Prolapsed Stoma: Symptoms, Types, Causes and Treatment

Stomal prolapse is a condition many ostomy patients may face, yet it often remains a topic shrouded in confusion and concern. If you or a loved one has a stoma, understanding prolapse—when part of the bowel protrudes excessively through the stoma opening—can make a significant difference in managing both comfort and quality of life. This article breaks down the symptoms, types, causes, and latest evidence-based treatments for prolapsed stoma, using current research findings to offer clear, practical information.

Symptoms of Prolapsed Stoma

Living with a stoma already requires adaptation, but when prolapse occurs, the changes are hard to ignore. Recognizing the signs early can help you seek timely care and avoid complications.

Symptom	Description	Impact	Source(s)
Protrusion	Stoma extends outward, sometimes >20 cm	Difficult care, discomfort	1, 3
Redness/Swelling	Skin and stoma become inflamed	Skin irritation	1
Erosion	Surface of stoma may become raw or ulcerated	Bleeding, pain	1
Difficulty Caring	Hard to apply appliances or clean stoma	Hygiene challenges	1, 3

Table 1: Key Symptoms

Overview of Prolapsed Stoma Symptoms

A prolapsed stoma is most easily recognized by a sudden or gradual increase in the length of the stoma protruding through the abdominal wall. In some cases, the bowel may stick out several centimeters longer than usual—reports note lengths even up to 20 cm in severe instances 1. This dramatic change is often the first clue.

Common Physical Signs

• Redness, Swelling, and Erosion: As the stoma protrudes, the exposed tissue is vulnerable. Redness and swelling are common, and the surface may become eroded or ulcerated, leading to tenderness or bleeding 1.
• Difficulties in Stoma Care: A prolapsed stoma complicates the routine of cleaning and appliance changes. The increased length and possible swelling make it tough to secure the pouching system, raising the risk of leaks and skin damage 1 3.
• Discomfort or Irritation: Patients often report that the stoma feels irritable or painful, especially if the prolapse cannot be manually reduced (pushed back in) 1.

Functional Impact

These symptoms disrupt daily life, causing hygiene challenges and, in some cases, anxiety or embarrassment. Prompt recognition is important to minimize complications and maintain quality of life.

Types of Prolapsed Stoma

Not all prolapsed stomas are the same. Depending on the type of stoma and the nature of the prolapse, management strategies may differ. Let’s explore the main types.

Type	Stoma Involved	Frequency/Notes	Source(s)
Loop Colostomy	Colon (loop)	Most commonly affected	2, 3, 4
End Colostomy	Colon (end)	Less frequent	1, 3, 4
Loop Ileostomy	Small intestine	Occasionally affected	3, 4
End Ileostomy	Small intestine	Rare	3

Table 2: Types of Prolapsed Stoma

Loop vs. End Stoma Prolapse

Loop Colostomy Prolapse:
Among all ostomies, loop colostomies are by far the most prone to prolapse 2 3 4. In these cases, the bowel is brought to the surface as a loop, creating two openings (proximal and distal limbs). The mobile nature of the bowel at this site makes it more likely for one end—usually the proximal limb—to prolapse through the abdominal wall.

End Colostomy Prolapse:
End colostomies, formed by bringing one end of the colon to the surface, can also prolapse, though less frequently than loop stomas 1 3 4. When prolapse occurs, it is typically the stoma itself that lengthens, not a specific limb.

Ileostomy Prolapse:
Ileostomies, which involve the small intestine, are less commonly affected by prolapse. When they do occur, loop ileostomies are more at risk than end ileostomies. Prolapse of the proximal limb in loop ileostomies has been reported but may be more challenging to repair 3.

Limb-Specific Prolapse

In loop stomas, it’s often just one limb (usually the proximal) that prolapses. However, there are instances where both limbs can be involved, or a new prolapse can occur in the previously unaffected limb after repair 3.

Causes of Prolapsed Stoma

Why does stoma prolapse happen? Understanding the underlying causes can help with prevention and guide treatment choices.

Factor	Description	Risk Profile	Source(s)
Emergency Creation	Stomas made urgently, less precise	Higher risk	1, 4
Stoma Type	Loop vs. end, colostomy vs. ileostomy	Loop colostomies > risk	2, 3, 4
Patient Factors	BMI, prior hernia, age, smoking	No clear association	4, 5
Surgical Technique	Method and site of creation	Influences risk	1, 4

Table 3: Causes and Risk Factors

Surgical and Procedural Factors

• Emergency Surgery:
  Prolapse is more likely when the stoma is constructed during an emergency operation, possibly due to less optimal technique or positioning 1.
• Stoma Type and Location:
  Loop colostomies are inherently more at risk due to the structural nature of bringing both limbs of the bowel to the surface 2 3 4.

