Category: Oncology — Rectal Cancer, Stoma Care and Stoma Prolapse
Stoma prolapse in a loop colostomy (two openings): bulges when standing, retracts lying flat, leaks every day — leak-proof pouching, skin care, support belts, and when to see the surgeon
AI Overview / Quick Answer (BLUF)
Stoma prolapse is bowel telescoping through the stoma as abdominal pressure rises on standing; it affects 2–26% of stomas, most often a loop colostomy’s distal limb.
Pouches leak when cut to the bulge: cut to the base plus 1–2 mm and apply lying flat
(Parini 2023).
What this page focuses on, and what to read alongside it
- This page focuses on stoma prolapse in a loop colostomy (two openings): why it slides out standing and back lying down, why the pouch leaks daily, choosing and cutting wafers, accessories, support belts, radiotherapy, and when surgery is needed
- General pouch changes, why reversal is delayed, and LARS after reversal → Stoma after rectal cancer surgery: why reversal is delayed and how to care for it
- Preoperative chemoradiotherapy with capecitabine and tumor shrinkage → Large rectal tumor shrinking with chemoradiotherapy
- TNT, multidisciplinary planning and sphincter preservation → Locally advanced rectal cancer: TNT and sphincter preservation
A common situation: “it sticks out 3 inches when I stand and the pouch leaks every day”
Direct answer: when a doctor says “it’s OK,” they usually mean the bowel is safe (good color, reducible, still working) — but daily leaks are not normal and can be fixed by changing how the wafer is measured, cut and applied.
A stoma that protrudes about 3 inches (roughly 7–8 cm) needs different products and technique from a standard stoma. This page walks through what to do, step by step, and when to go back to the surgeon.
Red flags — go to the emergency department or call the surgical team now
Direct answer: a prolapse that is pink-red, reducible and still passing stool is usually not an emergency, but any of the signs below may mean the bowel is trapped or losing its blood supply. Do not wait for the next appointment.
- The stoma turns dark red-purple, grey or black, or looks unusually cold and dry — the blood supply may be failing
- It will not go back when you lie flat and keeps swelling, or is clearly longer than usual
- Severe pain in the stoma or around it — a typical prolapse is painless because bowel lining lacks skin-type pain nerves
- No stool or gas with a swollen abdomen, cramping, nausea or vomiting — possible bowel obstruction
- Bleeding that will not stop after about 10 minutes of pressure with clean gauze, or a visible tear in the bowel (unlike the minor spotting when cleaning, which is common)
- Fever ≥38.0°C with red, hot, spreading skin, swelling or pus around the stoma — especially during chemotherapy, when white cells may be low
1. What stoma prolapse in a loop colostomy is, and why a doctor may say “it’s OK”
Direct answer: stoma prolapse is a full-thickness telescoping of bowel out through the stoma. It affects about 2–26% of people with a stoma,
is more common with colostomies than ileostomies, and is most common in transverse loop colostomies, where it usually involves the distal limb
(Parini D, World J Emerg Surg 2023;
Kwiatt M, Clin Colon Rectal Surg 2013)
A loop colostomy has two openings in one pouch
- Proximal (functioning) limb — connects to the upper bowel; stool comes out here
- Distal limb or mucous fistula — leads to the lower bowel and the resting rectum; it can pass mucus, and people who still have a rectum may pass mucus from the anus from time to time, which is common
- Surgeons often create a loop colostomy to divert stool away from a rectal tumor, for example when the tumor starts to obstruct before or during chemoradiotherapy
Numbers worth knowing
- In 84 patients with a transverse loop colostomy, prolapse occurred in 11 (13.0%), at a median of 99 days after surgery; a temporary loop colostomy in the right transverse colon during rectal cancer surgery carried higher risk (odds ratio 5.07)
(Yano T, J Anus Rectum Colon 2023) - Overall stoma complication rates are reported at about 21–70%, including leakage, prolapse, parastomal hernia and retraction
(Shabbir J, Colorectal Dis 2010) - A UK-wide audit of 3,970 stomas found 34% needed accessories to stay clean and dry within the first 3 weeks, and stomas under 10 mm high had more problems
(Cottam J, Colorectal Dis 2007)
Causes and risk factors
- A wide opening in the abdominal wall — a loop colostomy brings up a whole loop of bowel, so the opening is usually larger than for a single-opening stoma
- Raised abdominal pressure — standing, walking, chronic cough, constipation, straining, heavy lifting or fluid in the abdomen
- Older age, excess weight, a lax abdominal wall, very mobile bowel above the opening, and no stoma-site marking before surgery
- A coexisting parastomal hernia — often makes the wafer harder to seal
Why it bulges when standing and retracts lying flat
This is a sliding prolapse, as opposed to a fixed prolapse that is out all the time.
