelling and makes it easier for the stoma to return to the abdominal cavity.
• If you have managed to reduce the prolapse - 
  • Stay in a reclined position for at least 30 minutes to avoid immediate prolapse again.

When is surgery needed for Stoma Prolapse?

Surgical intervention may be necessary if conservative measures fail to fix stoma prolapse. Surgery is inevitable when the prolapsed stoma does not shrink, causes pain, hampers blood flow, impacts bowel or bladder activity, or makes it difficult to attach the pouch.

The surgeon will explain the potential risks and benefits of a stoma revision and whether this is an option for you.

The surgery is performed under local anesthesia. The surgeon will remove the prolapsed section of the bowel and either re-suture the stoma to your abdominal wall or move it to a new site.

Alternatively, the surgeon may perform stoma reversal surgery if that is possible.

When to seek emergency medical care

Get immediate medical attention if:

• Your stoma turns blue, purple, brown, or black.
• The stoma is bleeding or painful.
• The prolapse is cool to the touch.
• The stoma has been prolapsed for more than 1 hour, and no conservative measures make it shrink.
• There has been no stool output for several hours, and this is accompanied by nausea, vomiting, or abdominal pain.

Can a Stoma Prolapse be prevented?

Prevention is not always possible, but you can do the following things to minimize the risk of developing a prolapsed stoma:

• Strengthen abdominal muscles.
• Avoid lifting excessively heavy objects.
• Maintain moderate body weight.
• Eat a balanced diet with plenty of fiber and drink lots of water to make bowel movements softer.
• Boost your immunity to help avoid diseases that may cause frequent coughing.
• Wear support vests or ostomy belts whenever required.

HPFY hosts a complete line of ostomy products, such as ostomy bags, skin barriers, ostomy belts, adhesive removers, barrier wipes, and much more, to help manage stoma prolapse. Explore today!

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