Hernias occur when the internal part of your body pushes through a weakness in the muscle or surrounding wall. It can happen anywhere between your throat and hips and most are found in the abdomen and groin. But what happens if you have stoma and develop a hernia? You may be wondering why and how you can develop a hernia around your stoma, also known as parastomal hernias and what causes them?
It is usually a combination of muscle weakness and strain around the area that causes the hernia to form. Following your stoma surgery, the abdominal wall will have become weakened and is therefore more vulnerable than it was before. The muscles in the abdominal wall should create a snug fit around the stoma opening, so if the muscles in this area become weak, a hernia can form. Hernias are unfortunately quite common in those with a stoma and can often develop gradually as the area stretches and weakens over time.
How do I know I have a parastomal hernia?
There are a few symptoms to look out for if suspect you may have a hernia. If you do notice any of these symptoms, try not to worry as it most likely will not be a problem. However, you should get it checked out by a health care professional who can support you.
Here are the most common symptoms:
- A large bulge behind your stoma
- Discomfort or pain around your stoma, this is often described as a “dragging sensation”
- Issues with keeping your stoma pouch in place
- Changes in bowel habits
- Discomfort or pain when you cough or lift things.
What can be done?
If you suspect you may have developed a parastomal hernia it is wise to contact your Stoma Care Nurse or GP for a review. Do not ignore the symptoms as this could make things worse. If the issues are not addressed, hernias can grow in size causing more discomfort and problems. Although stoma hernias are not usually an emergency, they can get worse over time, and sadly they do not go away by themselves. They do not usually cause pain or discomfort but can be seen as a nuisance as the stoma pouch becomes difficult to attach properly and as the hernia gets larger, it can be more visible beneath clothes.
Your stoma nurse will be able to provide you with reassurance and tips to manage any symptoms that your hernia maybe causing. Your Stoma Care Nurse can advise you on support garments. If your hernia is small, you may benefit from some supportive under wear, which you can now buy from high street stores. If necessary, your Stoma Care Nurse may measure and fit you with a prescription support garment/belt. Both of these garments can be worn during the day over your stoma pouch and hernia, to provide support and comfort to the area.
Will I need surgery for my stoma hernia?
Although it is a rare complication of hernias, the intestine can become trapped or kinked within the hernia and become obstructed (blocked). Even more seriously, the intestine may then lose its blood supply, known as strangulation. This is very painful and does require emergency surgery to untwist the intestine and prevent the strangulated part if the bowel from being irreversibly damaged.
There are many surgeons who advocate that small stoma hernias which are not causing any symptoms, do not need any treatment. They usually advise that if the hernia does not require surgical treatment, that the ostomates should wear a wide fitting support belt to provide support to the stoma itself. This is more ideal for ostomates with small hernias, who are elderly and for whom an anaesthetic and further surgery maybe high risk.
Operative repair of the stoma hernia is only given serious consideration if it is required to improve quality of life and prevent progressive enlargement of the hernia over time and make it easier to manage the stoma.
Surgical Repair of the stoma hernia
If the symptoms are severe, the hernia will be repaired surgically. The repair of the stoma hernia requires the tissue from the abdominal wall, to be made to fit back snugly around the stoma, leaving no weakness. Many different surgical approaches have been tried for this problem.
There are two surgical options available: the stoma can be moved to a new site on the abdomen (stomach) therefore creating a new opening elsewhere and repair the hernia at the old site as one would for any other hernia. Or the other option is that the stoma can be left where it is with attempts to repair the hernia around the hernia.
In both surgical options for hernia repair, mesh is used to reinforce the whole weakened muscle structure. This is a vast improvement in the original suturing method. The mesh is wafer thin and super light and once inserted it becomes incorporated within the muscle and surrounding tissue forming the core of a much stronger area within the abdominal wall. The use of mesh serves to avoid recurrence in the future.
Recovery from surgical stoma hernia repair
Following the stoma hernia repair surgery, you may remain in hospital for a 1-2 days. The bowel will be closely observed to check it is fully functioning again. Due to the reinforcing effects of the mesh, most patients are usually able to be completely mobile again within a few days, returning to their regular routine in the following weeks. It is wise to avoid bending and lifting heavy objects for the first 6 weeks after surgery, to prevent any recurrence. You may also be advised to wear support garments.