A sliding prolapse with good color that can be reduced is usually managed first by changing the pouching system — which is why a doctor may say it is not dangerous yet
(Parini 2023;
Husain SG, Clin Colon Rectal Surg 2008)
2. Why “loose lying down, bulging standing up” makes pouches leak and stool pool under the wafer
Direct answer: most leaks come from a wafer opening larger than the stoma base — if it is cut to the fully prolapsed size, a gap is left once the bowel retracts, and stool runs onto the skin and eats the adhesive from the inside.
In a study of 202 people with permanent stomas, peristomal skin disorders affected 35% of those with a colostomy, and about 77% of disorders were linked to contact with stoma output
(Herlufsen P, Br J Nurs 2006)
Cutting to the bulge instead of the base
- The protruding part is often wider than the base — cutting to it leaves several millimeters of bare skin around the base when you lie down
- A loop colostomy has two openings and is usually oval; a round cut leaves gaps at both ends
- Conversely, a wafer or pouch edge that is too narrow or rigid can cut or press the bowel when it slides out, causing bleeding or swelling
The leak cycle: stool under the wafer → skin inflammation → wafer fails
- Stool seeps under the inner edge and damages adhesive and skin (irritant contact dermatitis)
- Skin becomes red, sore and weepy — moist skin stops the next wafer from sticking
- Changes become more frequent, repeated stripping of adhesive damages skin further — leaks come sooner
(Herlufsen 2006). Needing a daily change because of leaks is your signal to book an ostomy nurse.
Why leaks get worse during radiotherapy
- Chemotherapy given with radiation, such as capecitabine, can loosen output, and liquid stool seeps under a wafer faster than formed stool
- Fatigue, poor appetite and weight loss make skin thinner and slower to heal and change the abdominal contour, so the stoma needs re-measuring more often
- Prolapse often begins weeks to months after the stoma is made, which frequently coincides with chemoradiotherapy
Prolapse, leaks or symptoms during radiotherapy — how urgently should you contact the team?
Assess the severity of your symptoms and get personalized guidance from our Advisory team.
If the stoma is dark, will not go back, is very painful, or has stopped working with vomiting, go to the emergency department first — do not take the score first.
Take the Cancer-Care Warning-Sign Score (free)
3. Fixing leaks with a prolapse: choosing wafers, pouches and accessories
Direct answer: the principle is a wafer that hugs the stoma base + a pouch long enough + nothing rigid pressing on the prolapsed bowel — usually a shape-to-fit wafer or flexible flat wafer with a seal ring.
