Page 12 - May 2021 Newsletter

The Problem Stoma – a retracted stoma
A retracted stoma is where the stoma no longer lies on the abdominal wall, appears sunken or in a dip. This type of stoma can sometimes be difficult to manage. Leakage, sore skin and difficulties with appliance management sometimes result.
In the ideal world, all stomas would be sited on a flat surface of the abdomen, and protrude above the level of skin (colostomy slightly, ileostomy and urostomy by about an inch). Unfortunately some stomas are not perfect: there may be problems at the time of surgery – adequate bowel and mesentery are not able to be mobilised enough to create a ‘spout’, or in an emergency situation the patient’s abdomen has not been marked pre-operatively to select an appropriate site for the stoma; post-operatively there may be weight gain, or scar tissue from infection, or muco-cutaneous separation.
These are possible causes of a retracted stoma – which sits either flush or below skin level, or in a skin crease, and is at risk of allowing faeces or urine onto the skin surface. This results
in leakage from the bag and sore skin, and causes distress
and discomfort for the patient. You will have to use accessory products in addition to a normal stoma bag to ensure a good seal around the stoma and help the bag adhere well to the skin.
Some of the additional products that you can use are paste, powder, seals, washers, belts, convex or soft-convex flanges, flange-extenders, skin protection wipes or sprays, thickeners.
When drawing up a care plan, your nurse has to consider your ability to change your bag as well as the most cost-effective system. A certain element of ‘trial and error’ may be necessary to find the most efficient way of dealing with the problem.
A bag with a convex or soft-convex flange may be used to enable the stoma to protrude more or for a superficial crease. A thin elastic belt can be attached to the bag for added security. This type of flange may be too rigid if there is a deep crease, and would be forced off when the you bend, e.g., when sitting. In these circumstances you can use a bag with a flexible flange and apply paste or a seal
(or a combination of both) to fill the crease. You need to build up the edges of a sunken stoma to form a seal to prevent stool or urine leaking and causing erosion of the skin.
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