Understanding Stoma Retraction and What to Do About It

Stoma retraction is a common ostomy complication that occurs when the stoma pulls inward or sits below skin level. It can make achieving a secure seal more difficult and increase the risk of leaks and skin irritation, which can be concerning to many ostomates. However, with the right adjustments to your routine and supportive ostomy supplies designed to improve fit, stoma retraction is often completely manageable. Some instances require more serious treatment, but these are less common. Here, we'll talk more about what stoma retraction is and what you can do about it.

Quick Overview: Understanding Stoma Retraction

• Stoma retraction occurs when the stoma pulls inward or sits below skin level, which can make it harder to maintain a secure pouch seal and may increase the risk of leaks and skin irritation.
• Common signs include frequent leakage, shorter pouch wear time, skin irritation, and difficulty achieving a proper fit with your ostomy system.
• Causes range from normal post-surgical healing and scar tissue to weight changes, abdominal pressure, or weakened abdominal support.
• Most cases can be managed without surgery through pouching system adjustments, convex barriers, supportive ostomy accessories, and proper skin protection.
• Working with an ostomy nurse and using the right ostomy supplies can help restore comfort, prevent complications, and support confident daily ostomy care.

What Is Stoma Retraction?

Stoma retraction occurs when the stoma pulls inward and sits flush with or below the level of the surrounding skin instead of protruding slightly outward. A healthy stoma typically extends about one to two centimeters above the skin surface, which helps ostomy output flow directly into the pouch. When retraction happens, output may collect around the base of the stoma rather than moving cleanly into the stoma bag.

Signs and Symptoms of a Retracted Stoma

Some of the most common signs and symptoms associated with a retracted stoma include:

• The stoma sits flush with or below the skin surface instead of protruding outward
• Frequent pouch leaks, especially around the base of the stoma
• Output getting into the skin barrier, causing the seal to loosen sooner than expected
• Shorter than usual wear time for your pouching system
• General discomfort
• Burning, stinging, or itching around the stoma
• Red, irritated, or broken peristomal skin due to prolonged moisture exposure
• Difficulty achieving a secure fit, even when using the correct flange and pouch size
• Changes in how the stoma looks, including appearing smaller or less raised than before

Some people also notice that they need to change their pouch more often or adjust their ostomy supplies more frequently to maintain a reliable seal.

Why Stoma Height Matters

The overall height of your stoma plays an important role in long-term ostomy management, as the protrusion can help:

• Direct output away from the skin
• Create a secure seal between the skin barrier and the abdomen
• Reduce leakage under the pouch barrier
• Protect peristomal skin from irritation

When the stoma sinks below the skin, it can be more challenging to get a strong seal, which can lead to additional complications or problems with your ostomy bag.

Is Stoma Retraction Common?

Yes, stoma retraction is one of the more common ostomy-related complications. It occurs in about 1% to 17% of ostomates, depending on the type of surgery, with other studies reporting higher rates of prevalence. In many cases, it's easily manageable with a few strategic adjustments. Your stoma care nurse can help you better understand what's happening and provide you with personalized insight regarding how to help the stoma protrude or make adjustments to your ostomy products to ensure a strong seal.

What Causes Stoma Retraction?

Stoma retraction can develop soon after surgery or appear later as the body changes during healing. It can affect people with a colostomy, ileostomy, or urostomy, and the severity can range from mild flattening to deeper inward pulling. Some of the most common reasons that the stoma may retract include the following:

• Normal healing changes after surgery, especially as swelling decreases and the stoma settles into its final size and shape
• Tension on the bowel or abdominal wall following ostomy surgery
• Scar tissue formation that tightens the surrounding skin and tissue
• Sudden or gradual weight gain or weight loss, which can change abdominal contours and stoma positioning
• Weak abdominal muscles or aging skin, which reduces structural support around the stoma
• Postoperative complications, such as infection or mucocutaneous separation
• Parastomal hernias, which may alter how the stoma sits on the abdomen
• Increased abdominal pressure from heavy lifting, chronic coughing, or straining
• Underlying health conditions that affect wound healing or tissue strength
• Stoma necrosis, which is a potentially life-threatening condition that requires medical attention

