As we already know, having a stoma means that a section of your bowel has been brought out through a cut in your abdomen. Sometimes, this can lead to weakness in the area around your stoma, that can lead to the abdominal muscles bulging out, creating a lump, or swelling. Although the size of the parastomal hernia is different from person to person, it is often the size of a lime when it first appears. As time goes by, the hernia is bound to get bigger.
Types of parastomal hernia
Sliding hernia
It is called a sliding parastomal hernia, when a segment of the intestine that was used to create the stoma, loops – or ‘slides’ – under the skin.
True hernia
With a true parastomal hernia, a loop of the intestine pushes through the hole in the abdomen and stays under the skin, forming a bulge. If you suspect a true hernia, contact your nurse or doctor immediately as there is a great risk of your bowel being squeezed between the muscle layers.
What causes a parastomal hernia?
There are many different factors that can contribute to the development of a parastomal hernia. These factors can include coughing, obesity, or an infection after your stoma surgery. Other factors that can contribute to the development of hernias are:
- Chronic constipation
- Smoking
- Chronic coughing
- Malnutrition
- Corticosteroid use
Symptoms of a parastomal hernia
Often, your parastomal hernia will not cause any symptoms for you although you might experience some discomfort or a dragging feeling. The latter tends to happen at the end of the day when your muscles are tired or after the stoma has been active. Over time, your skin might feel somewhat thinner and stretched and it may tear more easily when you’re removing your ostomy pouch. You might also find irrigation more difficult or less effective with a hernia as water will struggle to move through the collapsed bowel loops. In extreme cases, the loops of your bowel can become strangulated and obstructed which will cause extreme pain and vomiting. If this happens, it is important that you seek emergency medical attention. General symptoms include:
- Bulging around stoma, especially when coughing
- Pain or discomfort around stoma
- Trouble keeping your stoma appliance in place
- Greater possibility of sore skin and leakage due to changes in the shape of your abdomen around the stoma
How is a parastomal hernia treated?
In many cases, your parastomal hernia can be treated with simple lifestyle changes such as losing weight, exercising more regularly, or following a balanced diet. Using an abdominal support belt can also help to ease the symptoms. If lifestyle changes don’t work, there are several surgical treatments.
Closing the stoma: This is by far the best option for repairing a parastomal hernia, although only an option for a small group of people who have enough healthy bowel left to reattach the end that forms the stoma.
Repairing the hernia: With this type of surgery, the surgeon` opens the abdominal wall over the hernia and sews the muscle and other tissue together to narrow or close the hernia. This surgery is most successful when the hernia is still fairly small.
Relocating the stoma: If you have developed a parastomal hernia, there is a possibility to close the stoma and create a new one on a different part of your abdomen. Although this repairs the current hernia, a new one can form around the newly created stoma.
Mesh: Currently, mesh inserts are the most common type of parastomal hernia repair. Biological mesh is often considered more comfortable than synthetic mesh, but, at the same time, it is also much more expensive. With this surgery, the hernia is repaired using the same technique as other repairs, then the mesh is placed over the repaired stoma or below the abdominal wall. The mesh insert will then incorporate into the tissue around the stoma and creates a strong area in the abdomen that helps to prevent the hernia from forming again.
Can you prevent a parastomal hernia?
A parastomal hernia can’t be prevented completely but the risk can be significantly reduced by avoiding heavy lifting and straining and by maintaining a healthy weight.