Prolapsed stoma

A prolapsed stoma is when a section of your bowel pushes further out through your stoma than it should, making the stoma look longer than when it was formed. It's a known complication of stoma surgery such as a colostomy or an ileostomy, and although it can be alarming to see, however it usually isn't serious.

What are the symptoms of a prolapsed stoma?

The change you notice first is the stoma itself. Instead of sitting close to your tummy, it sticks out further and looks longer and thicker than usual.

The amount of bowel showing varies a great deal. It could be anywhere between 2–3cm and more than 10cm.

You may also notice:

• your stoma looks swollen and produces more mucus than usual
• the skin around your stoma becomes sore or irritated
• your bag doesn't stick as well, so it leaks or lifts at the edge
• the opening you cut in your bag no longer fits, because the stoma has got bigger
• discomfort or pain around the stoma

Your stoma should stay a healthy pink or red colour and carry on working as normal. If the colour changes or it starts to look darker, contact your stoma care nurse straight away.

What causes a prolapsed stoma and who is at risk?

Prolapse is mostly about pressure. Anything that raises the pressure inside your tummy can push the bowel forwards through the opening in your abdominal wall.

Common triggers include:

• coughing or sneezing hard
• straining, including straining from constipation
• heavy lifting or other hard physical effort
• pregnancy, or a tumour taking up space inside your abdomen
• putting on weight after your surgery, or carrying excess weight

You may also be more likely to have a prolapse if the muscles supporting your stoma are weak, or if the opening made in your abdominal wall during surgery was larger than it needed to be. Babies are at higher risk because their tummy muscles have not fully developed.

Once you have had a prolapse, it often happens again whenever the pressure inside your tummy rises. That includes coughing, sneezing, lifting something and even sitting up. When you lie down and the pressure drops, the stoma will often slide back in and return to its usual size.

Are there different types of prolapsed stoma?

A prolapse can happen with any type of stoma. It is recognised after both colostomy and ileostomy surgery, but it is more common in loop stomas than in other kinds.

In a loop stoma, raised pressure inside the abdomen pushes the stoma up through the gap between the abdominal wall and the bowel. This is more likely to happen when the bowel is long or moves around a lot.

Prolapse is also described as a late complication, which means it tends to appear some time after your operation rather than in the first few days.

How is a prolapsed stoma diagnosed?

A prolapse is usually easy to see. Your stoma becomes visibly longer and stands further out from your tummy than it did before.

Even so, you should have it looked at by a stoma care nurse. They will check the colour of your stoma, whether it is still working normally and the condition of the skin around it, then decide whether it can be managed at home.

Regular stoma check-ups also give your nurse the chance to spot changes early and to suggest different products if the ones you are using no longer fit properly.

How is a prolapsed stoma treated?

Treatment without surgery

Most prolapses are managed without an operation. Lying down is usually the first thing to try, because it lowers the pressure inside your tummy and lets the bowel slide back.

1. Lie flat on a bed so that the pressure inside your tummy drops.
2. Lie with your head back, looking up at the ceiling.
3. Resist the urge to watch what you are doing. Lifting your head tenses your tummy muscles and pushes the pressure straight back up.

Your stoma care nurse may also suggest:

• gentle, steady pressure applied to the bowel to help it back into place
• a cold compress placed on the stoma to bring the swelling down
• a support belt or abdominal support garment, put on while you are lying down
• a specialist pouch designed for a prolapsed stoma
• a larger bag, or a bigger opening cut in your existing bag, so it fits the stoma properly
• products to protect and settle sore skin around the stoma.

Your nurse can show you how to do some of these yourself at home.

Surgery

Surgery is considered when the prolapse is too large to manage with the measures above, when the stoma has changed colour, or when it is causing complications such as the bowel becoming trapped or blocked.

The options described in the sources are:

• removing the prolapsed section of bowel and re-forming the stoma
• attaching a new section of bowel and making the stoma again
• creating a new stoma in a different part of your abdomen
• reversing the stoma altogether, where the stoma was only ever meant to be temporary.

A clinical review groups the surgical repairs into three approaches: fixing the bowel in place, shortening the bowel, and closing the gap between the bowel and the abdominal wall around the stoma opening.

When should I see a doctor?

Contact your stoma care nurse or GP if you notice your stoma has prolapsed.

Get in touch sooner rather than later if:

• your stoma changes colour or starts to look darker
• the skin around your stoma is sore
• your bag will not stay on, or the edge of the stoma lifts your bag away from your skin
• your bag fills much faster than it usually does.

Go to your nearest emergency department if you have:

• sharp tummy pain, particularly pain that comes and goes
• bleeding from your stoma
• a stoma that turns purple or black, which can be a sign the tissue is dying
• nausea or vomiting
• loss of appetite