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Stoma care · Complications, calmly
Retracted Stoma: Why It Happens, How to Stop the Leaks and Live Comfortably
A stoma that sits flat or below the skin is one of the most common reasons for leaks. Here is how to recognize a retracted stoma, why it happens, how convex pouches, seals and support help, and when to get it checked.
Quick answer
A retracted stoma sits level with or below the skin, or in a skin crease, instead of sticking out slightly. Output can then reach the edge of the barrier, so the main sign is a pouch that keeps leaking and sore skin. It can happen soon after surgery or later, often with weight gain or scarring. Most retracted stomas are managed with a convex barrier, which pushes the skin down so the stoma sits higher, plus seal rings or paste to fill creases and sometimes a light belt. Get urgent help if the stoma turns dark or black, or a new stoma suddenly sinks with pain or fever.
- Flush or belowthe stoma sits at or under skin level
- Leaksare the most common first sign
- Convexityis the usual first fix
- Snug, not tightfor any belt on a convex pouch
What is a retracted stoma?
A retracted stoma sits level with your skin, below it, or tucked into a skin crease, instead of sticking out a little above the surface. You may also hear it called a flush, flat, sunken or recessed stoma.
Most stomas protrude slightly, so output drops straight into the pouch. When a stoma sits low, output can reach the edge of the barrier and creep underneath it. That is why the first thing most people notice is not how the stoma looks, but that their pouch keeps leaking, often around the same spot, and the skin there gets sore.
Retraction can affect the whole stoma or just one side, and it may be more obvious when you sit or bend, as your belly changes shape. It is a well-known stoma problem, and in most cases the right pouching system brings the leaks under control.
Retracted, prolapsed or a hernia?
| What you notice | What it is | |
|---|---|---|
| Retracted stoma | The stoma sits flat, low or in a dip, and the pouch leaks | The stoma being pulled inwards |
| Prolapsed stoma | The stoma itself gets longer and sticks out further | Bowel sliding out through the opening |
| Parastomal hernia | A bulge in the skin around the stoma, bigger when you stand or cough | Bowel pushing through a weak spot beside the stoma |
If you recognize one of the others, our guides to a prolapsed stoma and a parastomal hernia explain what helps.
Why does a stoma retract?
Retraction can show up soon after surgery or months and years later. Common reasons include:
- How the stoma was made. Sometimes the bowel cannot be freed enough during surgery to create a spout, or there was no time to mark the best spot beforehand, as can happen in emergency surgery.
- Weight gain. A softer, fuller belly can draw the stoma inwards or create a fold around it.
- Healing and scar tissue. Scarring after an infection, or after the stoma edge separates from the skin and heals, can pull the stoma down.
- Changes in your belly shape over time, including a hernia nearby or new skin folds when you sit.
None of these are things you did wrong. They are simply how surgery and your body worked out, and there is a lot you can do about the leaks.
When to call your stoma nurse or doctor
Book in with your stoma nurse if your pouch leaks more than once a week, if the skin around your stoma is sore or broken, or if you notice the stoma sitting lower than before. Leaks are a problem with a solution, and you do not have to put up with them.
Get urgent help if
- the stoma turns dark red, purple, gray or black;
- a new stoma suddenly sinks inwards in the first weeks after surgery, especially with pain or a fever;
- you have severe belly pain, or nothing comes out of the stoma for longer than usual with nausea or vomiting;
- there is bleeding that will not stop with gentle pressure.
Not sure what a healthy stoma looks like? Our guide to stoma color shows what is normal and what is not.
How convex pouches help a retracted stoma
A convex barrier has a gently curved, domed back instead of a flat one. When it is pressed against your belly, the curve pushes the skin around the stoma down, so the stoma can sit a little higher and output drops into the pouch instead of running under the edge. It also flattens out shallow creases around the stoma.
- Soft or firm convexity. Soft convexity flexes with your body and suits mild retraction or a soft belly. Firmer convexity gives more push for a deeper dip. Your stoma nurse will help you find the right depth.
- A narrow stoma belt that clips onto the convex pouch can add a little extra pressure and security. It should never be pulled tight; snug is enough.
- Mild redness around the stoma when you take the pouch off is normal with convexity. Report bruising, broken skin, pain or leaks that carry on.
Our guide to convexity in ostomy barriers goes deeper into the options. Pouch makers send free samples, so ask your nurse which convex systems to try.
| Problem | What usually helps |
|---|---|
| Output creeps under the barrier | A convex barrier, with a light belt if your nurse suggests one |
| The stoma sits in a deep crease | A flexible barrier with a seal ring or paste to fill the crease; a rigid convex barrier can be pushed off when you bend |
| The stoma is sunken all round | Build up the edges with a seal ring so the barrier sits flat and tight |
| Sore, weepy skin | Stoma powder to dry it, then a seal or paste, and a skin barrier wipe; see your nurse if it does not settle |
| Leaks only at night | Empty before bed and wear the belt at night if your nurse recommends it |
A pouching routine that holds
Measure in the right position
Check the stoma and the creases around it while sitting as well as standing, because that is often when the dip shows up.
