A hernia is a weakness or split in the muscle wall of the abdomen which allows the abdominal contents (usually some part of the intestine) to bulge out. The bulge is particularly noticeable upon tensing the abdominal wall muscles.

Stomas pose an additional problem. When a stoma is created, an incision is made into the muscles of the abdominal wall, and a hernia occurs when the edges of the stoma come away and can no longer be supported by the weakened muscles. This allows a section of bowel to protrude through and sit outside the abdomen but under the skin, causing it to bulge.

Surveys have reported that, over time, up to 70% of ostomates develop a parastomal hernia. The longer a stoma is present, the more likely it is that a hernia will occur. Hernias usually occur gradually and can increase over time if not supported. Many hernias are asymptomatic and cause no problems unless they get bigger.

For more information and advice about living with a stoma, visit UOAA.

Factors that can contribute to causing a stoma hernia to occur include coughing, being overweight or having developed an infection in the wound at the time the stoma was made.

The development of a stoma hernia is often gradual, with the area next to the stoma stretching and becoming weaker with the passage of time. This weakness, or gap, means that every time one strains, coughs, sneezes or stands up, the area of the abdomen next to the stoma bulges, or the whole stoma itself protrudes as it is pushed forwards by the rest of the abdominal contents behind it.

As with all hernias, the size will increase as time goes by. Stoma hernias are rarely painful but are usually uncomfortable and can become extremely inconvenient.

Some patients are more prone to hernias as a result of increased pressure in the abdomen pushing against weakened muscles.

High risk factors include:

• Obesity
• Chronic Respiratory Conditions
• Smoking
• Excessive coughing and sneezing
• Chronic constipation
• Extensive abdominal surgery

Certain factors during surgery can lead to an increased risk of developing a hernia such as emergency surgery or certain stoma sites. Unfortunately, these factors are beyond control.

First line treatment is to wear a stoma support garment. Additionally, exercise or pilates, aimed at strengthening the core muscles, may help.

Most parastomal hernias do not require surgery. However, if the hernia is causing pain and/or becoming unmanageable, surgery can be considered. As with all operations that require an anaesthetic there are associated risks. Surgery, therefore, may not be recommended for those who are elderly and infirm or those with serious heart or breathing problems.

Having a hernia repair does not guarantee it will not recur.

Most hernias can be managed conservatively without the need for further surgery.

The longer a stoma is present the greater the chance of a hernia developing. Lifestyle changes can help to reduce the likelihood of a hernia occurring.

• Maintain a healthy weight
• Stop smoking
• Take regular exercise such as walking or swimming
• Avoid activities that include heavy lifting
• Avoid coughing, sneezing and straining
• Support the stoma and wound when straining
• Avoid constipation

Wearing a support garment can also help to reduce the risk of a hernia developing. A well fitted garment will give support to enable you to continue your daily activities but will still enable your stoma to function properly.

Our support garments are available via our online shop.

If you develop a parastomal hernia you are recommended to contact your healthcare provider who will carry out an assessment.

You should avoid heavy lifting for 3 months post-surgery and try to maintain a good posture at all times.

Follow a healthy, balanced diet and exercise shortly after discharge, as long as any wounds have completely healed.

Support your stoma and abdomen when coughing, especially in the first few months post-surgery.

Regularly monitor your stoma to ensure it is functioning properly, and sleep on the opposite side to your stoma.

It is natural for our body shape to change over time, and if you find that your support garment no longer provides the required support or simply does not fit please contact us to arrange a specialist fitting appointment.