Your stoma is swollen and sticking out more? This, first of all, is frightening. What you are experiencing most likely is a prolapsed stoma. 

But don’t worry: a stoma prolapse is not life-threatening. With care and management, most cases of the prolapsed stoma can be treated without requiring surgery.

Even if you don’t have a prolapsed stoma, there are a couple of ways to prevent it from happening. 

But let’s no longer wait and tell you directly how to treat a stoma prolapse:

To treat a prolapsed stoma, try the following: Lie down for 20 minutes, apply gentle pressure on the end of the stoma, use a cold compress on the stoma bag, or apply granulated sugar on the stoma for 20 minutes. If your stoma is still prolapsing, contact the hospital for further stoma prolapse management.

To get a deeper understanding of the different ways to treat a stoma prolapse at home, keep on reading! We will further tell you what a prolapsed stoma is and show you its symptoms and cause. Additionally, we will explain you prevention techniques to reduce the risk of a stoma prolapse significantly.

What is a stoma prolapse?

An ostomy prolapse occurs when the bowel sticks out of the stoma opening in the skin further than it is expected. The stoma is protruding out abnormally. This stoma protrusion can be anywhere from 2 to 3 cm long to over 10 cm long.

What does a stoma prolapse look like?

The symptoms of a prolapsed stoma reach from changes in size, length and color and can be one or more of the following:

• The stoma is swollen
• The stoma is telescoping out, protruding 
• The stoma sticks out further than usual
• The stoma becomes purple,  dark red or light pink
• The stoma feels cool by touching it

The appearance of a stoma can change depending on your position; for example, it may protrude when you are standing or sitting, but return to normal when you lie down.

What causes a stoma to prolapse?

A stoma can prolapse for a variety of reasons; the most common of them are:

• Flu or other diseases causes the patient to sneeze or cough a lot; this increases abdominal pressure and can push out the bowel from the stoma. 
• The patient does heavy core exercises or heavy weight-lifting. This increases pressure on the core that can cause the bowel to protrude.  
• The patient gets pregnant. A growing fetus will push other internal organs and increase the risk of a prolapsed stoma. 
• The patient develops a tumor in the abdominal region; like with pregnancy, a large enough tumor in the abdominal can push internal organs, thereby pushing the bowels out of the stoma. 
• The patient’s abdominal support is poorly developed, such as in infants; with infants or people whose abdominal muscles are poorly developed, the muscles may not be able to hold the bowels in place and cause a prolapsed stoma. 
• Obesity; gaining excessive weight can increase abdominal pressure and cause the stoma to telescopically protrude.
• The opening created during surgery for the stoma is excessively large.

How high is the risk of a stoma prolapse?

Stoma prolapse represents one of the most common late complications, occurring in 1–16% of stoma patients. The risk of a prolapse differs between different kinds of ostomies and ages. A US study was conducted between early 1998 to late 2000 with 204 participants who have had ileostomies or colostomies. It is found that the risk of developing a prolapsed stoma is 22% for adults and 38% for children. Furthermore, the risk is greater for people who have had a loop colostomy or loop ileostomy prolapse.

We asked ostomates about their experience with stoma prolapse: “Have you ever had a stoma prolapse? If yes, indicate your kind of ostomy.” The data proves the statement mentioned above:

*This survey was conducted in May2021 among international stoma patients. The data results from 22 voluntary respondents with colostomies, ileostomies or urostomies. It was published in the following stoma-specific facebook group “Ileostomy,colostomy, stoma and bowel support”.

How do I deal with a prolapsed stoma?

In most cases, stoma prolapse management can be done by the patient themself. Often, the prolapsed stoma fixes itself. But if it doesn’t, here are some things you can do if you notice your stoma protruding:

• Lie down for 20 minutes. This allows for your abdominal muscles to relax and reduces pressure around your abdominal region.
• Apply gentle pressure on the prolapsed end of the stoma. This can allow the bowel to return to its original space if your stoma is not swollen.
• If the prolapse appears swollen, use a cold compress, i.e. ice cubes in a plastic bag wrapped with a towel for no more than 5 minutes. Keep your stoma bag on while doing this.
• You can also use granulated sugar to reduce swelling! Apply generous amounts of granulated sugar (it has to be granulated) on the stoma and leave it for 20 to 30 minutes. Granulated sugar works by absorbing any fluids around the stoma creating a fluid gradient and causing the fluids from the stoma to be drawn out. This reduces the swelling and makes it easier for the prolapse to return into the abdominal cavity.

When should I contact a medical professional for a prolapsed stoma?

Even when you are treating the prolapsed stoma yourself, it is important to keep your doctor and nurse in the loop so they know what is going on and can monitor your condition. Your doctor/nurse will be more familiar with your individual case, and can give you advice specific to your treatment.

