One complication colostomy patients might encounter is developing a stoma prolapse. A prolapse occurs when the colon extends and telescopes outwards through the current stoma. This causes the stoma to grow in length from 2 to 10 inches in some cases. It can be quite shocking when first noticed as most colostomy patients are not expecting their stoma to grow. There are potential complications that can arise from the condition, but a lot of times it comes down to simply learning how to manage and better protect a prolapsing stoma.
There are two types of stoma prolapse. A fixed prolapse, which is less common and is a result of the initial colostomy surgery. More of the colon is brought out of the abdomen than is necessary resulting in a permanent prolapse. The second type is a sliding prolapse. This is the most common and is characterized by a stoma that may increase and decrease in length usually in response to different types of movement or abdominal pressure of the patient.
Causes of Stoma Prolapse
While one exact cause of why a stoma may prolapse is not clear there are several factors that may contribute to an occurrence. Some of these may include:
- Abdominal pressure than can be caused by coughing, pregnancy, sneezing etc.
- Weak abdominal muscles
- Over-sized hole created in the abdominal wall during the colostomy surgery
- Location of stoma
- Type of colostomy
Certain types of colostomies are more prone to prolapsing such as loop colostomies. Transverse loop colostomy patients report the highest rate of prolapse among all ostomy patients. End colostomy patients report lower rates of prolapse and ileostomy patients report the lowest rates. The characteristics of a loop colostomy are believed to play a role contributing to a prolapse.
Stoma Prolapse Complications
Fewer than 10% of cases produce serious complications, with the two most prevalent being the restriction of blood supply to the stoma and bowel obstruction.
Reduction of blood supply can cause the stoma to exhibit significant changes. These may include:
- Change in color, the stoma can become extra dark or extra pale
- Change in temperature of the stoma, noticeable to the touch
- Ulcers on the stoma, usually light colored sores
A prolapsed stoma may also cause and obstruction of the bowel so proper monitoring of bowel movements should be observed with the presence of a prolapsed stoma to ensure everything still works as normal.
If there is any severe pain or discomfort, fear of obstruction or anything present that is extra-alarming then immediate medical attention is advised.
Stoma Prolapse Treatment
Surgery for a prolapsed stoma is usually performed as a last resort or if complications present themselves. The first course of action is usually to try and manage the stoma site.
Extra care and vigilance is needed to protect the protruding colon for lacerations and undue trauma. A sliding prolapse may be cut or irritated on the patient’s flange or other colostomy appliances as it moves in and out. An adjustment to the size of the flange may need to be made. Also, a large prolapse may interfere with the function of the patient’s current colostomy pouching system and a bigger pouch may be needed to accommodate the larger stoma. This will help reduce the risk of leakage from a poor fitting colostomy pouch. The doctor or ostomy nurse should able to help in this area.
Living with a prolapse involves protecting it from undue traumatic contact. The patient needs to be aware when leaning against objects, or when lifting anything heavy. Special ostomy prolapse belts and stoma guards can be purchased and used to shield the stoma and offer another layer of protection.
This option is normally taken when the prolapse produces severe complications for the patient. If the doctor determines that surgery is needed it will usually fall into 1 of 4 types of procedures:
- Reversal – If reversal is an option it may be performed earlier than expected.
- Revision – This is mostly done for those with loop colostomies. It involves “revising” the loop colostomy and performing an end colostomy.
- Resection – Primarily done for those with an end colostomy.
- Relocation – Involves moving the stoma site to another area of the abdomen
For patients that develop this condition, there are many options available to mange and correct, if necessary, their prolapsed stoma. As always, informing your doctor or nurse of any change in your stoma or overall condition is always recommended. If the stoma prolapse produces severe pain or a possible bowel blockage then prompt medical care is advised.