A prolapse of the stoma can be quite alarming if it happens to you! Try not to panic, it is not life threatening. The good news is the majority of prolapses can be treated without surgery. It is a common late complication following stoma formation. Although prolapses can occur in any types of ostomy, it is more commonly found in loop ostomies. Here are some tips to help you understand why it has happened and what steps can be taken.
What is a prolapsed stoma
A prolapsed stoma is when the stoma suddenly becomes longer than normal. It may have the appearance of protruding further from the body than it should.
Why does it happen?
A stoma can occur if the abdominal muscles or the muscles surrounding the stoma become weak. Other reasons it may happen include:
- Weight gain/obesity
- Lifting heavy objects
When your abdominal muscles become weak, your stoma can easily pop out when you are moving throughout the day.
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.
What to do if your stoma prolapses?
If you experience a prolapse, it is a good idea to call your stoma nurse for support. The stoma nurse will advise you how to care for your prolapse and stoma and what you need to look out for. If the prolapse 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.
As long as the prolapse naturally reduces in size when you are resting/lying down, or can be very gently pushed back into place then it isn’t a cause for concern.
When should I worry?
If your stoma changes to a purple or black colour, becomes painful, ulcerates, or stops functioning then you should contact your Stoma Nurse or GP.
Will the stoma change appearance?
If your stoma prolapses, it can often become more swollen and longer in size. It’s a good idea to cut your aperture size accordingly which will help 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 and to allow 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-suring 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.