How should a recessed (retracted) stoma be managed?

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Last updated: May 19, 2026 • View editorial policy

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Management of Recessed (Retracted) Stoma

A recessed stoma should be managed primarily with specialized pouching techniques including convex appliances, ostomy belts, paste, and barrier rings to elevate the stoma off the peristomal skin and prevent leakage, with surgical revision reserved only for cases with severe pouching difficulties, persistent skin breakdown, or complications that cannot be managed conservatively. 1

Initial Conservative Management Approach

The cornerstone of managing a retracted stoma is preventing and controlling leakage, which is the primary driver of morbidity through peristomal skin breakdown, pain, and significantly impaired quality of life 1. Retracted stomas are particularly prone to leakage because the stoma sits flush with or below the skin level, allowing effluent to pool and undermine the pouching seal 1.

Pouching System Modifications

The following techniques should be implemented systematically to bolster stoma height:

  • Convex appliances: These press into the peristomal skin to create protrusion of the stoma above skin level 1, 2
  • Ostomy belt: Provides additional pressure to maintain convexity and secure the seal 1
  • Barrier rings and paste: Fill in irregular contours around the retracted stoma 1
  • Two-piece ostomy systems: Allow for easier management and bag changes without disturbing the baseplate seal 3

Application Technique Optimization

Critical technical details that improve seal integrity include 1:

  • Heat the appliance with a hair dryer before application to improve adhesion
  • Lie flat for several minutes after application to allow proper seal formation
  • Ensure peristomal skin is completely dry before application
  • Apply fine dusting of stomal powder followed by skin sealant on any compromised peristomal skin
  • Cut the appliance opening one-eighth inch larger than the stoma to prevent mucosal irritation while minimizing exposed skin

Stool Consistency Management

Thickening liquid effluent with antimotility agents is essential to reduce the volume and liquidity of output, which directly decreases leakage risk 1. This is particularly important for ileostomies or in patients with chronic diarrhea.

Advanced Conservative Options for Severe Cases

When standard pouching modifications fail and peristomal skin breakdown occurs:

Negative-Pressure Wound Therapy (NPWT)

For retracted stomas with severe peristomal infection or moisture-associated skin damage (MASD) that fails conventional treatment, single-use NPWT dressings can effectively protect the wound from bowel leakage while allowing simultaneous use of ostomy bags 3. This approach achieved complete wound healing in a case series with mean treatment duration of 14 days, avoiding surgical revision in all cases 3.

Modified Fecal Diversion Devices

In critically ill patients who are not surgical candidates, modified endotracheal tubes can be used for temporary fecal diversion, achieving complete ulcer healing within 10 days in reported cases 4. However, this requires close monitoring for tube obstruction.

Wound Ostomy Continence (WOC) Nurse Consultation

Referral to a specialized WOC nurse is mandatory for any patient with a retracted stoma experiencing recurrent leakage or skin complications 1. These specialists can provide individualized pouching solutions and ongoing troubleshooting that significantly improves quality of life and reduces complications 1.

Surgical Revision Indications

Surgical revision should be considered only when conservative management fails and the patient experiences 5:

  • Impossibility of adequate stoma care despite maximal conservative efforts
  • Severe, refractory peristomal skin breakdown
  • Recurrent bowel obstruction
  • Stoma-related bleeding or ischemia
  • Incarceration

The decision between local revision versus transabdominal revision with stoma relocation depends on individual anatomy and the presence of other complications 5. However, it's important to note that moving the stoma to a new location carries significant risk of developing a new parastomal hernia at the relocated site 1.

Prevention is Critical

The best management is prevention through preoperative stoma site marking by a WOC nurse and meticulous surgical technique to ensure the stoma protrudes adequately above the skin level at creation 1. Stomas should be placed through the rectus muscle and positioned away from skin folds, scars, and bony prominences 1.

Common Pitfalls to Avoid

  • Do not use stoma rods/bridges to prevent retraction—evidence shows they do not reduce retraction risk and may cause additional complications including edema, necrosis, and peristomal skin damage 6
  • Avoid premature surgical revision when conservative pouching modifications have not been fully optimized
  • Do not overlook the psychological impact—address patient concerns about leakage, odor, and lifestyle limitations through education and support 1

References

1
Guideline

aga clinical practice update on management of ostomies: commentary.

Clinical Gastroenterology and Hepatology, 2023

2
Research

Measurement of Flexibility and Compressibility in Convex Ostomy Barriers: Report of a Transdisciplinary Consensus Conference.

Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society, 2025

5
Research

[Stoma prolapse and stoma retraction].

Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen, 2010

6
Research

The Use of a Stoma Rod/Bridge to Prevent Retraction: A Systematic Review.

Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society, 2021

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.