Surgery is reserved for when the pouch still will not stay on after product changes, or for complications
(WOCN Guideline 2018;
ASCRS Ostomy Guideline 2022)
Comparison of stoma prolapse management options: products, belts, reduction and surgery
| Option | What it does | Who it suits | Limits / risks |
|---|---|---|---|
| Moldable (shape-to-fit) wafer + seal ring | Roll the opening with your fingers to hug the oval base; the soft edge wraps the bowel without cutting it, and the ring fills small gaps | Loop colostomies that are not round, change size, or leak at the corners | Takes practice; still leaks if opened too wide; may not be covered by every scheme |
| Flexible flat wafer + larger pouch | A soft wafer follows a moving abdomen; a long pouch lets the prolapsed length sit inside without pressure | Long prolapse when standing, fairly even peristomal skin | Larger pouch shows under clothes; the opening must always be cut to the base |
| Two-piece vs one-piece system | Two-piece: change the pouch without removing the wafer; one-piece: thinner, softer, more flexible | Two-piece for fragile skin that needs fewer adhesive removals; one-piece when maximum flexibility is needed | Some two-piece coupling rings are rigid and can press on a prolapse — choose an adhesive or soft coupling if used |
| Prolapse support belt / garment + prolapse shield | Supports the abdominal wall around the opening and limits protrusion on standing; a soft shield keeps the bowel from sliding far out | Reducible sliding prolapse, or prolapse with a coexisting parastomal hernia | Does not cure it; must be put on lying down after reduction; never squeeze the stoma; should be fitted by a nurse |
| Manual reduction lying flat ± cold compress | Gentle, steady pressure slides the bowel back; cold reduces swelling | Pink-red bowel, after the team has shown you how, before applying the wafer or belt | Never force; heavy swelling, dark color or failure to reduce is an emergency; sugar for swelling only under team guidance |
| Local stoma revision / refashioning | Opens around the stoma edge, reduces or trims redundant bowel, and remakes the stoma at the same site | Pouch will not stay on despite product changes; repeated bowel injury or bleeding | Frequent recurrence — one study found 43.5% needed repeat surgery |
| Resection of redundant bowel | Removes excess or ischemic bowel, locally or through an abdominal operation | Very long, incarcerated or ischemic prolapse | Bigger surgery, with risks of wound infection, leak and recurrence |
| Earlier reversal (if the stoma is temporary) | Closes the stoma and reconnects the bowel; the prolapse goes with it | A temporary loop colostomy once the cancer has been treated and the team judges it safe | Timing depends on the cancer treatment plan; not possible for everyone |
| Conversion to an end colostomy | Divides the loop, leaving a single working opening and closing or burying the distal limb that usually prolapses | Long-term or permanent stomas where the distal limb is the main problem | Surgery, possibly abdominal, and it affects future reversal plans — discuss with the surgeon |
Summarized from Parini 2023, Mittal 2020, ASCRS 2022 and StatPearls — Colostomy Care — device names on this page are generic types, not brand names.
A convex wafer is not the answer to prolapse
(Hoeflok J, J WOCN 2017 — convexity consensus).
A prolapsed stoma already protrudes a lot, and a rigid or deep convex ring can press on the protruding bowel and injure it or make it swell, so it is generally avoided unless an ostomy nurse judges it necessary in a specific case,
such as a deep skin crease as well — advice to “use a convex wafer for prolapse” is therefore not accurate.
Accessories table: what they are for, how to use them, and cautions
| Accessory | What it is for | How to use | Caution |
|---|---|---|---|
| Seal ring / barrier ring | Fills the gap between the stoma base and the wafer edge; can be shaped to an oval | Stretch or mold it to hug the base, then place it on the skin or wafer before applying | Do not let the ring sit on the prolapsed bowel itself; replace it with every wafer |
| Alcohol-free stoma paste / strip paste | A caulk that fills creases and dips so the skin is level before the wafer goes on | Apply a thin bead in the crease, smooth with a damp finger, and let it set briefly | Not a wound healer; many pastes contain alcohol that stings broken skin; too thick a layer makes the wafer lift |
| Stoma powder | Absorbs weeping from raw skin so the wafer can stick | Dust lightly only on weepy areas and brush off all excess (used with barrier film for crusting) | Do not layer thickly or use on normal skin; leftover powder stops adhesion |
| No-sting barrier film | Leaves a thin protective layer against stool and adhesive irritation | Dab or spray thinly and let it dry fully for about 30 seconds before applying the wafer | Choose alcohol-free; do not apply on the stoma itself |
| Adhesive remover | Reduces skin stripping when removing the wafer | Spray or wipe at the wafer edge, then ease the skin away from the wafer slowly | Rinse residue with warm water and pat dry before the new wafer, or it will not stick |
| Elasticated barrier strips / flange extenders | Hold the outer edge of the wafer down during movement or when the pouch is heavy | Apply half on the wafer and half on the skin around the outer edge, away from the opening | They do not stop leaks from the inside — if the opening does not fit, fix that first |
