Colostomies should typically protrude 1.5 to 2.5 cm and stomas of the small bowel should evert 2.5 to 3.5 cm. Stomas that do not evert at least 1 cm above the skin surface 48 hours after surgery have a 35% chance of causing problems.
A prolapsed stoma occurs when the stoma becomes longer than normal If your stoma has prolapsed it will look longer than normal and stick out further from the body. A stoma can prolapse if the muscles supporting it are weak or it may happen as a result of straining the abdominal muscles i.e. through lifting.
A prolapsed stoma is when the intestine extends to an abnormal length through the ostomy site. This may look like the stoma is longer or more swollen than what you are used to. Two images of prolapsed stomas in the belly.
All stomas vary in size and shape. Some protrude outwards and others can be flat or flush to your tummy. No two stomas are ever the same. A colostomy may often appear slightly larger as the surgery has been performed on the large bowel (colon), whereas an ileostomy (small bowel) or a urostomy are smaller in size.
A stoma will normally protrude slightly above the skin level. The length of the protrusion will depend on whether you have a colostomy or ileostomy (ileostomies tend to protrude further out) and the size of your bowel. A retraction of the stoma is when the stoma lays flat to the skin or below skin surface level.
The skin around your stoma should look just like the skin on the other side of your abdomen, or anywhere else on your body. The skin around the stoma should be intact without irritation, rash, or redness. A properly fitting skin barrier protects the skin from being irritated or damaged by the stoma drainage.
A healthy stoma is pinkish-red and moist. Your stoma should stick out slightly from your skin. It is normal to see a little mucus. Spots of blood or a small amount of bleeding from your stoma is also normal.
Poor blood supply can cause a variety of changes to your stoma, from small ulcerations on the surface (called ischemic ulcers) that look like yellowy-white patches, to more significant changes in colour or temperature. The stoma can become dark red or purple, or sometimes a very pale pink, and may be cool to touch.
Things to watch out for
If your stoma is or becomes black, dusky, pale or sloughy (separating from the body), report it to your doctor or stoma nurse. You should also report any soreness, inflammation or ulceration of the skin around the stoma, and any sudden or unexplained swelling of the stoma.
Your stoma will be moist and pinkish-red in colour and should protrude from your abdomen. It may be quite swollen to begin with but will reduce in size over time – usually 6 to 8 weeks after surgery.
A Parastomal Hernia (Stoma Hernia) is a weakness or protrusion in the muscle wall of the abdomen at the site of a Stoma which allows the abdominal contents to bulge out. The bulge often protrudes more when coughing or undertaking physical activity.
A prolapse of the stoma occurs when the bowel protrudes through the stomal opening in the skin to a greater extent than was anticipated. The amount of protruding bowel can vary from 2-3cm to more than 10cm. Although when this first happens it can be very distressing and frightening it is usually not serious.
An ileostomy is an opening (stoma) of the small bowel (ileum) onto the surface of the tummy (abdomen). When you have an ileostomy your poo comes out through the stoma. It is collected in a bag that sticks over the stoma. The poo is usually liquid rather than solid.
The best position to sleep in when you have a stoma is on your back, or on your side. If you prefer to sleep on your stomach, this will be fine at the beginning of the night but increases the chances of leaks as the night progresses and your bag fills.
Traditional ostomy guidelines recommend cutting the pouch opening no more than 1/8 larger than the size of the stoma to protect the peristomal skin, but in the 6 circumstances described and in the 5 case studies presented, assessment determined the need for pouch openings larger than 1/8 inch beyond the stoma.
Signs of Stoma Problems
The stoma is no longer beefy red or pink but pale in appearance. The stoma is no longer moist in appearance but seems dry. Your stoma turns dark red, purple, or even black in color. Your stool from the stoma is always watery or diarrhea.
Some common complications of stoma include poor siting, parastomal hernia (PH), prolapse, retraction, ischemia/necrosis, peristomal dermatologic problems, mucocutaneous separation, and pyoderma gangrenosum. Each will be discussed separately in further detail.
Contact your physician if you experience any of these stoma complications: The stoma turns from its normal red color to a very pale pink, bluish purple or black color. An abnormal bulge is visible near or underneath the stoma. The effluent (output) drains from anywhere other than the stoma.
What Are the Symptoms of Prolapsed Stoma? Your stoma will be longer than usual and it could be swollen. You might only notice it when you lie down. It may disappear when you stand up.
When the skin becomes infected it can start to look inflamed and the infection tends to cause some swelling around your stoma. The skin colour often changes from a healthy pink/reddish colour, to pale, bluish purple or even black. If there is any discharge of blood or pus this is often a definitive sign of infection.
To secure optimal adhesion the baseplate should be applied to clean and completely dry skin. Clean water is sufficient for the cleaning of your stoma and skin around it. When it comes to fitting your ostomy baseplate, the hole should be cut so that it fits the diameter and shape of your stoma exactly.
You might worry about how the stoma will affect your relationships with a partner or with friends. Or have practical worries about the stoma bag being noticeable, leaking or smelling. Stoma bags are well designed. They can't be seen through your clothes and should not smell or leak.
This is because it is a mucous membrane, just like the mucous membrane inside your mouth. There is no sensation in the stoma, so it is not at all painful to touch. The stoma can bleed a little when being cleaned, especially in the beginning, but this is quite normal, and should stop shortly afterwards.