A parastomal hernia is where the intestines push through the muscles around the stoma, resulting in a noticeable bulge under the skin.

 

To reduce your risk of getting a parastomal hernia:

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• wear a support garment (belt or underwear)

• avoid heavy lifting and straining

• maintain a healthy weight – being overweight can place additional strain on your abdominal muscles

 

Most hernias can be managed with the help and support of your stoma nurse. In some cases, surgery may be needed to repair the hernia. But the hernia can come back, even after surgery.

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Who commonly presents with it?

Some people have a higher risk of developing a parastomal hernia.

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Common risk factors include:

• older age

• obesity, especially if you carry weight around your waist, stomach, or hip area

• cancer

• diabetes

• high blood pressure

• respiratory diseases

 

Your risk also increases if you’ve previously had an abdominal wall hernia.

 

How does it present?

Parastomal hernias usually develop and grow gradually. As it develops, you may notice:

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• pain or discomfort around your stoma

• trouble keeping your stoma appliance in place

• bulging around your stoma, especially when you cough

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What can be done?

In many cases, parastomal hernias are treatable with lifestyle changes, such as losing weight or quitting smoking. Wearing an abdominal support belt may also help ease symptoms. However around one in five of parastomal hernias are severe enough to need surgical repair.

 

There are several surgical repair options for a parastomal hernia, including:

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• Closing the stoma. This is the best option for repairing a parastomal hernia. It’s 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. In this type of surgery, a surgeon opens the abdominal wall over the hernia and sews the muscle and other tissues together to narrow or close the hernia. This surgery is most successful when the hernia is small.

• Relocating the stoma. In some cases, a stoma with a parastomal hernia can be closed and a new stoma can be opened on another part of the abdomen. However, a new parastomal hernia can form around the new stoma.

• Mesh. Mesh inserts are currently the most common type of surgical parastomal hernia repair. Either synthetic or biological mesh can be used. Biological mesh is often considered more comfortable, but is much more expensive. In this type of repair, the hernia is repaired using the same technique as in other surgeries. Then, mesh is placed either over the repaired stoma or below the abdominal wall. Eventually, the mesh incorporates into the tissue around it. This creates a strong area in the abdomen and helps prevent the hernia from forming again.

 

How long will your recovery take?

Recovery will depend upon various factors including general health and the type and complexity of procedure performed. Most people can expect to be mobile within 48 hours following surgery and able to resume most normal day to day activities within a few weeks. Lifting and carrying should be avoided for several months. In the longer term, a follow-up period of at least five years is often advocated as incidence of reherniation increases over time.

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What are the main risks of surgery?

Your surgeon will advise on any specific complications and risks. For all types of surgery there is always a risk of wound infection and a 1-2% risk of recurrence of the hernia.

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