During stoma formation, the surgeon creates an opening in the abdominal wall to bring the intestine through. This weakens the area, putting patients at risk of developing a parastomal hernia. A parastomal hernia is when the intestine or another organ protrudes through the weakened abdominal wall. This can happen shortly after surgery or many years later.

Parastomal hernia symptoms and complications

The size of the weakened area and the extent of the protrusion can vary, meaning hernias range from small, causing a minor lump, to large and visible under clothing. Symptoms, if present, may include abdominal pain, discomfort, changes in bowel habits, and in severe cases, bowel obstruction or strangulation. However, some people may have no symptoms at all.

The shape and size of your stoma may change, making it difficult to get your bag to fit securely and stay stuck. The shape and size of the hernia may also change as you move around. This can lead to leaks and irritated skin.

Identifying risk factors

While predicting who will develop a parastomal hernia is challenging, research suggests several factors contribute, including:

• Stoma placement
• Obesity
• Malnutrition
• Age-related muscle weakness
• Smoking
• Postoperative infection
• Chronic constipation
• Use of Corticosteroids
• Activities that increase intra-abdominal pressure (e.g., chronic coughing, severe sneezing, or heavy lifting).

Preventing parastomal hernia

Preventing a hernia involves navigating factors that are often beyond our control. Good luck stopping sneeze, right? Or ageing…

Many of us won’t have a problem not doing particular forms of exercise, but for others, it is a problem. Whether it’s part of their preferred lifestyle or their job, no one wants to think a stoma prevents them from doing something they want to do.

I reached out to Zoey Wright, renowned bodybuilding ostomate, and she shared four valuable tips for parastomal hernia prevention:

1. Know your limits with day-to-day lifting tasks.
2. Incorporate exercises to strengthen your core/pelvic muscles.
3. Invest in hernia support wear.
4. Recognise that prevention is personal; find what works for you.

Maintaining a healthy weight (excess puts additional strain on your abdominal muscles), and regular exercise, where possible, will be helpful and will also contribute to your overall well-being. I understand the following may not be possible due to disease and health. However, I believe that doing what you can do is better than doing nothing at all. Here are some things to consider before and after surgery:

Pre-surgery:

• Nutritious diet: Support wound healing with a balanced, healthy diet. Consult a dietitian for supplement advice if you can’t get enough nutrition from the foods you can tolerate.
• Core strengthening: Focus on strengthening stomach muscles to improve healing.
• Quit smoking: Smoking slows wound healing and increases the risk of muscle damage during excessive coughing after surgery.

Post-surgery:

• Gradual strength building: Slow and steady progress in strength and activity to avoid harm.
• Avoid strain: Refrain from heavy lifting or vigorous exercise for twelve weeks, minimum.
• Support during coughing/sneezing/vomiting: Use a folded towel, blanket, or cushion to support the abdomen in these circumstances.

Ongoing:

• Hernia prevention support garment: Wear specialised support during physical activities involving heavy lifting or straining.
• Proper lifting techniques: Learn and apply proper lifting techniques to minimise strain on abdominal muscles.

Dealing with a hernia

We can’t control post-op infection, being malnourished or what medications we need to take. And sometimes, despite all our best efforts, hernias still occur.

Dealing with a hernia may mean using hernia support belts or underwear, or it might require surgical intervention.

If you suspect a parastomal hernia, consult your stoma nurse for guidance. In urgent or severe cases, seek immediate medical attention.

Remember, the journey with a hernia is traversable. Use support groups to talk to others in similar situations and use your healthcare professionals to explore the best course of action for your unique situation.