Has your stoma suddenly grown longer, leaving you concerned and confused? Don’t panic – you may have a stoma prolapse. This is a common stoma problem that can be alarming, but is usually nothing to worry about. Read our guide to stoma prolapses so you know what to look out for and what you should do if you have one.
What is a stoma prolapse?
A stoma prolapse is when the bowel pushes through the opening for your stoma and protrudes past the skin and out of your body further than usual. This can be as small as 2cm to more than 10cm, and it may even completely fill up your stoma bag. They can happen suddenly. Although frightening, this is usually not serious, but you should ask your stoma nurse to review it.
This can happen with any type of stoma, including colostomy, ileostomy and urostomy.
It is different from a parastomal hernia, which is where the bowel pushes past an area of weak muscle and bulges against the skin.
Less than 1 in every 100 patients with a stoma experiences a prolapse within the first 3 weeks of stoma surgery. It is more common if you have a loop stoma – about 1 in 4 people with a loop transverse colostomy will get one. People with an end colostomy only have about a 3 in 100 chance. (source)
What causes a stoma to prolapse?
There are a number of different factors that can contribute to a stoma prolapse, but it may have no apparent reason. Some typical causes include:
- The opening in your abdominal wall was cut too large during surgery
- Pressure in your abdomen caused by coughing, sneezing, pregnancy, a tumour, etc.
- Exertion such as heavy lifting
- Obesity
- Low abdominal muscle (more common in infants)
If your stoma has prolapsed before, these factors are likely to cause it to happen again at some point in the future.
How to prevent a stoma prolapse
There are steps you can take to reduce the risk of your stoma prolapsing, including:
- Gently holding your abdomen when sneezing or coughing
- Avoiding heavy lifting and strenuous activities soon after stoma surgery
- Gradually returning to exercise
- Gently increasing the strength of your abdominal muscles with stoma-safe exercises
- Wearing a support garment for strenuous activities
- Lifting heavy items safely
- Maintaining a healthy weight
How to fix a stoma prolapse
But what can you do if your stoma has prolapsed? There is a chance it may fix itself and go back into the body – more likely to happen when you lie down and your abdominal muscles relax. You may want to wear a stoma shield to help prevent the prolapse from recurring.
However, you should always talk to your stoma nurse or another medical professional if your stoma has prolapsed and follow their advice. This may include using specialist stoma pouches or abdominal support belts. They may suggest you use cold compresses to help reduce the swelling.
Your stoma nurse may attempt to manipulate the prolapsed stoma back into the body. They might use sugar for this. Don’t attempt this yourself without medical supervision.
Is a stoma prolapse dangerous?
Although alarming, a stoma prolapse is typically not dangerous or an emergency. However, keep an eye on the bowel and note if it becomes darker or black in colour because this requires urgent medical attention.
Contact a stoma specialist if your stoma has been inactive for longer than is usual for you, as this could be a sign of a blockage. Also, seek help if you are experiencing pain.
If a stoma prolapse is too large to manage conservatively, or it has caused other problems such as excessive bleeding, it may require surgery. This could include removal of the prolapsed section and resiting the stoma, although this is rare. Most people can manage their stoma prolapse without the need for surgery with the support of their stoma nurse.
Problems caused by a prolapsed stoma
Although generally not dangerous, stoma prolapses can cause problems that make your life as an ostomate more challenging. For example, the prolapsed bowel and the moisture it produces may irritate your skin and affect the adhesion of your stoma appliance, which could lead to leakage. It may also cause your stoma to produce more mucus than usual, which again could impact the seal of your appliance to your skin. To tackle this, you may benefit from changing your appliance more often and using barrier films to protect your skin.
Plus, you may find it challenging to know how big to cut the baseplate of your stoma bag if you tend to prolapse; it will be much larger than normal. If the baseplate is not cut to the right size (snug to your stoma), this again can lead to leaks. You could hold off on precutting your baseplates so that you can cut them to a bigger size if needed. Ensure you always have plenty of spare supplies when out and about. Read our guide to peristomal skin protection
With more bowel exposed, there is a greater chance of it getting knocked and bleeding. This is usually nothing to be concerned about, and gentle pressure should stop it. However, if it is bleeding heavily and will not stop, seek medical attention.
Conclusion
Always get in contact with a medical professional if your stoma has prolapsed and follow their advice for managing it. This can be a worrying issue for ostomates, but with the right knowledge and care, your prolapsed stoma should not impact your quality of life.