Stoma Retraction vs. Prolapsed Stoma

Stoma retraction and stoma prolapse are two different types of ostomy complications that affect the position and shape of the stoma. However, the two are essentially opposite. Retraction pulls an otherwise normal stoma inward, creating a sunken abdominal opening. A prolapsed stoma is when a portion of the intestine telescopes outward. This causes the stoma or the skin around the stoma to protrude outside the body further than normal. This can make the stoma appear longer or swollen. The key differences between the two are as follows:

Problems Caused by Stoma Retraction

Although most retracted stomas don't cause further issues, that doesn't mean they can't occur. In some instances, they can lead to:

• Freaquent leakage
• Peristomal skin breakdown
• Pain or soreness
• Ulceration
• Ischemia (reduced blood supply or flow)
• Shorter pouch wear time
• Pancaking
• Increased risk of infection
• Reduced confidence and quality of life

Always see your doctor if you experience any signs of an issue that doesn't get better after adjusting your ostomy care routine.

How Is Stoma Retraction Treated?

Managing a retracted stoma often depends on the severity, so it may be necessary to work with your ostomy care nurse to get a better understanding of what to do. Some possible options to treat a retraction and prevent further complications include:

Pouching System Adjustments

One of the most effective ways to manage a retracted stoma is by modifying your pouching system to create a better seal against the skin. Some ways to help adjust your system include:

• Using a bag with a convex skin barrier, which gently presses around the stoma to help it protrude slightly and direct output into the pouch
• Switching barrier flexibility, such as choosing soft or firm convexity based on abdominal contours
• Ensuring the opening is properly sized to match the current stoma shape
• Trying different pouching systems, including one-piece or two-piece options for improved fit

A proper seal helps reduce leaks, reducing the risk of skin irritation caused by output exposure.

Using Ostomy Accessories Strategically

Ostomy accessories can help fill uneven areas around the stoma and reinforce the pouch seal. Although the fundamentals should always be used, some additional helpful options may also include:

• Barrier rings or seals to create a smoother surface around the stoma
• Ostomy paste to fill small gaps or creases in the skin
• Support belts to maintain gentle pressure and stabilize the pouching system
• Adhesive extenders for added security and longer wear time

These products are often used together to customize the fit based on individual needs, but make sure to speak with your ostomy nurse or a specialist if you're unsure how to use them.

Protecting Peristomal Skin

When the stoma sinks below the skin level, leakage becomes problematic. Skin that's in persistent contact with stool can result in a variety of issues, which is why skin protection is so important. Some of the most effective skin care strategies include:

• Keeping the skin clean and dry during pouch changes
• Using skin barrier wipes or protective powders if irritation develops
• Changing the pouch promptly if leakage occurs
• Monitoring for redness, burning, or breakdown

When Is Surgery Needed for a Retracted Stoma?

Surgical revision is typically only recommended in severe cases when conservative treatments do not resolve persistent problems. This may be considered if:

• Leakage cannot be controlled with pouching adjustments
• Skin damage becomes severe or recurrent
• The stoma retracts deeply below the skin level
• Other complications develop

Most people with stoma retraction are able to manage the condition successfully with non-surgical solutions and individualized ostomy care strategies. However, if problems persist, regular follow-ups with your stoma nurse are essential to determine whether surgery is necessary.

Living Confidently With a Retracted Stoma

Luckily, as mentioned, a retracted stoma can be managed with the right products and ostomy care. The best option is to use a convex flange or wafer and work with your stoma nurse to ensure that you're able to continually create a strong seal. If you have any questions or concerns, always contact your doctor for medical advice. In the meantime, Byram Healthcare carries a wide range of high-quality ostomy products to help you live a confident, comfortable life. Contact us today to learn more.