Stoma Retraction: What It Is and How It's Managed

Stoma retraction is one of the more common complications that can occur after the formation of a colostomy, ileostomy, or urostomy. It occurs when the stoma recedes to the level of — or below — the surface of the abdominal skin, rather than protruding the customary 2–3 cm above it. Although retraction can be alarming to discover, it is a recognised and manageable clinical problem, and a range of conservative and surgical options exist to address it.

What Is Stoma Retraction?

A well-formed stoma is intentionally created with a small spout or bud that extends above the skin surface. This protrusion is deliberate: it directs effluent away from the peristomal skin and into the pouch, helping to maintain a secure seal. When retraction occurs, this protective projection is lost.

Clinicians typically classify retraction by severity:

• Mild (Grade 1): The stoma sits flush with the skin surface but remains visible and functional.
• Moderate (Grade 2): The stoma sits slightly below skin level, creating a depressed channel that disrupts appliance adhesion.
• Severe (Grade 3): The stoma is significantly sunken, sometimes partially hidden within a skin fold, and reliable pouching becomes very difficult.

Retraction may affect the entire circumference of the stoma or only a portion of it, sometimes creating an uneven, asymmetric appearance.

Why Does Retraction Occur?

Retraction has several recognised causes, and in many cases more than one factor is involved.

Surgical Factors

Insufficient bowel length or excessive tension on the mesentery at the time of surgery is a primary cause. If the bowel is pulled too tightly to reach the abdominal surface comfortably, it may gradually pull back inward as swelling subsides in the weeks following the operation.

Weight Gain

Significant weight gain after surgery is a well-established cause of late-onset retraction. As adipose tissue accumulates around the abdominal wall, the stoma can be drawn inward relative to the new skin surface level. This is particularly relevant for people who experience rapid weight gain in the months or years after surgery.

Post-operative Oedema

In the immediate post-operative period, the stoma may appear well-formed because surrounding tissue is swollen. As this oedema resolves over several weeks, a stoma that had marginal length may retract. For this reason, retraction is sometimes only identified at the six-to-eight-week post-operative review.

Ischaemia and Scarring

Inadequate blood supply to the bowel end can lead to necrosis and subsequent scarring, which shortens the effective length of the stoma. Peristomal scarring from repeated skin damage or infection can also tether the stoma and draw it inward over time.

Disease-related Causes

In people with inflammatory bowel disease (IBD) or Crohn’s disease in particular, ongoing inflammation, fistula formation, or disease recurrence near the stoma site can contribute to retraction.

How Does Retraction Affect Daily Life?

The loss of the stomal bud has direct practical consequences. Effluent — whether liquid stool, formed stool, or urine — no longer drains cleanly into the pouch. Instead, it may pool at the skin surface, seep under the adhesive baseplate, and cause repeated leaks. This leads to:

• Peristomal skin damage: Prolonged contact with stool or urine causes moisture-associated skin damage, erosion, and dermatitis. Ileostomy output is particularly harmful because it is rich in digestive enzymes.
• Appliance failure: Constant leaks undermine confidence, restrict activities, and may require multiple appliance changes each day.
• Psychological impact: Anxiety, social withdrawal, and reduced quality of life are well-documented consequences of uncontrolled leakage.

Conservative Management

For most cases of mild to moderate retraction, a specialised pouching approach can achieve a reliable seal without the need for further surgery.

Convex Appliances

The cornerstone of conservative management is the use of a convex baseplate or flange. Unlike flat appliances, a convex profile creates an outward pressure on the peristomal skin that encourages the stoma to protrude slightly and improves the seal around it. Convex appliances are available in varying degrees of convexity (soft, moderate, and firm) and should be selected with guidance from a stoma care nurse, as using an inappropriate convexity can itself cause complications such as peristomal pressure injury.

Support Belts

An ostomy support belt worn over the appliance can enhance the effect of convexity by maintaining steady, even pressure on the baseplate against the abdomen. This is particularly useful for people with soft or pendulous abdominal walls.

Accessory Products

Several adjunctive products may be used to fill the peristomal depression and create a level pouching surface:

• Mouldable or flexible seals/rings: Applied around the stoma opening before the baseplate, these fill uneven contours and extend wear time.
• Ostomy paste: Used to fill creases or gaps, though it is not an adhesive and is used as a skin-protective filler.
• Barrier rings: Similar to seals, these provide both protection and levelling.

Skin and Wound Care

Any existing peristomal skin damage must be addressed concurrently. This may involve barrier films, medical-grade moisture barrier creams, or absorbent wound products, depending on the nature and severity of the skin condition.

Surgical Management

When conservative measures fail to provide an adequate quality of life, or when the retraction is severe and associated with complications such as obstruction, fistula, or severe skin breakdown, surgical revision is considered.

Stoma Revision

The standard surgical approach involves refashioning the stoma — freeing it from adhesions, mobilising additional bowel length, and resiting or reconstructing the stoma to achieve the correct protrusion. This may be performed as a local procedure through the peristomal skin or, in more complex cases, via laparotomy or laparoscopy.

Surgical risk must always be weighed against the degree of disability caused by the retraction. The decision should be made jointly between the patient, stoma care nurse, and surgeon.

Prevention

Prevention begins at the time of original surgery. Careful siting of the stoma by a specialist nurse before the operation, adequate bowel mobilisation, and meticulous surgical technique all reduce the risk of retraction. Pre-operative body weight optimisation is also beneficial where time permits.

Post-operatively, early and regular review by a stoma care nurse allows retraction to be identified and managed before significant skin damage occurs.

The Bottom Line

Stoma retraction is a recognised complication that can develop early or late after stoma formation. While it disrupts pouching and can damage peristomal skin, it is almost always manageable. Conservative approaches — particularly convex appliances, support belts, and sealing products — resolve the majority of cases without further surgery. If you notice your stoma appearing sunken, or if you are experiencing frequent leaks and skin problems, contact your stoma care nurse promptly. Early specialist input leads to better outcomes and helps protect both your skin and your quality of life.