About

A prolapse is a condition when stoma telescopes (collapse) through itself, leading to abnormal lengthening of the stoma. The prolapsed stoma looks very distressing. You should adapt some changes to manage your Ostomy along with prolapsed stoma.

Causes:

The patients with colostomies have higher chances to develop prolapses than ileostomy patients. Prolapses occur mostly in loop colostomies, especially the loop stomas that reside in the transverse colon.  End stomas are formed as a result of a complete cut throughout the intestine and the end is pulled to the abdominal wall, while loop stomas result from pulling an intestinal loop through the abdominal wall.

Since there is no clear evidence for the occurrence of prolapses, there are different factors that can act as the driving force behind the prolapses:

• Poor muscle tone in abdomen

• Obesity or weight gain

• Pregnancy

• Any surgical procedure (such as creating a large hole in the abdominal wall in order to create a stoma)

• Increased fluid due to cough that leads to increase pressure within the abdomen

• A colostomy because of abdominal incision

Influence of prolapse on stoma

Your stoma care can be affected by some properties of prolapse. A prolapse can be present or absent according to your posture i.e. sitting, standing or lying. For example you will notice that when you are standing prolapse is visible but as soon as you lay on your back the stomal sizes become normal and there is no prolapse. This is referred as spontaneous reduction. Sometimes the stoma becomes swollen and remains prolapsed. There can be an increase in its size as well as diameter.

The color or warmth of a stoma can be affected because there can be interrupted of blood supply to the prolapsed stoma. Poor blood supply can cause following changes in your stoma:

• Small ulceration (ischemic ulcers) that appear with yellow-white patches

• Changes in color and temperature: The stomal color can change from pink to dark red or purple or sometimes it become light pink, and it will be cool to touch.

• Stomal functioning can also be altered due to a prolapse that can lead to an obstruction. 

If you observe any changes in the stoma size, color or temperature you should consult your doctor immediately.

Daily life changes

You need to change your routine care in case of a prolapse. Besides observing your stoma size, color and temperature you need to consider the pouching system you have been using. In case of a large prolapse a large pouch is required that can accommodate the stool and stoma at the same time. You may observe that you need to change the pouch more often. You may also require an extra flange, one that will prevent any injury or trauma to the stoma

In some conditions the prolapse can be very mobile (sliding in and out with the changes in your posture).This can develop the risk of laceration of stoma with of the flange. A laceration does not cause any pain but it may cause bleeding or white lines where flange has been in contact with it. In this situation you may need to adjust the size or opening of the flange according to your stoma size. Another solution is to exchange the product with moldable flange that is available at ConvaTech. Your ET can help you to choose your pouching systems.

You need to protect your stoma from any external trauma until it remains prolapsed. You need to be careful about the activities you do, type of working and even for standing against a counter to cook food. All of these can cause stomal bruises. There are some protectors and guards (according to your soma size0 that can work for you. Prolapse belts are available in markets that are used to reduce its size. But in some cases the potential of prolapse is much more than the belt, enabling the stoma to pop out of the belt. The two piece pouching system can be dangerous too.  It can hurt stoma, by trapping it between the flange and the pouch. One piece pouching system may work. But you should take help from your Ostomy nurse to choose the best pouching system or prolapse belt for you.

It can be guard for you to find clothing that is comfortable, does not cause any injury to stoma, and helps to hide the stoma and the pouch. Yu should not place the belts or waistbands directly on the stoma. You can avoid this issue by placing your pants above or below your stoma. The clothing fashions such as pleated pants or skirts or patterned dresses can help you to conceal bulges.

Conclusion

At the end, determining the severity and symptoms of your prolapse a surgeon might consider to revise a surgery for repairing the stoma. Your surgeon will explain to you about the risks and benefits of the stoma revision and he will also add if this works for you or not.