Patient-Related Factors

• Body Mass Index (BMI):
  While high BMI has been suggested as a risk for other stoma complications like parastomal hernia, its association with prolapse isn’t as clear. Some cases of hernia occurred in patients with higher BMI and prior hernia repairs, but no definitive link with prolapse was established 5.
• Age, Sex, Smoking, ASA Score:
  No consistent association has been found between these patient characteristics and the risk of stoma prolapse or its recurrence after repair 4.

Technical Aspects

• Site and Construction:
  The way the bowel is brought through the abdominal wall and fixed in place can influence prolapse risk. Less secure fixation or a larger abdominal opening predisposes to prolapse 1 4.

Summary

In essence, the type of stoma and circumstances of its creation are the most important factors, while individual patient factors appear less relevant.

Treatment of Prolapsed Stoma

Treating a prolapsed stoma focuses on restoring function, improving comfort, and preventing recurrence. Recent advances provide several options, from minimally invasive office procedures to formal operations.

Treatment	Approach/Method	Recovery/Outcome	Source(s)
Stapler Repair	Local, minimally invasive	Short operation, low risk, low recurrence in most stomas	1, 2, 3, 5
Local Reconstruction	Open, local repair	Slightly longer recovery, some hernia risk	4, 5
Laparotomy	Formal abdominal surgery	Similar recurrence rates to local repair	4
Conservative Care	Manual reduction, support	For minor cases only; not effective for severe prolapse	1

Table 4: Treatment Approaches

Minimally Invasive Stapler Techniques

Local Stapler Repair:
Recent studies highlight the effectiveness of repairing a prolapsed stoma using surgical stapling devices under mild sedation 1 2 3 5. In this method, the protruding segment is amputated and reconstructed at the skin level using a linear stapler. Benefits include:

• Can be performed without general anesthesia 1 2
• Short operative time (as little as 20 minutes) 5
• Minimal blood loss and pain 1 3
• Very low recurrence rates in most stomas (1 in 25 repairs) 3
• Quick recovery with short hospital stays 5

However, repairs on the proximal limb of loop ileostomies may have higher recurrence rates 3.

Local Surgical Reconstruction

Some cases require open local reconstruction (without stapler), which also tends to be minimally invasive but involves a slightly longer operation and recovery 5. Both stapler and open local repairs are considered safe and effective, though parastomal hernia can develop as a late complication, particularly in patients with previous hernia repairs and higher BMI 5.

Formal Laparotomy

In rare or complex cases, a full abdominal surgery (laparotomy) may be needed to reconstruct the stoma. However, research shows that recurrence rates are similar whether the repair is performed locally or via laparotomy 4.

Conservative Treatments

For minor or early prolapse, manual reduction—gently pushing the prolapsed bowel back in—may be attempted. Supportive measures, such as ensuring the stoma appliance fits well, can help in mild cases. However, for significant prolapse, especially when the stoma cannot be reduced manually or is causing pain, surgical intervention is necessary 1.

Long-Term Outcomes and Recurrence

• Recurrence Rates:
  Recurrence following surgery remains a challenge. In one long-term study, almost half of patients needed repeat operations for recurrent prolapse, regardless of whether a local repair or laparotomy was performed 4.
• Complications:
  Both short-term and long-term complications are uncommon with minimally invasive approaches, but the risk of developing a parastomal hernia remains 5.

Conclusion

A prolapsed stoma can be distressing but is a manageable complication. Here’s a recap of the main points:

• Symptoms:
  • Protrusion of the stoma beyond normal length, redness, swelling, and skin irritation are key signs 1 3.
• Types:
  • Loop colostomies are most commonly affected, but end stomas and ileostomies can also prolapse 2 3 4.
• Causes:
  • Emergency creation and loop stoma type are major risk factors; individual patient characteristics are generally less relevant 1 2 3 4.
• Treatment:
  • Minimally invasive stapler repairs offer quick, safe, and effective results for most patients, with local open repairs and laparotomies reserved for select cases 1 2 3 4 5.
  • Recurrence remains a challenge, emphasizing the need for ongoing follow-up and individualized care 4.

Understanding the symptoms, risk factors, and latest treatment options empowers patients and caregivers to take an active role in managing stoma prolapse—and ensures the best possible outcomes for those living with an ostomy.