| Prolapse support belt (with opening) | Supports the abdominal wall, limiting protrusion and the pouch weight pulling on the wafer | Put it on lying flat after the bowel has retracted, with the pouch through the opening or under a soft shield | Never squeeze the stoma; remove it and call the team if there is pain, color change or swelling |
Weepy, red, sore skin: crusting done properly
- Clean with plain warm water and pat dry (no alcohol, oily soap, or scented wipes)
- Dust stoma powder lightly on the weepy area, then brush off the excess
- Dab no-sting barrier film on top and let it dry — repeat 2–3 times to build a thin layer
- Apply the ring and wafer as usual; see an ostomy nurse or doctor if the skin is deeply broken, has pustules, a sharp-edged fungal-type rash, or does not improve within 1 week
4. Step-by-step pouching for a prolapse: do it lying flat after the bowel retracts
Direct answer: change the wafer lying flat after the bowel has retracted, cut or mold the opening to the base plus 1–2 mm as an oval around both openings, seal gaps with a ring,
then hold with warm hand pressure for about 30–60 seconds before getting up — for general pouch changes see
the stoma care guide after rectal cancer surgery
Step table for pouching a prolapsed stoma: step, how, and caution
| Step | How | Caution |
|---|---|---|
| 1. Set up before lying down | New wafer and large pouch, ring, powder, barrier film, adhesive remover, warm water, gauze, waste bag, gloves, a mirror | Keep everything within reach so you do not need to sit up, which pushes the bowel out again |
| 2. Lie flat and let it retract | Lie on your back, breathe slowly and relax the abdomen for about 5–10 minutes | If it does not retract and your team has shown you how, reduce it gently — never force |
| 3. Remove the old wafer | Empty the pouch first, use adhesive remover, and ease the skin away from the wafer from top to bottom | Do not rip it off; stripped skin leaks sooner next time |
| 4. Clean and check the stoma | Wipe with plain warm water, pat completely dry, check that the bowel is pink-red and moist | Dark, grey or black color, or a tear, means call the team now; minor spotting when cleaning is common |
| 5. Treat weepy skin | Use crusting only on weepy areas and let it dry | Do not powder the whole area under the wafer |
| 6. Measure the base | Use a measuring guide or template at the base at skin level, including both proximal and distal openings — usually an oval | Do not measure the widest bulge; re-measure whenever weight or shape changes |
| 7. Cut or mold the opening | About 1–2 mm larger than the base, or roll a moldable wafer to hug the base | Smooth cut edges so no sharp edge cuts the bowel when it slides out |
| 8. Add the ring, then the wafer | Mold the ring around the base, apply the wafer from the bottom up, and ease the bowel through without squeezing | Check there is no gap around the base, especially at both ends of the oval |
| 9. Hold with a warm hand | Rest your palm on the wafer for about 30–60 seconds; warmth helps the adhesive bond, then add edge strips if used | No need to hold 3–5 minutes; if it keeps leaking, the problem is usually the opening size or wafer type |
| 10. Attach the pouch and belt before getting up | Attach a large pouch, put on the support belt (if you have one) while still lying down, then roll to your side to get up | The pouch must be long enough for the prolapsed length so the tip of the bowel does not hit or get pressed by the pouch edge |
How long should a wafer last?
- A colostomy wafer typically lasts about 3–5 days (varies with product, output consistency and skin)
- Needing a daily change because of leaks is not normal — it is a reason to reassess with an ostomy nurse, not something to put up with
- Itching, burning or a damp feeling under the wafer means change it now, without waiting for the usual day
- Empty the pouch when it is a third to half full; a heavy pouch pulls the wafer up
5. Support belts and manual reduction: how much they help
Direct answer: a prolapse support belt or garment reduces daytime protrusion for many people but does not cure the prolapse;
gentle manual reduction lying flat is accepted first-line care alongside pouching changes
(Parini 2023)
How to wear a support belt
- Choose one designed for stomas, with an opening for the pouch or a soft prolapse shield — not an ordinary abdominal binder that presses on the pouch
- Have an ostomy nurse measure your waist and stoma position; firm enough to support, loose enough to slide a finger under
- Put it on lying flat after the bowel has retracted, then get up; take it off at night unless your team advises otherwise
- Never squeeze the stoma directly; remove it and call the team if there is pain, color change or swelling
- Avoid heavy lifting, support your abdomen with your hand when coughing or sneezing, and treat constipation to reduce straining
Gentle manual reduction (once your team has shown you)
- Lie flat on your back, relax, put on gloves, and remove the pouch
- If swollen, apply a cold compress through a clean cloth for about 10–15 minutes (never ice directly on the bowel)
- Support the tip of the bowel with gauze moistened with clean water and apply gentle, steady pressure so the end slides back in first
- Apply the wafer and belt while still lying down
(Myers JO, Dis Colon Rectum 1991 — 2 cases;
Shapiro R, Tech Coloproctol 2010).
