A stoma is a surgically created opening on the abdomen that allows waste to leave the body, typically following an ostomy procedure like a colostomy or ileostomy. It is formed by bringing a section of the bowel through the abdominal wall and stitching it to the skin. While a stoma is meant to protrude slightly, a noticeable change in its length or size is referred to as a protrusion or prolapse. Understanding the difference between a minor fluctuation and a true prolapse, and the reasons this happens, is the first step toward proper management. This analysis explains why the bowel may telescope outward and outlines the necessary steps for patient safety and care.
Identifying Stoma Prolapse and Protrusion
A stoma prolapse occurs when the bowel telescopes out through the opening, causing the stoma to become longer than its usual, fixed length. This change can vary widely, sometimes extending a few centimeters, but occasionally protruding more than ten centimeters. The prolapse may be intermittent, appearing when standing and retracting when lying down, or it can be constant.
A simple protrusion is often temporary swelling or lengthening, which can be a normal consequence of increased activity. A true prolapse is a significant and persistent increase in the stoma’s length and circumference. The prolapsed bowel may also appear swollen due to fluid pooling at the end of the extended tissue. Monitoring the length, especially when standing upright, helps determine the extent of the change.
The prolapsed tissue can rub against the ostomy appliance, leading to irritation, bleeding, or small sores on the mucosal surface. This complication creates difficulty in achieving a secure seal for the ostomy pouch, which can lead to frequent leaks and subsequent skin irritation around the stoma.
Underlying Causes of Stoma Prolapse
The primary mechanism leading to a stoma prolapse is an increase in intra-abdominal pressure combined with anatomical or surgical factors. Any force that pushes the bowel tissue outward can cause it to extend through the stoma opening. This pressure increase can be acute, such as from severe coughing, sneezing, or forceful straining during a bowel movement.
Chronic conditions that elevate abdominal pressure, like chronic obstructive pulmonary disease (COPD), obesity, or pregnancy, also increase the risk over time. Lifting heavy objects creates a sudden increase in pressure that can force the bowel to prolapse. A stoma that has prolapsed once is more susceptible to doing so again whenever abdominal pressure is raised.
Surgical technique contributes to the risk, particularly if the opening created in the abdominal wall is too wide. An excessive orifice allows too much space for the bowel to move and push through. If the bowel tissue is not sufficiently fixed to the abdominal wall, or if there is a redundant, mobile section of the intestine, these factors permit the bowel to telescope outward.
Prolapse occurs more frequently in loop ostomies compared to end ostomies, as the loop structure may leave more internal space for the bowel to shift. Weakness in the abdominal fascia or muscles surrounding the stoma site further compromises the structural support. This lack of support, combined with the continuous force of intra-abdominal pressure, causes the prolapse.
Urgent Symptoms Requiring Immediate Medical Attention
While most prolapses are not medical emergencies, certain signs indicate a severely compromised stoma requiring immediate care. The most serious warning sign is a change in the stoma’s color from a healthy red or pink to a dark red, purple, brown, or black hue. This discoloration suggests that the blood supply to the extended bowel tissue has been cut off, a condition known as ischemia or strangulation.
Severe pain in the stoma or abdomen is another urgent symptom, as is significant, continuous bleeding from the stoma itself. Patients must seek emergency medical help if they experience an inability to pass stool or gas into the ostomy pouch for several hours. This is especially true if accompanied by nausea, vomiting, or abdominal distention, which can indicate a bowel obstruction caused by the trapped, prolapsed segment.
If the stoma has been prolapsed for over an hour and attempts at gentle reduction have failed, medical attention is necessary. Contact emergency services or a specialized ostomy nurse immediately. Do not attempt forceful self-reduction, as this can cause severe trauma to the bowel.
Patient Management and Treatment Options
Once a non-urgent prolapse is identified, initial management focuses on reducing the protrusion and swelling. A common temporary measure is to reduce intra-abdominal pressure by lying down flat on one’s back for about 20 minutes. This position relaxes the abdominal muscles and may allow the bowel to slide back into the abdominal cavity on its own.
If the prolapsed stoma is swollen, a healthcare provider may recommend applying a cold compress, such as a towel-wrapped ice pack, to the stoma for short intervals to reduce edema. Another technique involves applying granulated table sugar directly to the prolapsed tissue. The sugar works through osmosis, drawing fluid out of the swollen stoma and helping to decrease its size enough for it to retract.
Long-term management depends on the severity and frequency of the prolapse. Adjusting the ostomy appliance is often necessary, which may involve cutting the pouch opening larger to accommodate the extended stoma and prevent trauma. Specialized support belts or abdominal binders can be worn to provide external support and limit the movement of the bowel.
Surgical intervention is reserved for cases where the prolapse is unmanageable, recurrently obstructs the bowel, or is compromised and non-reducible. Surgical options include revising the stoma by removing the excess bowel and re-suturing the stoma to the abdominal wall. In some instances, the surgeon may choose to relocate the stoma entirely to a new site on the abdomen.