A stoma (parastomal) hernia is a weakness or protrusion in the muscle wall of the abdomen which allows the abdominal contents to bulge out. The bulge often protrudes more when coughing or undertaking physical activity. A stoma hernia is one of the most common complications following stoma creation.
A stoma hernia resembles a bulge or a lump. Many people describe it a looking like a “golf ball” or a “grapefruit” behind their stoma. Having a hernia can cause your stoma to look more pronounced and potentially change shape, it may also appear larger or flatter than it did before the hernia.
We're talking about parastomal (peristomal) hernias. That's when more intestine than planned pushes through your muscles and causes a bulge at your ostomy site. You can tell if you might have a parastomal hernia by a noticeable bulge or by placing your hand over your stoma and seeing if it protrudes out when you cough.
Parastomal hernia is the most common complication in various types of stomas. It can progress almost asymptomatically, often resulting only in an abdominal deformity in the vicinity of the stoma, but in extreme cases it can lead to bowel incarceration and strangulation, thus necessitating immediate surgery.
Most parastomal hernias require a surgical procedure at some point in time. The open approach is done from the outside usually through the prior incision. The incision will extend through the skin, subcutaneous fat, and allow the surgeon to get to the level of the defect.
Background. Long standing ostomy related complications such as parastomal hernia and stoma prolapse may be at a higher risk of developing spontaneous rupture and evisceration, especially in patients suffering from chronic cough. Such patients may need early refashioning of the stoma to prevent this serious complication ...
There are two options. One can move the stoma to a new site on the abdomen, i.e. create a new opening elsewhere and repair the hernia at the old site as one would any other hernia, or one can try to repair the hernia around the stoma, leaving the stoma where it is.
It is important that you partake in some form of regular exercise, this could be simply a gentle daily walk. Gentle exercise is important to try and prevent the development of a parastomal hernia. It is necessary to try and strengthen your core muscles, your Stoma Care Nurse is able to advise you on specific exercises.
Although a parastomal hernia may restrict you from doing certain things, you can still live a 'normal life'. Things like gentle exercise, eating and drinking well, a good stoma product system and a hernia support belt or garment can help you manage your hernia and live a normal life.
Symptoms. Abdominal wall hernias are generally visible: they will look like a lump or bulge beneath the skin. These hernias don't usually cause any other symptoms except for mild pain or discomfort, usually when you are straining (for instance, lifting something heavy).
The first sign of a stoma infection may be a pus-like discharge, unusual swelling, increasing redness, or color changes. Some may notice an abscess or an ulcer. A Wound, Ostomy, and Continence Nurse (WOCN) or your doctor will be the best source for medical advice on this issue.
When the skin becomes infected it can start to look inflamed and the infection tends to cause some swelling around your stoma. The skin colour often changes from a healthy pink/reddish colour, to pale, bluish purple or even black. If there is any discharge of blood or pus this is often a definitive sign of infection.
Parastomal hernias may develop soon after surgery, or may take years to develop. Most people (about 80%) will not experience any difficulties with the hernia and will not require any intervention. The remaining 20%, however, may have symptoms that require some help to manage.
Very gently tilt your pelvis backwards and tighten your pelvic floor muscles. Lift your bottom off the bed/floor and slowly lift up vertebrae by vertebrae until your bottom is off the bed. Lift your bottom as high as you comfortably can. Hold this for a moment, then slowly lower your spine and pelvis back down.
Parastomal hernia is the most frequent complication following the construction of a colostomy or an ileostomy, occurring in up to 50 percent of patients.
Avoid heavy lifting, heavy pushing, overstretching/reaching or fully using your abdominal muscles. Support your stoma and abdomen when you cough and sneeze. And then: Avoid gaining weight, or try to lose weight if you need to.
Results: Of 14 patients, 12 patients had end-sigmoid stoma, one had end ileostomy following surgery for ulcerative colitis and one had urinary conduit. The size of the defect varied from 4.5 cm to 6 cm in diameter, and the average duration of surgery was 125 min.
The term parastomal hernia is used to describe a bulge or swelling around/under the stoma that leads to problems with stoma function and appliance security. This usually occurs gradually and the hernia may increase in size over time.
Parastomal hernia is the most common late stoma complication. Its appearance is usually asymptomatic, however, it may be associated with abdominal discomfort, pain, nausea, vomiting, obstruction, and strangulation.
Skin irritation around your stoma is usually caused by leakage from your ostomy pouch and the output from your stoma getting underneath the adhesive and onto your skin. It is uncomfortable and can stop your pouch from working well. The skin around your stoma should look similar to the skin on the rest of your body.
While it may not be causing trouble now, it is very likely that it could lead to more serious complications later if it is not repaired. One of those complications is strangulation. This occurs when the bulging tissue is squeezed by the muscle wall. As a result, the blood supply is cut off and the tissue begins to die.
Unfortunately, the answer is no. While a hernia cannot heal itself, it can almost always be treated effectively with surgery.
Depending on the severity of the prolapse, a referral can be made to the Surgeon for review, but is often not deemed as urgent, unless the prolapsed stoma changes to a very dark/dusky colour, stops functioning or causes pain. Pain may suggest bowel strangulation which is treated as an emergency.