The evidence is only a few case reports, so use it only under the guidance of your surgical team or ostomy nurse — never as a substitute for going to hospital with red flags.
6. During radiotherapy: caring for the pouch, skin and fluids
Direct answer: tell the radiation team every time the output loosens, you empty the pouch much more often, the prolapse lengthens, or the skin worsens — they can adjust medicines, book the ostomy nurse, or check the bowel sooner than your surgical appointment
(StatPearls — Colostomy Care)
- Keep a daily log: how often you empty the pouch, output consistency, wafer change days, and photos of the stoma and skin to show the team
- If capecitabine or radiation causes diarrhea, the team may pause the drug or give an anti-diarrheal — do not stop or adjust medicines yourself
- Drink enough as your team advises; with diarrhea, sip oral rehydration solution through the day; urine should be pale yellow
- Do not put creams, oils or medicines on irradiated skin without asking first — some stop the wafer sticking or interfere with treatment
- The distal opening and the anus may pass mucus or a little blood during pelvic radiotherapy — tell the team if it is heavy, has clots, or is painful
- Diarrhea with dizziness, low urine output or fever — contact the team the same day
7. When surgery is considered, and whether a temporary stoma prolapse goes away after reversal
Direct answer: urgent surgery is needed for ischemia, incarceration that cannot be reduced, or obstruction; planned surgery when the pouch still will not stay on after product changes or the bowel is repeatedly injured or bleeding.
If the loop colostomy is temporary, reversal is the best fix
(Parini 2023;
ASCRS 2022)
Surgical options
- Local revision — open around the stoma edge, reduce or trim redundant bowel, and remake the stoma at the same site without a large abdominal incision
- Abdominal surgery (open or laparoscopic) — when more bowel must be removed, the stoma relocated, or a parastomal hernia repaired at the same time
- Conversion to an end colostomy — leaves a single opening; suits a mainly distal-limb prolapse in a long-term stoma
- Worth knowing: of 23 patients who had surgery for prolapse, 43.5% needed repeat surgery for recurrence, whether by local repair (43.6%) or laparotomy (42.9%)
(Mittal R, Am J Surg 2020) — so products are usually optimized first
A temporary stoma during rectal cancer treatment: timing to discuss
- If the loop colostomy was made to divert stool before chemoradiotherapy, the surgeon usually plans tumor surgery several weeks after radiotherapy ends, according to the team’s plan — ask whether the prolapse or stoma can be dealt with at the same time
- If the stoma is temporary, later reversal removes the prolapse along with the stoma — ask where the reversal plan stands
- Why reversal sometimes happens later than planned → why the stoma has not been reversed yet
Questions to take to your surgeon
- Which part of the colon is this loop colostomy in, and is the prolapsing part the proximal or distal limb?
- What appearance means I must come back to hospital immediately (color, size, protruding length)?
- Can I be booked into the ostomy clinic to adjust the wafer and pouch and be fitted for a support belt?
- When is tumor surgery or reversal planned, and can the prolapse be fixed at the same time?
- If the prolapse lengthens while I wait, is there an earlier surgical option, and what are the pros and cons?
8. Thailand context: ostomy nurses and supply coverage
Direct answer: the person best placed to fix leaks is a wound, ostomy and continence nurse (ET nurse / ostomy nurse);
many large Thai hospitals run an ostomy or wound clinic — while coverage of wafers, pouches and accessories varies by health scheme and hospital, so confirm with your hospital
- Ask the surgical ward, surgical outpatient department or cancer center which days the ostomy clinic runs, and ask for a direct appointment if you are changing the pouch daily
- Bring the wafers and pouches you use, photos of the stoma standing and lying, photos of the skin, and your leak log
- Ask the ostomy clinic, social work department or the hospital’s benefits office which products are covered and how many per month — colorectal cancer costs under the Universal Coverage scheme are covered in the 30-baht scheme cost guide
- If you live far away, ask the hospital to refer you to home-visit nursing or primary care, and get the ostomy clinic’s contact to send photos for advice
Scientific mechanism (synthesized by the author)
Synthesized by
Asst. Prof. Dr. Norawit Raatpiboon:
stoma prolapse is telescoping of bowel out through the abdominal-wall opening. A loop colostomy brings a whole loop through the wall, so the opening tends to be wide,
and the transverse colon hangs on a long, mobile mesentery. When you stand, cough or strain, rising intra-abdominal pressure pushes the loose segment outward; lying flat lowers the pressure and it slides back.