Fill the gaps first
Smooth a seal ring or a little paste around the stoma so the surface is even before the barrier goes on.
Warm and press
Warm the barrier between your hands, apply it, then hold your hand over it for a minute so it settles into every curve.
Empty early
Empty at a third full. A heavy pouch pulls the barrier away from a low stoma.
Change before it fails
If leaks tend to happen on day three, change on day two. A planned change beats a surprise.
Keep notes for your nurse
When and where it leaks, and in what position, tells your nurse exactly what to adjust.
If you are still getting leaks after these changes, our guides to an ostomy bag that keeps leaking and stool leaking around the stoma cover the other common causes, and skin care around your stoma helps the skin recover.
Clothes and daily life with a retracted stoma
What you wear can make the pouch feel more secure. High-waisted, supportive pieces hold the pouch flat against your body, so it does not swing or drag on the barrier as it fills. That is especially helpful when you bend, sit for long periods or move a lot.
- Ostomy underwear with an inner pocket keeps the pouch close and covered all day.
- A soft ostomy wrap smooths everything under fitted clothes and holds the weight of the pouch, so there is less pull on the barrier.
- An ostomy belt holds the pouch securely when you walk, work or work out. It is everyday support, different from the narrow belt that clips onto a convex pouch, and many people wear both.
If your weight has changed since surgery and the dip around your stoma has deepened, gradual changes in weight can change how the stoma sits, for better or worse. Bring it up with your nurse, who can adjust your pouching as your body changes.
When surgery is considered
Most retracted stomas are managed well with convexity, seals and support. If leaks keep happening despite the right products, or the skin keeps breaking down, your surgeon may talk to you about refashioning the stoma, which means remaking it so it protrudes better, sometimes in a new place. If your stoma was always meant to be temporary, closing it during a planned reversal solves the problem too.
Ask your surgical team how likely an operation is to improve daily life for you and what recovery would look like, so you can weigh it up together.
Retracted stoma: your questions
What is a retracted stoma?
A retracted stoma sits level with the skin, below it, or in a skin crease instead of sticking out a little. It is also called a flush, flat, sunken or recessed stoma. The main sign is a pouch that keeps leaking because output can reach the edge of the barrier.
What causes a stoma to retract?
Common causes are tension on the bowel when the stoma was made, emergency surgery without time to mark the best site, weight gain, scar tissue after healing problems, and changes in the shape of the belly over time.
Is a retracted stoma dangerous?
Usually not. It mainly causes leaks and sore skin, which can be managed. Get urgent help if the stoma turns dark or black, if a new stoma suddenly sinks inwards with pain or fever, or if you have severe pain or the stoma stops working.
What pouch is best for a retracted stoma?
A convex barrier is the most common solution, because its curved back pushes the skin down so the stoma sits higher. Soft convexity suits mild retraction and firmer convexity deeper dips. Seal rings and paste can fill creases. Your stoma nurse will help you choose and can arrange samples.
Should I wear a belt with a convex pouch?
A narrow belt that clips onto the convex pouch can add extra pressure and security, and some people wear it only at night. It should be snug, never tight. An everyday ostomy support belt or high-waisted underwear can be worn as well to hold the pouch close.
Why does my retracted stoma leak at night?
Lying down and turning over can change the shape of your belly, and a fuller pouch pulls on the barrier. Emptying before bed, filling any creases with a seal, and wearing a convex belt at night if your nurse suggests it usually help.
Can a retracted stoma correct itself?
Sometimes early swelling settles and the stoma sits better, and weight changes can alter how it sits. More often, the pouching system is adjusted to work with the stoma as it is. Your nurse can review it as your body changes.
Does a retracted stoma need surgery?
Most do not. Surgery to refashion the stoma is considered when leaks or skin damage continue despite the right products. If the stoma is temporary, a planned reversal also solves it.
What is the difference between a retracted and a prolapsed stoma?
A retracted stoma sits too low, at or below skin level, and tends to leak. A prolapsed stoma sticks out further than usual because bowel is sliding out. They need different pouching solutions, so ask your nurse to take a look.
Can I exercise with a retracted stoma?
Yes. Empty the pouch first, use the convex system and belt your nurse recommends, and wear a supportive ostomy belt or high-waisted garment to keep the pouch secure while you move.
Sources and further reading
- Association of Coloproctology of Great Britain and Ireland: The problem stoma, a retracted stoma
- University Hospitals Birmingham NHS: Using a convex stoma pouch
- Convexity in stoma care: international consensus (PMC)
- United Ostomy Associations of America: When to contact your stoma care nurse
Written by María G. for SIIL Ostomy.
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