What Is a Parastomal Hernia? Signs, Risks and How to Reduce Your Chances

Introduction

If you have a stoma, you may already have heard the words "parastomal hernia", perhaps from your stoma nurse, or from someone in an online group. It's one of the most common complications of stoma surgery, and also one of the most feared.

The good news is that knowing what to look for, and taking a few sensible steps, can make a real difference. In this guide we explain what a parastomal hernia is, the early signs, who is most at risk and what you can do to help reduce your chances.

Managing and reducing hernias is so important to us here at Comfizz. Our business began after my dad's stoma surgery, and supporting the abdomen after surgery is what our garments were designed to do. I'm very glad to say that after more than 20yrs since his surgery and never a day without his Comfizz, Ernie (My Dad) never developed a hernia.

What is a parastomal hernia?

A parastomal hernia is a bulge that forms around your stoma. To create a stoma, the surgeon makes an opening in the muscles of your abdominal wall. Over time, that opening can stretch and weaken. Part of the bowel, or the fatty tissue around it, can then push through beside the stoma and form a bulge under the skin.

It's more common than many people realise. One study following people after stoma surgery found around a third (34.5%) had developed a parastomal hernia within two years. Rates are generally higher with a colostomy than with an ileostomy.

Most parastomal hernias appear within the first two years after surgery. However, the risk doesn't disappear entirely, so it's worth keeping these habits up for the long term.

If you've been diagnosed with one, please don't panic. Many parastomal hernias are small, cause few problems, and are managed without further surgery using support wear

What are the signs of a parastomal hernia?

A parastomal hernia often develops gradually, so the early signs can be easy to miss. Things to look out for include:

•         A bulge or swelling around your stoma. It's often more noticeable when you stand, cough or strain, and may flatten when you lie down.

•         Your bag no longer fitting or sticking as well. As the skin around your stoma changes shape, your baseplate may lift or leak more often.

•         A dragging, heavy or aching feeling around the stoma, particularly towards the end of the day.

•         Changes to your stoma's appearance or output, or finding irrigation harder if you irrigate.

•         Clothes fitting differently over one side of your tummy.

If you notice any of these, mention them to your stoma nurse. They can check the area and advise on the right appliance and support for you.

Who is most at risk?

Anyone with a stoma can develop a parastomal hernia, but some factors make it more likely:

•         Type of stoma. Colostomies tend to carry a higher risk than ileostomies.

•         Time since surgery. Risk is highest in the first two years.

•         Carrying extra weight around the middle, which puts more pressure on the abdominal wall.

•         A persistent cough, for example, with a chest condition or a lingering cold.

•         Heavy lifting or straining, including straining because of constipation.

•         Smoking, which can slow healing and weaken tissue.

•         Age over 60, and surgery carried out as an emergency.

Some of these you can't change, but several you can. That's where the next section comes in.

How can I reduce my chances of a parastomal hernia?

Nothing can guarantee you won't develop a hernia, but these steps can help protect your abdominal wall:

1.       Avoid heavy lifting in the early months. Follow your surgical team's advice, which is usually no heavy lifting for at least the first 6 to 12 weeks. After that, build up gradually.

2.       Lift the right way. Bend your knees, keep the load close to your body and avoid twisting. Shopping bags, laundry baskets and grandchildren all count!

3.       Support your tummy when you cough or sneeze. Place a hand or a small cushion over your stoma. Our guide to coughing with a stoma explains why this matters, especially in winter.

4.       Rebuild your core gently. Your stoma nurse or a physiotherapist can recommend safe core exercises. Start with gentle movements before progressing to anything strenuous. Our simple exercise guide is a good starting point.

5.       Keep things moving. Avoiding constipation means less straining. Stay well hydrated and include fibre in a way that suits your stoma. See understanding constipation and stoma output.

6.       Aim for a healthy weight, and get support to stop smoking if you smoke.

7.       Wear the right support. Support wear is one of the most practical everyday steps you can take, especially during exercise or physical work. Comfizz garments were designed to be as non-medical-looking and to replace regular underwear where possible. 

How does support wear help?

Stoma support wear applies firm, even pressure across your abdomen. This supports the muscles around your stoma, helps hold your bag securely and can ease the dragging feeling that many people with a hernia describe.

Support wear is useful both as a preventative measure and for managing an existing hernia. Many of our customers tell us it also gives them the confidence to get back to exercise, gardening, work and everyday life.

Our garments come in different levels of support:

Always follow your stoma nurse's advice if you have a diagnosed hernia. For help choosing the right style and size, read how to select stoma support wear correctly. Many Comfizz garments, including our Level 3 belts, are available on NHS prescription, so do ask your stoma nurse or GP.