The distal limb prolapses more often because no stool passes through it and it is less firmly anchored to the abdominal wall.
Veins and lymphatics of the protruding segment are compressed at the neck of the opening, causing edema; if swelling becomes severe enough to compress arterial inflow, the bowel becomes ischemic and darkens — which is why color and reducibility are the safety markers.
Cold constricts vessels and reduces swelling, while sugar creates an osmotic gradient that draws water out of the tissue.
On the skin side, stool contains enzymes and bacteria that break down the outer skin layer with prolonged contact, and moisture makes hydrocolloid adhesives absorb water and lose grip quickly.
Cutting to the stoma base, whose size changes little with posture, closes the channel that stool uses to get underneath, while a long pouch and soft edges reduce friction on the protruding mucosa.
Frequently asked questions (FAQ)
My stoma sticks out when I stand but goes back in when I lie down. Is that dangerous?
Usually not immediately. This is a sliding stoma prolapse: part of the bowel slides out through the opening when abdominal pressure rises on standing, coughing or straining, and slides back when you lie flat. It affects about 2–26% of people with a stoma and is most common in the distal limb of a transverse loop colostomy. When a doctor says it is OK, they usually mean the bowel is still pink-red, can be reduced, and is still working. Go to hospital at once if it turns dark purple, grey or black, swells and cannot be pushed back, becomes very painful, or stops passing stool and gas with bloating or vomiting.
Why does my pouch leak every day, with stool pooling under the wafer?
The most common cause is an opening cut too large. If the wafer is cut to the size of the fully prolapsed bowel, a gap is left around the base once the bowel retracts, so stool runs onto the skin and eats the adhesive from the inside. Inflamed, weepy skin then makes the next wafer fail, creating a leak cycle. In one study about 77% of peristomal skin disorders were linked to contact with stoma output. A wafer normally lasts about 3–5 days; needing a daily change because of leaks is a reason to see an ostomy nurse and reassess your products.
What size should I cut the wafer when the stoma is longer standing than lying down?
Measure and cut to the stoma base at skin level, not to the widest bulge, because the base size changes very little between standing and lying. Cut about 1–2 mm larger than the base. For a two-opening loop colostomy this is usually an oval that includes both openings. Re-measure whenever the shape changes, and choose a pouch long enough for the prolapsed length so the pouch edge does not press on or cut the bowel.
Can I use a convex wafer on a prolapsed stoma?
Generally not. Convex wafers are designed for flush or retracted stomas: they press the surrounding skin down so the stoma sits higher. A prolapsed stoma already protrudes a lot, and a rigid or deep convex ring can press on the protruding bowel and injure it or make it swell. A flexible flat wafer or a shape-to-fit wafer with a seal ring and a pouch large enough is usually a better choice, but an ostomy nurse should assess each person.
Does a support belt help a stoma prolapse, and how should I wear it?
It reduces daytime protrusion for many people, but it does not cure the prolapse. A prolapse belt or garment usually has an opening for the pouch or a soft prolapse shield. Put it on lying down after the bowel has slid back in, never squeeze the stoma directly, and have an ostomy nurse fit the size. Avoid heavy lifting, and support your abdomen when you cough or strain.
Can I push the prolapsed stoma back in myself?
If your team has shown you how and the bowel is still pink-red, yes, gently. Lie flat and relax, wear gloves, support the bowel with gauze moistened with clean water, and apply gentle, steady pressure so it slides back gradually. A cold compress can reduce swelling. Case reports describe sprinkling granulated sugar on a swollen prolapse to draw out fluid, but only do this under your care team’s guidance. Never force it; if it will not go back, keeps swelling or darkens, go to the emergency department.
The skin around my stoma is red, sore and weeping. What should I use?
Fix the cause first by cutting the wafer to fit so stool cannot reach the skin. For weepy skin use crusting: dust on stoma powder, brush off the excess, dab a no-sting barrier film on top, and repeat 2–3 times to make a thin layer before applying the wafer. Do not pile powder thickly under the wafer. Stoma paste is a caulk, not a wound healer, and many pastes contain alcohol that stings broken skin, so use an alcohol-free paste or a seal ring instead. See an ostomy nurse or doctor if the skin is deeply broken, has pustules, or does not improve within 1 week.