However, you must immediately go to the hospital in the following cases of a stoma prolapse: 

1. The prolapse appears to be purple, blue, dark red, or light pink; changes in color can be an indication of the stoma not getting enough oxygen and you need to go to the hospital. The prolapse is manageable if it is pink or red in color, warm, and moist. 
2. The prolapse is cool to touch; if the prolapse feels cool, it means that it is significantly below body temperature and can also indicate that it is not getting enough blood flow to keep it warm. 
3. The prolapse is swollen and neither a cold compress nor granulated sugar helps; this indicates a greater underlying issue and you need to go to a hospital. 
4. The prolapse lasts more than an hour and none of the conservative attempts at reducing it works; this could indicate a serious underlying issue and needs to be examined at the hospital.
5. The prolapse is painful; when this happens, you must speak to your doctor or nurse. 

Depending on the severity of the prolapse, the prolapsed stoma can be corrected surgically. Surgery can be conducted using local anesthesia. The process involves resecting the prolapsed part of the bowel and restructuring the stoma to prevent a prolapse from happening again.

How do I prevent a prolapsed stoma?

Whether you have never had a prolapsed stoma but are afraid of the risks, or if you have previously had a prolapse and don’t want it to happen again, you can do the following things to reduce the risk of developing a prolapsed stoma:

• Avoid heavy core exercise and heavy lifting: doctors generally recommend not to lift anything over 10 pounds or 4.5 kilos. 
• Take care not to gain an excessive amount of weight
• Wear support vests or belts
• Discuss with your medical provider the right pouch system for you
• Keep your immunity up through proper diet and exercise, so you can prevent a flu or coughing that could cause a stoma to prolapse.

People with an ostomy can and should exercise, as this article will tell you! You will find a gentle exercise program that will not cause a ostomy prolapse, but rather prevent it by strengthening your core!

If you want to also learn about how to maintain a proper diet while living with a stoma, check out those articles for colostomies and ileostomies that contain an indepth look at maintaining a healthy diet after surgery.

Colostomy: Colostomy Diet: What Can I Eat Without Consequences

Ileostomy: Ileostomy Diet: 10+ Tips & Recipes To Keep You Hydrated

Living with a prolapse: what should I do?

While a prolapsed stoma is not life-threatening, it does require certain changes in your daily routine and how you care for your stoma. Here are some things you need to keep in mind for living with and managing a prolapsed stoma:

• You may need a larger pouch to accommodate both the prolapse and your usual volume of waste.
• You may need to empty or change your pouch more often.

• Adjust the opening of the wafer or switch to a moldable wafer, if the prolapse is very mobile: If it slides in and out depending on your position (lying down or standing up), it can increase the risk of your prolapse getting injured. 
• You must protect the prolapse from external trauma. Anything can cause external trauma, from leaning against counters, contact sports, or even hugging family and friends. Stoma guards, protectors and belts with a stoma prolapse cap can help too, depending on the size of your stoma.
• Consider switching to a one-piece system. Some two-piece systems can injure the prolapse, either by direct contact, by rubbing against the prolapse, or by trapping some of the stomal surfaces between the pouch and the wafer.
• You may need to adjust your clothing in order to prevent your clothes from rubbing against the prolapse and causing injury. Never wear belts or waistbands directly across the stoma, whether you have a bag or not.

A prolapsed stoma can be a scary thing; but after reading this article, you should be able to treat and manage the prolapse. Always remember that you are not alone in what you are going through, and answers and support are available online whenever you need them! Check out this article if you are looking for other ostomates to share your thoughts with and find out about inspiring social media channels!

Furthermore, the use of specific stoma cleansing products, such as Bioderm Stoma Plus, is crucial. This product beats any conventional product as it prevents and even reduces irritation and speeds up healing of the peristomal skin.

In case your question has not been answered yet, we have answered some of the most frequently asked questions about stoma prolapses here:

FAQ

Is stoma prolapse an emergency?

Although stoma prolapses aren’t necessarily an emergency, if the prolapse lasts for more than an hour, appears blue, purple, or dark red in colour, is cool to touch, or is painful, it could be an emergency. In any of those cases, you must visit a hospital as soon as possible.

How far should a stoma protrude?

On average, stomas evert around 2.5 to 3.5 cm above the skin. It is normal for the bowel to protrude about 1.5 to 2.5 cm for colostomies. Generally, you should talk to your physician what is normal for your specific ostomy. Protrusion any greater than what you are used to is considered a prolapsed stoma.

Is it normal for a stoma to change size?

Your stoma will still be swollen right after surgery and as it heals, it is normal for its size to change. Your stoma will likely shrink about 6-8 weeks after surgery, and even more 4-6 weeks after you have been discharged from hospital.

What causes ileostomy prolapse?

Although prolapses can occur after any type of surgeries, the risk of developing a prolapse after an ileostomy is lower than for loop colostomies. Stoma prolapses can occur by any activities or events that cause an increase in abdominal pressure, such as pregnancies, obesity, heavy core exercise, excessive coughing or sneezing.