A parastomal hernia is a bulge or swelling around/under the stoma. It is a type of incisional hernia. When a stoma is created, a small cut is made in the abdominal muscles (tummy), to allow the bowel to be brought out and stitched to the skin. A weakness in healing between the bowel wall and the abdominal wall muscles result in a gap to develop. Over time this gap might enlarge allowing fat or bowel loops from inside the abdomen to bulge through. The hernia can cause problems with stoma function and fixing stoma appliances (bag) on to the skin.
How common is it?
Most surveys suggest that with time up to 70% of ostomates develop a parastomal
hernia; the longer a stoma is present, the more likely it is that a hernia will occur. It depends on how hard you look for the problem.
A bulge around the stoma which might slowly increase in size over time.
Chronic abdominal pain or discomfort around the stoma that might be worse on undertaking any heavy activity.
Changes in stoma function or bowel habits as the hernia might cause mild temporary blockages
Problems with fitting the stoma appliances (stoma bag). The bags might come off more easily as they do not stick well due to the bulge. This can result in leakages and skin reactions around the stoma which make the problem worse.
Breakdown of the skin around the stoma from injury or ischemia from pressure on the thinned peristomal skin.
Factors that can contribute to formation of parastomal hernia
Straining i.e. lifting heavy objects, gardening or strenuous exercise
Muscles weakening as part of the age process
Poor siting of stoma
Complications from a parastomal hernia
Functioning of the stoma can be unpredictable with the extra bowel within the abdominal wall causing alternation between constipation and diarrhoea.
The stoma itself can become reduced in size or even retracted as the bulge of the parastomal hernia increases in size.
The most serious complication from a parastomal hernia is a blockage in the bowel with abdominal swelling and risk of perforation or gangrene of the bowel caught up in the hernia. Fortunately, this is rare. If this happens, emergency surgery is necessary.
Prevention of parastomal hernia
There have been a few small studies that have shown a two to three fold reduction in the parastomal hernia rate if a mesh is placed around the stoma in the case of a permanent colostomy. The use of the mesh has been shown to be safe.
There is also some research that avoiding any heavy lifting for the first three months after surgery and the use of a support garment when doing any physical work (I.e. gardening, lifting decorating) in the first few months after your operation can reduce the parastomal hernia rate.
The use of hernia support garments such as a belt, girdle or pants are helpful to manage a parastomal hernia. These are available on prescription and your stoma nurse will be able to advise you as you will need measuring up for the garment before ordering.
If you are having problems with fixing your pouch on to your skin because of a parastomal hernia, you can seek advice from your local stoma nurse who may be at able to advise the use of different or additional products to help minimise the problem.