A parastomal hernia is a common complication after ostomy surgery, where a portion of the intestines or other abdominal contents protrudes through the abdominal wall near the stoma. This can cause discomfort and, for some, back pain. Recognizing symptoms and seeking medical guidance is important.
What is a Parastomal Hernia
A stoma is a surgically created opening on the abdomen that allows waste, such as stool or urine, to exit the body into a collection bag. This procedure is performed when natural digestive or urinary pathways are compromised. Common types include colostomy, involving the large intestine, and ileostomy, involving the small intestine.
A parastomal hernia develops when abdominal muscles around the stoma weaken, allowing internal organs to bulge. The incision made for the stoma can become a point of weakness. Up to 70% of individuals with an ostomy may develop a parastomal hernia over time, with the likelihood increasing the longer the stoma is present.
How a Parastomal Hernia Can Lead to Back Pain
A parastomal hernia can contribute to back pain through several mechanisms. One way is through direct pressure or impingement on nearby nerves. As the hernia swells and abdominal contents protrude, they can press against nerves in the abdominal wall or those originating from the spine, leading to referred pain felt in the back rather than directly at the hernia site.
The presence of a parastomal hernia can also alter a person’s posture and gait. The bulge and discomfort may cause individuals to shift their body weight or adjust their standing and walking patterns to alleviate pressure or pain. This altered biomechanics can place abnormal strain on the muscles, ligaments, and joints of the back, particularly the lower back, resulting in chronic or intermittent back pain.
The continuous strain placed on the body by the hernia, especially during activities like lifting, coughing, or straining, can exacerbate back pain. Abdominal wall muscles, which normally help support the spine, may be compromised by the hernia, leading to reduced core stability. This reduced stability can force back muscles to work harder to maintain balance and support, contributing to fatigue and pain.
Recognizing Other Symptoms
Beyond back pain, a parastomal hernia presents with several other noticeable symptoms. The most common sign is a visible bulge or swelling around or underneath the stoma, which may become more prominent when coughing, straining, or standing. This bulge can vary in size and may partially or completely surround the stoma.
Individuals might also experience general discomfort or a dragging, dull ache around the hernia site, which can worsen after physical activity or at the end of the day. The hernia can also interfere with the proper fit and security of the stoma appliance, leading to issues like leakage or difficulty keeping the pouch in place. This can cause skin irritation around the stoma. Changes in stoma function, such as unpredictable output, alternating between constipation and diarrhea, or a reduced or retracted stoma, can also indicate a parastomal hernia.
When to Seek Medical Attention and What to Expect
If you suspect a parastomal hernia, especially with back pain or other new symptoms, seek medical attention. A healthcare professional, such as a stoma nurse or surgeon, can assess the hernia and its impact. Early consultation ensures proper diagnosis and management, which can help prevent complications.
Diagnosis of a parastomal hernia typically involves a physical examination of the stoma area. Imaging tests like an ultrasound or CT scan may be performed to confirm the diagnosis, assess the hernia’s size, and rule out other conditions. While not all parastomal hernias require surgical intervention, medical professionals can provide guidance on managing symptoms, including lifestyle adjustments or support garments. They can also discuss treatment options if symptoms become difficult to manage or affect your quality of life.