A prolapsed stoma is when the stoma suddenly becomes longer than usual. It may have the appearance of protruding further from the body than it should. It can be quite alarming and stressful if it happens to you! But, it is not life threatening….so try not to panic. The good news is the majority of prolapses can be treated without surgery.
Here are some tips to help you understand why a prolapse happens and what steps can be taken.
What causes a stoma to prolapse?
It is often a late complication following stoma formation and although prolapses can occur in any types of ostomies, it is more commonly found in loop ostomies.
- A prolapse can occur if the abdominal muscles or the muscles surrounding the stoma become weak (poor abdominal muscle tone)
- Weight gain/obesity
- It can also happen through possible straining such as lifting heavy objects. When these muscles become weak and you increase your abdominal pressure whilst lifting, sitting up, coughing or sneezing the stoma can pop out when you are up and around during the day.
What to do if your stoma prolapses?
If you experience a prolapse, it is a good idea to call your stoma nurse for advice and support. The stoma nurse will advise you how to care for your prolapsed stoma and also what to look out for. If the stoma is functioning normally and remains a healthy reddish colour, then the prolapse is not too concerning.
It may be a good idea to get a ruler and monitor the size of it, whilst you are standing upright. Then you can check if it gets any longer in size. The amount of protruding bowel may vary from a few cm to more than 10cm.
As long as the prolapse naturally reduces in size when you are resting/lying down, or can be very gently pushed back into place, again this is not worrying.
So, when should I worry?
It’s important to monitor the colour of your stoma when you have a prolapse. If your stoma changes colour to a purple or black colour, becomes painful, ulcerates, or stops functioning, you should contact your Stoma Nurse or GP urgently.
Will the stoma change appearance?
If your stoma prolapses, it can often become more swollen in addition to longer in size. It is a good idea to try and cut the aperture size larger to incorporate this, which will also help to prevent leaks, sore skin and ulceration from the aperture being too tight. Your stoma care nurse can show you techniques for applying your pouch without compromising the adhesion (such as putting a split in the release paper). They can also show you how to use seals and washers and how to adapt the aperture of your pouch to protect your skin as well as allowing room for the prolapse to expand if needed.
If the prolapsed stoma is filling the pouch which you are currently using, your Stoma Nurse will advise some special prolapse pouches which are bigger and longer in length so that the bottom of the prolapse does not rub at the end of the pouch. It may also be worth looking at a two-piece product so that the flange can stay in place for a few days, protecting the prolapse for longer periods. If your prolapse can be reduced, your stoma care nurse may recommend a special type of support garment for you to wear. Some patients find the use of a ‘stoma shield’ helpful, but again only if your prolapse can be reduced. Be cautious of wearing tight clothing or support garments over a prolapsed stoma as this can cause trauma and inhibit the blood supply to the bowel.
What can I do to help?
It is advisable to have a lie down for 20 minutes in the afternoon, to allow the abdominal muscles to reduce the abdominal pressure and the stoma should go back into place. This will also help reduce any further potential swelling. It is important to keep in touch with your Stoma Nurse so your prolapse can be monitored.
Surgical intervention is only required if the blood supply of the bowel is compromised, if there is a bowel obstruction associated with the stoma or if your quality of life is impacted by the prolapse. The surgical procedure will include removing the excess bowel and re suturing the stoma to the abdominal wall, alternatively the surgeon may decide to reverse your stoma (if this is possible) or re-site the stoma and create an end stoma
If I’ve had a prolapse before, can it reoccur?
Yes, if you have experienced a prolapse once it can often happen again in the future. This is due to the weakness which has been created when you increase your abdominal pressure.