Sally Wright has worked as a Stoma Care Nurse for over 15 years, providing specialist care, education, and support to individuals recovering from stoma surgery within the community. Sally recognises that every patient’s recovery journey is unique, and she has a particular interest in the psychological aspects of adapting to life with a stoma. Her previous role as a Dermatology Sister highlighted the importance of emotional wellbeing whilst coming to terms with changes to our bodies and on self esteem.
Stoma prolapse, retraction, and stenosis
Stoma prolapse
A prolapsed stoma occurs when the bowel extends further through the stoma than usual which makes it appear longer or more swollen than normal. It can be managed with conservative measures like lying down, applying gentle pressure and using support garments. A severe prolapse can interfere with the stoma appliance or bowel function. In some cases, surgical intervention may be necessary if any complications arise.
Early warning signs of a prolapse
- An increase in length of the stoma or in circumference as the stoma may become wider
- Change in stoma colour (to dark/dusky) or increasing swelling (oedema)
- Stoma becoming more prominent when standing, coughing or straining
- Difficulty in maintaining a secure seal of your appliance
- Peristomal skin irritation from leakage
- Painful, reduced output or obstructive symptoms (such as the stoma stops functioning, increased stomach cramps or you start to experience nausea/vomiting)
Stoma prolapse: Clinical management
- Assess stoma size and monitor for any increase
- Monitor for a healthy red/moist colour, output, and signs of obstruction (where it might stop functioning) or ischemia (where the stoma itself turns a dark/dusky colour).
- A prolapse that is soft and producing output can often initially be managed conservatively
- Reduce swelling (oedema) where appropriate and optimise pouching equipment. A stoma care nurse can help with your stoma appliance fitting and checking the current pouch has plenty room for the larger size of stoma and the aperture is not too tight
Any persistent, symptomatic or complicated prolapse may require surgical review and revision.
Emergency assessment via A&E is required for a dusky/black stoma, severe pain, significant bleeding or features of bowel obstruction.
Stoma retraction
A retracted stoma occurs when the stoma pulls back or sinks below the level of the skin instead of projecting slightly above it. If this happens it can affect the fit of your stoma bag and cause leaks. This may lead to irritation and damage of your surrounding skin. It can be managed with convex ostomy appliances, barrier rings, or pastes to help improve the seal. Sometimes with persistent or complex cases, further surgery may be required.
Early warning signs of a stoma retraction
- Stoma becoming flush to your stomach or recessed below the skin
- Frequent leakage beneath the appliance
- Peristomal (surrounding) irritation or sore skin
- Reduced ability to maintain a pouch seal
- Progressive sinking of the mucocutaneous junction
Stoma retraction and clinical management
- Identify contributing factors such as tension on the bowel after surgery, any weight changes or poor surgical healing due to co-morbidities
- Contact your stoma care nurse for a review and support
- Introduce a convexity product with your stoma nurse’s guidance, seals/rings, paste or other accessories when appropriate.
- Treat associated any skin damage and leakage promptly.
- Significant or progressive retraction, especially with stenosis or obstruction, may require surgical revision.
Stoma stenosis
The stoma sits below the skin surface, rather than protruding adequately above it. It involves an abnormal narrowing of the stoma opening, which can hinder stool passing through. Symptoms include ribbon-thin stools and painful evacuation. Severe stenosis can cause abdominal pain, bloating, or bowel obstruction. Treatment may involve digital dilations by a stoma nurse and severe cases may require reconstructive surgery.
Early warning signs of stoma stenosis
- Decreasing or increasingly difficult stoma output
- Narrow, ribbon-like stool in a colostomy
- Abdominal cramping or bloating
- An increasing need to strain to evacuate
- Episodes of partial bowel obstruction
- A progressively smaller stomal opening
Stoma stenosis and clinical management
- Assess hydration, abdominal symptoms such as pain, the stoma is still active and there is a regular output
- Look for an underlying cause such as scarring, ischaemia, retraction, or inflammatory disease.
- Mild stenosis may sometimes be managed conservatively under specialist supervision.
- Progressive or symptomatic stenosis may require dilation by your Stoma Care Nurse
- In severe cases it may warrant colorectal/surgical assessment and or operative revision.
- Urgent assessment is required if there is no stoma output accompanied by abdominal pain, distension, vomiting or other signs of obstruction.
Any sudden change in stoma colour, severe pain, significant bleeding, loss of output, vomiting, or abdominal distension should be treated as a potential emergency rather than simply a pouching problems.
Further reading:
FAQ: Stoma prolapse, retraction, stenosis
What is a stoma prolapse?
A stoma prolapse is when the bowel pushes further out through the stoma than usual, making it look longer or more swollen. Mild cases are often managed with rest, gentle support and the right stoma bag fit, but a stoma that turns dark or dusky, or comes with severe pain or bleeding, needs emergency assessment.
What is stoma retraction?
A stoma retraction is when the stoma sinks back below the skin instead of sitting slightly proud of it, which often causes leaks and skin irritation because the appliance can't seal as well. It's usually managed with convex products, barrier rings or pastes, with surgery reserved for persistent or complex cases.
What is stoma stenosis?
Stenosis is a narrowing of the stoma opening that makes it harder for output to pass, often causing thin, ribbon-like stool, cramping and bloating. Mild cases may be monitored, while progressive or symptomatic stenosis is often treated with dilation by a stoma care nurse.
Can stoma prolapse be treated without surgery?
Often, yes, especially when the prolapse is soft and still producing output — conservative measures like rest, gentle pressure, support garments and appliance adjustments are usually tried first. Surgery is generally reserved for prolapses that are persistent, symptomatic or complicated.
When should I seek emergency care for a stoma complication?
Treat a dusky or black stoma, severe abdominal pain, significant bleeding, loss of stoma output, vomiting or abdominal distension as a potential emergency and seek urgent medical assessment rather than waiting for a routine appointment.
Who should I contact if I notice early warning signs?
Your stoma care nurse is the first point of contact for changes like leaking, skin irritation, or a change in how your stoma looks or functions — early review can often prevent a complication from progressing.