An ostomy procedure creates a stoma, a surgically fashioned opening in the abdomen that diverts waste from the body. A normally functioning stoma appears pink or red, moist, and slightly protrudes above the skin surface, ideally by about 2.5 centimeters. Stoma retraction is a common complication where the intestinal tissue pulls back to the level of the skin or recedes below it. This anatomical change significantly compromises the ostomy appliance seal and surrounding skin health, raising the question of whether a retracted stoma can spontaneously correct itself.
Defining Stoma Retraction
Stoma retraction is defined by the loss of the normal protrusion, causing the stoma to sit flush with or below the skin’s surface. A healthy stoma’s slight projection allows effluent to drop directly into the collection pouch without touching the surrounding skin. When retraction occurs, the stoma may appear sunken, creating a concave area on the abdomen.
The severity of retraction is typically classified based on how deep the stoma has pulled back. A partial retraction involves the stoma receding only to the level of the skin or subcutaneous tissue. A more severe, complete retraction is defined by the stoma pulling back entirely below the level of the abdominal fascia, the strong connective tissue lining the abdominal muscles.
The functional consequence of retraction is a compromised seal between the skin and the ostomy appliance. Since the stoma no longer projects outward, output can seep underneath the barrier, leading to leakage and skin irritation. This quickly causes excoriation, or skin breakdown, around the stoma.
The Likelihood of Spontaneous Resolution
For a structurally retracted stoma, spontaneous self-correction is highly improbable. The underlying causes are structural or physiological, meaning they are fixed issues the body cannot naturally undo. Once established, the condition is considered permanent without intervention.
One primary cause is excessive tension on the bowel mesentery, the tissue connecting the intestine to the back of the abdominal wall. If the surgeon was unable to fully mobilize the bowel during surgery, the natural tension can pull the stoma inward. This mechanical problem cannot be reversed by the body’s healing processes.
Another common factor is the formation of scar tissue, which can contract and pull the stoma inward over time. This type of retraction may occur months or years after the initial surgery. Late retraction can also be attributed to significant weight gain, where the expanding abdominal wall causes the stoma to appear sunken relative to the new body contour.
While temporary swelling or inflammation immediately after surgery may subside, giving the appearance of a change, true structural retraction persists. Factors contributing to retraction, such as inadequate bowel length or scar tissue, are permanent anatomical alterations. A persistent, structural retraction requires active management and potentially surgical correction.
Immediate Management and Non-Surgical Interventions
Since spontaneous resolution is unlikely, the immediate focus shifts to managing the complication to ensure patient comfort and prevent skin damage. The primary goal of non-surgical management is to create a secure, leak-proof seal around the retracted stoma using specialized ostomy equipment designed to provide mechanical assistance.
The cornerstone of non-surgical intervention is the use of a convex skin barrier or faceplate. These barriers have a dome-like shape that gently presses into the peristomal skin, forcing the retracted stoma tissue to protrude slightly. This counter-pressure directs the effluent away from the skin and into the pouch. A specialized ostomy belt is often used with the convex barrier to provide the necessary continuous pressure.
Additional accessories enhance the seal and protect the skin from corrosive output. Stoma paste, rings, or strips are used to fill in any uneven surfaces, dimples, or creases in the abdominal wall. These hydrocolloid products act like a caulk, creating a smooth, flat surface for the convex barrier to adhere to.
A trained wound, ostomy, and continence nurse (WOCN) is instrumental in tailoring these products to the individual’s anatomy. They can experiment with different levels of convexity, ring thicknesses, and accessory combinations to maximize wear time and minimize skin exposure. This practical, non-surgical approach is considered the first line of defense and successfully manages many cases of mild to moderate retraction.
When Surgical Intervention is Necessary
When non-surgical management fails to provide a consistent, secure seal, or if retraction leads to severe medical complications, surgical intervention becomes necessary. The need for surgery is determined by the persistence of uncontrollable leakage, chronic peristomal skin breakdown, or signs of more serious issues. Persistent leakage requiring frequent appliance changes is a common indication for operative correction.
Surgery is also indicated if retraction is associated with obstruction or severe ischemia, where the blood supply to the stoma is compromised. These complications are considered medical emergencies requiring immediate attention. In less acute cases, a surgeon is consulted when conservative management has been maximized but the patient’s quality of life remains significantly impaired.
The surgical procedures to correct retraction are typically a stoma revision or a stoma relocation. A local stoma revision involves the surgeon re-fashioning the stoma at its current site, potentially mobilizing the bowel further to ensure adequate protrusion. If the original stoma site is problematic, such as being located outside the rectus muscle or in an area of complex scarring, a complete relocation to a new, more suitable site may be required. The goal of either procedure is to achieve a stoma that protrudes by at least 10 millimeters, the minimum height for optimal pouching.