A stoma is a surgically created opening on the surface of the abdomen, diverting the flow of waste from the body. Importantly, a stoma has no nerve endings, so touching it does not cause pain. While a stoma can be life-saving for various conditions, individuals with a stoma may experience complications, including the stoma pulling back or retracting.
Understanding Stoma Retraction
Stoma retraction occurs when the stoma sinks below the skin level, appearing flat against or receding into the abdomen. While a healthy stoma normally protrudes slightly (about 2.5 cm), a retracted stoma appears sunken or flush with the skin. A stoma is considered retracted when the mobilized bowel sits more than 5 mm beneath the skin surface. This condition can develop weeks, months, or even years after the initial procedure. Stoma retraction is reported to occur in approximately 1% to 6% of cases after stoma creation.
Potential Risks of Retraction
A retracted stoma can lead to several complications. One primary concern is persistent leakage, as the recessed stoma makes it difficult for the ostomy appliance flange to form a secure seal. This leakage allows waste to come into contact with the skin around the stoma, which can cause irritation, skin breakdown, and discomfort. The inability to properly secure the ostomy pouch can also lead to frequent appliance changes.
Beyond skin issues, the spillage of bodily contents into the subcutaneous tissue can increase the risk of infection around the stoma site. Retraction can also contribute to problems like stoma obstruction, where the passage of waste becomes blocked. Tissue death, or necrosis, can occur if the stoma experiences inadequate blood supply due to tension from retraction. Such complications often require immediate medical attention.
Causes of Stoma Retraction
Several factors can contribute to stoma retraction. Obesity is a common cause, as increased abdominal fat can exert traction on the bowel wall. Weight gain after surgery can also lead to retraction because the abdominal wall expands around the stoma. The patient’s body mass index (BMI) is considered an independent predictor of postoperative stoma complications, including retraction.
Another reason for retraction is excessive tension on the bowel or its supporting mesentery during the initial surgical creation of the stoma. This can result from inadequate mobilization of the bowel, meaning insufficient bowel was freed to create a protruding stoma without strain. The development of a parastomal hernia, which is a bulge of intestine around the stoma, can also contribute to retraction by creating tension that pulls the stoma inward. Other contributing factors may include poor healing of the stoma area, scar tissue formation, or ischemia, which is a lack of blood flow to the tissue.
Managing a Retracted Stoma
Managing a retracted stoma often begins with conservative approaches. A primary strategy involves using specialized ostomy appliances designed for retracted stomas, such as those with a convex (outward-curving) flange or wafer. These convex barriers apply gentle pressure to the skin around the stoma, helping it protrude and directing waste into the pouch, which improves the seal and prevents leakage. Additional products like stoma seals, washers, and pastes can be used to fill gaps and enhance adhesion.
Consulting with an ostomy nurse or healthcare professional is important for proper appliance fitting and personalized advice. They can help select the most suitable products and provide guidance on managing skin integrity. Ostomy belts can also be used to provide gentle pressure and support, helping to keep the stoma from retracting further. In some instances, weight reduction can alleviate pressure on the stoma site and reduce the risk of further retraction. If conservative methods are insufficient, or if severe complications like persistent skin breakdown, recurrent leakage, or obstruction occur, surgical intervention known as stoma revision may be considered to correct the issue.