Parastomal hernias happen when part of your intestines stick out through a stoma. A stoma is a surgically made opening in your stomach, small bowel, or colon that allows you to pass waste into a bag. This is sometimes needed when patients have gastrointestinal problems that prevent them from having normal bowel movements.
Up to 78 percent of people develop a parastomal hernia after surgery to create a stoma, usually within two years of surgery.
Parastomal hernias usually develop and grow gradually. As it develops, you may notice:
- pain or discomfort around your stoma
- trouble keeping your stoma appliance in place
- bulging around your stoma, especially when you cough
Having a stoma sometimes weakens your abdominal muscles, causing them to pull away from the stoma. This process can lead to a parastomal hernia. Several other factors can contribute to the development of a parastomal hernia, including:
- chronic coughing
- chronic constipation
- corticosteroid use
- infection after stoma surgery
Some people have a higher risk of developing a parastomal hernia. Common risk factors include:
- older age
- obesity, especially if you carry weight around your waist, stomach, or hip area
- high blood pressure
- respiratory diseases
Your risk also increases if you’ve previously had an abdominal wall hernia.
In many cases, parastomal hernias are treatable with lifestyle changes, such as losing weight or quitting smoking. Wearing an abdominal support belt, like this one, can also help ease symptoms.
However, about 20 percent of parastomal hernias are severe enough to need surgical repair.
There are several surgical repair options for a parastomal hernia, including:
- 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.
In some rare cases, the intestines can become trapped or twisted in the hernia. This blocks the intestine and can lead to loss of blood supply. This is known as strangulation, which is a very painful condition. Strangulation requires emergency surgery to untwist the intestine and restore blood supply, so that the obstructed part of the intestine isn’t permanently damaged.
Parastomal hernias are a common complication of colostomies and ileostomies. In many cases, they are asymptomatic or only cause slight discomfort and can be managed effectively with lifestyle changes. In cases where surgery is necessary, hernia repair with mesh support is the most effective treatment.
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