Parastomal hernias are a type of medical condition that occur in people who have had ostomies. An ostomy is a diversion surgery that reroutes stool or urine past diseased or malfunctioning parts of the urinary tract system or digestive system. After undergoing ostomy surgery, waste products exit the body through a stoma—a small opening created on the abdominal wall—instead of through the urethra or colon. This is a fairly common treatment as there are between 700,000 and one million people currently living in the United States with some type of temporary or permanent ostomy. While you can enjoy a full life with an ostomy, there are some complications that can arise, one of which is a parastomal hernia. Here, we’ll go over everything you need to know about parastomal hernias and how to have them repaired.
Important Information About Parastomal Hernias
A parastomal hernia occurs at the site of the stoma in ostomates when a part of the intestines sticks out through the opening. They develop in nearly 78% of individuals within two years of the initial surgery. Recognizing a parastomal hernia is fairly easy, as it will appear as a bulge underneath the skin next to the stoma. In almost all instances, parastomal hernias contain a small, balloon-like pouch called a peritoneal sac. They tend to require some type of medical intervention for treatment.
Causes and Risk Factors
Parastomal hernias only occur in individuals who have undergone an ostomy surgery. The primary cause of a parastomal hernia following this surgery is weakened abdominal walls. An individual’s core is subject to gradual atrophy, especially over the years, and if muscles degenerate to a certain point, parastomal hernias can occur. They’re also commonly caused by injury, previous incision sites, congenital abdominal weakness, or aging. Chronic or excessive strain placed on the abdominal wall can also increase your risk of parastomal hernias. This is especially true in the case of heavy lifting, strenuous bowel movements, and persistent coughing.
When the abdominal muscles separate, weak points appear, and a hernia can develop. Other risk factors include obesity, malnutrition, pulmonary disease, infection, corticosteroid use, constipation, and smoking. Those who have had abdominal wall hernias in the past are at a greater risk for developing future parastomal hernias. Talk to your doctor about ways you can stay healthy and reduce your risk of occurrence.
Preventative Measures to Take
There are a few preventative measures you can take to reduce the chance of developing a parastomal hernia. First and foremost, make sure that you allow adequate time for your body to recover following an ostomy surgery. Don’t try to overdo it, especially in the first week of recovery. Avoid exercising until your doctor tells you it’s safe to do so and consider wearing supportive garments to keep your abdominal wall strong.
Following recovery, once you’re fully healed and have your doctor’s approval, begin performing regular core exercises to help strengthen abdominal muscles and reduce your risk of developing a hernia. Begin with gentle exercises and slowly increase intensity to avoid problems. Always consult with your doctor prior to starting any exercise regimen, especially as a new ostomate.
Signs and Symptoms of a Parastomal Hernia
Parastomal hernias only develop near an abdominal stoma and are fairly easy to recognize. There will be a bulge that appears underneath the skin that surrounds the stoma opening. These hernias can vary in size from the size of a golf ball to as large as a football. This can make it difficult for individuals to attach their pouching system or keep it in place throughout the day. In the early stages of a parastomal hernia, pain may only occur when performing strenuous activities, when coughing, or during prolonged periods of maintaining one position. However, as it progresses, the pain may become sharper or extend throughout the day as a dull ache that gets worse as the hours pass.
In rare cases, the hernia can entrap or begin to strangle your intestines. Symptoms of an entrapped hernia include severe, continuous pain that’s coupled with redness or tenderness at the site. If you notice any of these symptoms, contact your doctor immediately or go to the hospital. Entrapped hernias can lead to a loss of blood supply, which requires emergency surgery to repair.
How a Parastomal Hernia is Repaired
There are several ways that a parastomal hernia can be repaired. If it’s small and not causing you too much disruption, your doctor may recommend beginning with some lifestyle changes to see if it can heal on its own. These primarily include beginning a weight loss regimen and quitting smoking as both obesity and the toxins in cigarette smoke can make a parastomal hernia worse. Your doctor may also recommend a stomal support belt, which is a type of compression belt that helps keep the abdominal muscles compact. If anything, support belts can help decrease the likelihood that the parastomal hernia gets worse.
Severe or persistent cases of parastomal hernias will require surgery. There are several different options that your doctor will discuss with you, each of which tends to depend on your hernia’s severity and size. These include closing the stoma, relocating the stoma, repairing the hernia, or performing mesh surgery.
Closing the Stoma
Some individuals who undergo an ostomy surgery only require a temporary diversion. If you’ve developed a parastomal hernia and your doctor has determined that you have enough healthy bowel left to reattach internally, the stoma can be closed, and the problem will subside. However, since many ostomies are permanent, this surgery only applies to a small number of people.
Relocating the Stoma
Some candidates who are unable to close their stoma may benefit from relocating it to another area on the abdomen. This will close the active parastomal hernia and create a new pathway for waste to exit the body. Unfortunately, new parastomal hernias can still form, so it’s not always a permanent solution.
Repairing the Hernia
Oftentimes, a surgeon will go in and physically close the hernia. This is done by reconnecting the muscles and tissues together to help close the parastomal hernia. Repairs performed this way are only beneficial when the hernia is small, as large incidents usually can’t be fully treated.
Mesh Surgery
The most common type of surgery performed to repair a parastomal hernia is a biological mesh surgery. The procedure begins by repairing the hernia in the same way as described above. Then, the repairs are reinforced using either a synthetic or biological mesh. This allows the surgeon to compact the hernia and help keep it under control. Oftentimes, the mesh will either be placed over the hernia or below the abdominal wall. As time passes, the mesh becomes intertwined with the surrounding tissue, thus creating strong abdominal support and preventing future hernias from forming. Due to the long-term success of mesh surgery, it’s the preferred method for repairing parastomal hernias
When to Call Your Doctor
While parastomal hernias are a common complication of many ostomy surgeries, they can develop into something more serious. To avoid any long-term problems, always contact your doctor if you notice any signs of pain, discomfort, skin irritation, changes to your stoma, or problems with your pouching system. Seek immediate medical assistance if you notice any signs of an entrapped hernia and discuss future preventative options with your doctor.
If you’ve recently undergone ostomy surgery and are having difficulty adjusting to your new circumstances, consider joining an ostomy support group. To do this, search the list of support groups affiliated with The United Ostomy Associations of America (UOAA). UOAA is a national, 501(c)(3) nonprofit organization that supports, empowers, and advocates for people who have had or will have ostomy or continent diversion surgery. In addition to providing local options for support, they offer a variety of resources for new and existing ostomates. By integrating into a community of ostomates, you’ll be able to ask questions, get clarification, and express any frustration or negative emotions you may be having.
Byram Healthcare also aims to be a helpful resource for ostomates. We provide ongoing updates to the ostomy community, ostomy education and support, and hernia belts that can be discreetly delivered to your door. For young children undergoing an ostomy, check out our Awesome Ollie Bear Program.
