Can You Prevent a Parastomal Hernia?

Anyone with a stoma can get one; I have heard it said that 1 in every 2 people with an ostomy will at some point develop a parastomal hernia.¹

It is something that is not talked about enough. No one before my ostomy surgery even mentioned to me about it being a risk or how I could prevent it.

After my surgery, I found support groups online and then read documentation from ostomy support companies to learn some best practices to prevent a parastomal hernia.

What is a parastomal hernia?

Parastomal hernia describes a bulge or swelling around or under the stoma that leads to stoma function and appliance security problems. This usually occurs gradually, and the hernia may increase over time.²

When a stoma is created, the surgeon generally brings the end of the intestine out through the abdominal muscles, which provide support for the stoma. By making an incision in the muscle, a potential weakness is created. A parastomal hernia can occur when the stoma edges come away from the muscle, allowing abdominal contents (usually a section of the bowel) to bulge.²

If a parastomal hernia is going to occur, it usually occurs within the first 2 years, post-surgery, but can happen at any time.

How is a parastomal hernia (PSH) treated?

There are a few different options available for the treatment of PSH. It depends on how much the hernia protrudes and how it affects the individual physically and emotionally. As well as the surgical history of the individual, whether the individual is well enough for surgery, and whether the hernia prevents the individual from applying and keeping an ostomy bag in place.²

Possible treatment

• Often, the hernia is not causing any major issues, so no action is taken other than to monitor it for any changes
• Some people may be advised to wear a stoma belt to support the stoma and the surrounding area
• Support underwear is often enough for small hernias

If the hernia is larger, causing pain, or could lead to complications, an operation to repair the hernia or re-sit (create a stoma in a new position) may be considered. This would be a case-by-case decision.²

What causes a parastomal hernia?

A few things are known to possibly cause a PSH:²

1. Sneezing
2. Coughing
3. Being overweight
4. Smoking
5. Any type of straining, such as when lifting heavy items

How can you reduce your chances of developing a PSH?

There are a few small things you can do to prevent PSH.

Try to hold your ostomy area when sneezing or coughing or maintain a healthy weight through diet and exercise. Seek advice for smoking cessation if you are a smoker. Be careful when lifting heavy items. I was advised to avoid any heavy lifting for 6 weeks to 12 weeks post-surgery.

I have maintained this since my surgery 4.5 years ago and, until now, have managed to avoid a PSH in either of my ostomies. My rule is – that if I go to pick something up and strain to lift it, it's too heavy for me.

Test and compare what works best for you

Post-surgery, look to do simple exercises as directed by your ostomy nurse to strengthen your abdominal muscles when it is safe to do so. And experiment with light support wear – this could be a support belt or underwear. I wear underwear with a pocket for my ostomy bags, which support my ostomies.