Female first responders, including a nurse who was conducting CPR on the prone official, were repeatedly ordered to leave the ring by a referee, prompting much debate in Japan about the controversial male-only sumo tradition.
The Japan Sumo Association has now apologised for the "inappropriate response".
Maizuru city mayor Ryozo Tatami collapsed while making a speech in a gym near Kyoto on Wednesday.
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When women rushed to help him, the referee can be heard repeatedly asking the women to get out of the ring.
Tradition forbids women from entering the ring on the grounds that it is sacred and their presence, considered "unclearn", would pollute it.
The 77-year-old mayor was eventually taken to a nearby hospital and found to have suffered a brain hemorrhage, according to Japan's NHK News.
A woman performs CPR on the local mayor in the sumo ring. Source: YouTube
The sumo association's newly elected chairman Hakkaku has apologised for the incident and thanked the women.
"It was an inappropriate response in the life-threatening situation. I deeply apologise," Hakkaku said in a statement.
The action of the referee has drawn sharp criticism from some section of the Japanese media, including sumo wrestling journalist Taro Arai.
"I think it is all right for women to get on the ring when there is a reason to do so," Arai told Reuters. "There is no historical ground or reason at all why they cannot."
Arai said the rules have been relaxed in recent times.
"In the past, there have been cases where little girls got on the ring and wrestled with sumo wrestlers in sumo fan events," he stressed.
"So, in fact, women on the ring has been approved by the Sumo Association (previously)."
Grand sumo champion Harumafuji retired after an assault incident. Source: AAP
The incident comes at a difficult time for sumo in Japan. The ancient sport has been plagued by a series of scandals in recent months.
Hakkaku is attempting to rebuild his sport's tarnished reputation, after former yokozuna - the highest ranking in the sport - Harumafuji retired in December after assaulting a junior wrestler.
In February, Japanese police said they had referred a sumo wrestler to prosecutors on suspicion of indecent assault and last month Egyptian wrestler Osunaarashi was asked to retire after being involved in a car accident while driving without a license.
