Stomas are created to drain waste through the abdominal wall. This is usually either because of down-stream disease, or to protect a newly constructed surgical join.
Making a hole to tunnel the stoma through can sometimes create problems. If abdominal pressure is greater than the forces holding your stoma to the abdominal wall muscles, the abdominal contents can prolapse down the side of your stoma, causing a bulge which you can feel.
A hernia will be a bulge under the skin, which you can see and feel. It will be more visible when standing, and when you cough.
If you are concerned that you might have a parastomal hernia, please speak to your stoma nurse.
Parastomal hernias are common, affecting roughly 70% of people with stomas. It is rare that these hernias cause major complications, and the deveopment of a hernia doesn't mean you always need surgery.
Improving your core strength with exercise, and managing a healthy weight can help improve comfort.
If a parastomal hernia causes a bowel blockage, this can be dangerous. If you hernia starts to hurt, then your GP can refer you to a surgeon for advice.
If your hernia swells and will not go down, and you have symptoms of a blocked bowel (vomiting/abdominal distension/stoma not working for >12 hours) then your bowel may be pinched in your hernia.
If you can, lie down to relax your abdominal muscles. Press firmly on the hernia with the flat of your hand. You may be able to feel the bowel slipping back inside your abdominal cavity where it belongs. This is called "reducing the hernia".
If you are in pain, your bowel is blocked, and you have been unable to reduce the hernia, you will need to go to hospital.
Depending on the symptoms caused by your hernia, sometimes you can learn to live well alongside it. Reach out to your stoma nurse and surgeon if you are worried. The Colostomy UK website has lots of helpful lifestyle advice.
If a parastomal hernia is causing serious problems, then surgery may be an option. Discussion with a surgeon will prompt imaging to define the problem, and a patient-tailored approach - every patient and hernia is different.
A temporary stoma can be closed once it has finished its job, and the abdominal wall closed.
Fixing a hernia next to a permanent stoma requires careful thought, as the bowel in the hernia needs to be returned to the abdomen, but space left for the stoma to drain. Sometimes there are both traditional and minimally invasive options to consider. Parastomal hernia surgery will often require reinforcement with mesh in the abdominal wall, to reduce the risk of recurrence.
In all cases, international guidelines for hernia repair recommend stopping smoking, and having a healthy weight (BMI<30). This has been shown to reduce complication rates, and reduce recurrence of the hernia. Your surgeon may insist on this prior to any surgery for hernia.
There are steps you can take to try and prevent the formation of a hernia.
Allow your body to recover after your surgery, and introduce exercise slowly. Walking, running, dancing, swimming and cycling are good sports to start with.
Wear support garments.
Stengthening your core muscles stregnthens the abdominal wall. This can reduce the risk of a hernia forming, or improve your comfort if you already have a hernia.
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