Retracted Stoma
A stoma is a round or oval opening in your abdomen where a small part of your digestive tract, usually the small intestine, is brought to the skin’s surface and kept in place to facilitate waste removal from your body into a special stoma bag that attaches to the stoma. A stoma is usually created after a surgical procedure to treat an injury or condition that affects your bowels.
A normal stoma protrudes slightly above skin level, appearing pinkish or reddish with a slightly moist and shiny look. A retracted stoma occurs when a normal stoma sinks below the skin. It does not completely sink back into your bowel area; it may still function normally in most cases. However, in some cases, a retracted stoma can cause problems, especially if it causes waste to leak onto the skin’s surface, which can damage the skin and cause discomfort.
What Causes a Retracted Stoma?
A retracted stoma may sit either flush or just below skin level instead of protruding slightly above skin level. The retraction can occur due to various factors, but it does not happen immediately; you may notice something amiss later on when your stoma appears smaller or less apparent than usual. According to existing data, stoma retractions are reported to occur in 1% to 6% of cases after a stoma is created.
The most common causes of a retracted stoma are:
● A sudden or gradual increase in weight where the stoma remains in the same place, but the abdominal wall expands around it, causing it to become retracted.
● Severe malnourishment or immunosuppression that affects the body’s well-being.
● Internal surgical scarring or scar tissue formation.
● Ischemia, a lack of blood flow to the intestines.
● Poor healing of the stoma area, may cause it to retract or result in other complications.
● Mucocutaneous separation, where the stoma becomes detached from the surrounding skin. This condition may occur due to various factors, such as surgical site infection and tension on the suture line.
● Poor stoma siting. Stomas cannot simply be attached anywhere, as some areas of your body may experience more skin contact or creasing that may rub against the stoma and cause discomfort. It can also result in poor ostomy bag fittings.
● Stoma necrosis, can be life-threatening if left untreated.
Signs of a Retracted Stoma
The most obvious sign of a retracted stoma is when it seems smaller than usual or has almost disappeared entirely. A healthy stoma usually protrudes about 2.5 cm above your skin, so anything less than that may indicate a gradual retraction. It may not necessarily be obvious at first glance, however, until you try to fit your ostomy bag and find it more difficult than usual to fit. If you also find that waste matter leaks more often than normal, even after fitting your ostomy bag, or if the skin around your stoma frequently feels irritated, that may also be a sign of a retracted stoma. It is a good idea to see your wound care nurse or specialist immediately for further advice.
There have been times when a retracted stoma returns to its original position after some time, but such cases are very rare. In most instances, a retracted stoma will not return to its original position and may require additional support or treatment to restore.
Managing a Retracted Stoma
The good news is that most, if not all, cases of a retracted stoma are manageable with the support of your wound care nurse or specialist. The most effective method of managing a retracted stoma is to use an ostomy bag or appliance with a convex (curving outwards) flange or wafer that makes it easier to fit over a retracted stoma. The convex device can gently push the skin around the stoma inwards by a small amount, giving the ostomy bag or appliance better adhesion that prevents leakage onto your skin.
Other assistive devices can ensure that your ostomy bag fits nicely over your stoma. Your wound care nurse or specialist can help you by recommending the right products for your needs and explaining how to use them effectively. For example, a stoma seal may be helpful by adding some thickness around the stoma, ensuring that your ostomy bag or appliance can stick better and prevent leakages. It is common to use a mix of devices to ensure proper adhesion to your ostomy bag or appliance.
Weight loss is also recommended to undo a stoma retraction by ensuring it does not retract further from additional weight gain. Regular exercise can help you gradually lose excess weight and ensure the stoma does not retract. You may need to discuss your fitness routine with your wound care nurse or specialist to ensure positive results.
Regular follow-up checks will also help to ensure your retracted stoma is doing well and detect complications early.
Will I Need Stoma Revision Surgery?
Stoma revision (or resiting) surgery is a surgical procedure that shifts the stoma to a different position from its original position. While most cases of a retracted stoma will resolve on their own, especially if you have the support of your wound care nurse or specialist, surgery is typically unnecessary. However, if a retracted stoma cannot be adequately resolved with nonsurgical methods or if it causes significant complications affecting your health, then surgery is a must.
During surgery, you will be placed under general anaesthesia to ensure your comfort throughout the procedure. The surgeon will carefully make incisions to move the stoma from its current position to its new location, then stitch the original location up before preparing the stoma at its new site to prevent unpleasant side effects. You will need to be monitored in the hospital for a few days to ensure you are recovering well and prevent any complications from arising that can interfere with your recovery.
Resiting the stoma will not drastically change your lifestyle; you only need to acclimatise to its new position and how that may affect how you wear your clothes or hide your ostomy bag. Your stoma care nurse or specialist will help you through this adjustment process.
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