How should I care for my stoma and skin during radiotherapy for rectal cancer?
Tell your radiation team every time the output becomes looser, you are emptying the pouch much more often, or the skin around the stoma gets worse. Chemotherapy given alongside, such as capecitabine, can cause diarrhea, and fatigue and poor nutrition make skin thinner and slower to heal. Drink enough fluid as your team advises, and do not put any cream or medicine on irradiated skin without asking first. If diarrhea comes with dizziness, low urine output or fever, contact the team the same day.
When is surgery needed for a stoma prolapse, and will a temporary stoma prolapse go away after reversal?
Urgent surgery is needed when the bowel loses its blood supply, becomes stuck and cannot be reduced, or causes obstruction. Planned surgery is considered when the pouch still will not stay on after product changes, the bowel keeps getting injured or bleeding, or the prolapse is long enough to disrupt daily life. Options include local revision, resection of redundant bowel and conversion to an end colostomy, but recurrence after repair is common, about 43.5% in one study. If the loop colostomy is temporary, reversal is the best fix, so ask your surgeon whether the planned reversal or post-radiotherapy surgery can deal with it at the same time.
E-E-A-T and academic citations
Written by Asst. Prof. Dr. Norawit Raatpiboon (ผศ.ดร.นรวิชญ์ ราษฎร์พิบูลย์) — synthesized from ASCRS / WOCN guidance, reviews of stoma complications, and research on PubMed
- Davis BR, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Ostomy Surgery. Dis Colon Rectum 2022 (PMID 35616386)
- Parini D, et al. Surgical management of ostomy complications: a MISSTO-WSES mapping review. World J Emerg Surg 2023 (PMID 37817218)
- Kwiatt M, Kawata M. Avoidance and management of stomal complications. Clin Colon Rectal Surg 2013 (PMID 24436659)
- Shabbir J, Britton DC. Stoma complications: a literature overview. Colorectal Dis 2010 (PMID 19604288)
- Husain SG, Cataldo TE. Late stomal complications. Clin Colon Rectal Surg 2008 (PMID 20011394)
- Yano T, et al. Stomal Prolapse Due to Sidedness of Transverse Loop Colostomy: A Retrospective Cohort Study. J Anus Rectum Colon 2023 (PMID 37900692)
- Mittal R, et al. Surgical management of stomal prolapse: Is there a superior approach to repair? Am J Surg 2020 (PMID 32089244)
- Myers JO, Rothenberger DA. Sugar in the reduction of incarcerated prolapsed bowel. Report of two cases. Dis Colon Rectum 1991 (PMID 2022149)
- Shapiro R, et al. Reduction of an incarcerated, prolapsed ileostomy with the assistance of sugar as a desiccant. Tech Coloproctol 2010 (PMID 19593624)
- Herlufsen P, et al. Study of peristomal skin disorders in patients with permanent stomas. Br J Nurs 2006 (PMID 17108855)
- WOCN Society Clinical Guideline: Management of the Adult Patient With a Fecal or Urinary Ostomy, An Executive Summary. J Wound Ostomy Continence Nurs 2018 (PMID 29300288)
- Hoeflok J, et al. Use of Convexity in Ostomy Care: Results of an International Consensus Meeting. J Wound Ostomy Continence Nurs 2017 (PMID 28002174)
- Cottam J, et al. Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery. Colorectal Dis 2007 (PMID 17672873)
- StatPearls — Colostomy Care (NCBI Bookshelf NBK560503)
Medical disclaimer
This content is general education about stoma prolapse in a loop colostomy, pouching, skin care, support belts, and surgical options —
not a diagnosis, treatment order, or individual product selection. Research figures describe specific patient groups and do not predict any individual’s outcome.
Device names on this page are generic types, not brand names. Manual reduction or using sugar for swelling should only be done under the guidance of your surgical team or ostomy nurse.
Supply coverage varies by provider; confirm with your hospital. If the stoma changes color, will not go back, is very painful, or you have an emergency, go to the emergency department or call emergency services (1669 in Thailand) immediately.