A hernia is an abnormal protrusion or displacement of intestine through a weak area or defect. Hernias are made up of the defect (weakened opening), the hernial sac (the bulge), and the sac’s content (intestine segment). There are two incisions done during surgery, one to perform the procedure and the other to create the stoma (when undergoing colostomy, ileostomy, or urostomy procedures). Both openings debilitate the abdominal wall and may eventually create defects. If this occurs, it becomes feasible for a section of the intestine to lodge and pass through one or both of these defects. All it takes for a hernia is for an organ to stray from the abdominal wall.
When the pathway is around the stoma it is called a parastomal hernia, and when it is through the surgical wound it is an incisional hernia. A parastomal hernia may protrude out through the stoma, or it may settle in between the abdomen inner layers. An ostomy may expand at any moment and create the space for the intestine to displace and form a parastomal hernia. Incisional hernias are internal. As time elapses and the wound heals, the avenue for an incisional hernia closes making herniation more difficult. However, being less likely does not in any way precludes it from developing. The risk of incisional and parastomal hernias is latent. It all indicates that one should be serious about taking preventive measures.
Parastomal hernias may take years to surface. In most cases they are asymptomatic. They may be small and almost unnoticeable or large and painful. Most people learn to live with them as long as they do not interfere with bowel functioning and management of the stoma. An Ostomy Support Belt (or Hernia Belt) is an effective and easy way to withstand hernias, and it is a good practice to wear one regardless of their presence. Ostomy support belts are meant to prevent and contain parastomal hernias.
What if There is a Parastomal Hernia?
To spot a parastomal hernia you need to create intra-abdominal pressure (e.g.: cough) while standing up. A bulge may show up, and it will usually disappear when lying down. The bulge eventually grows if the defect grows. If this happens, more intestine might move into the sac and caring for the stoma might become harder. Hole sizes for ostomy bags might need to change constantly. Seals might loose effectiveness because of the skin’s constant stretching and constricting resulting in leakages and irritations. Continued hernial growth may obstruct view to the stoma complicating maintenance even more.
A large parastomal hernia may become too painful and uncomfortable to bear. It may affect stoma functioning. It may create cramping and bloating. If you have a colostomy and irrigate, it may force you to stop irrigation and switch back to using ostomy bags. At that stage, your doctor might recommend surgery to alleviate these problems and to avert a serious obstruction or strangulation of the intestine.
Surgical parastomal hernia repair should be the last resource. It is traumatic and not necessarily a permanent solution. Hernia recurrences are high, and vary according to the chosen technique. Non-surgical treatments including the use of belts, diets and quit smoking programs should be seriously implemented to try avoiding these complications.