A parastomal hernia is a common complication that can arise for individuals who have undergone ostomy surgery. This condition involves a protrusion of abdominal contents through a weakened area in the abdominal wall, specifically where a stoma has been surgically created. While not always problematic, parastomal hernias can lead to discomfort and other issues, prompting a need for understanding and appropriate management.
Understanding the Condition
A stoma is a surgically created opening on the abdomen that allows the diversion of waste (urine or feces) from the body into an external pouch. This opening is formed when a section of the intestine or urinary tract is brought through a small incision in the abdominal wall and sutured to the skin. While the abdominal muscles normally provide support for the stoma, the creation of this opening inherently introduces a potential weak point in the muscle layers.
A parastomal hernia forms when abdominal contents, such as a loop of intestine or fatty tissue, bulge through this weakened area around the stoma. This occurs because the edges of the stoma may separate from the surrounding muscle, allowing internal tissues to push outwards. The bulge may increase in size over time.
Factors Contributing to Development
Several elements can increase an individual’s likelihood of developing a parastomal hernia. Surgical factors play a role, including the size of the stomal opening created during the procedure; larger apertures are associated with an increased risk of hernia formation. The placement of the stoma, particularly if not brought through the rectus muscle, can also contribute to weakness in the abdominal wall. Emergency surgery, as opposed to elective procedures, has also been identified as a factor.
Patient-related characteristics also influence the risk. Obesity significantly increases the chance of developing a parastomal hernia due to added pressure on the abdominal wall. Advanced age can lead to weakened abdominal muscles, making hernias more common. Conditions that increase intra-abdominal pressure, such as chronic cough or straining during bowel movements or heavy lifting, can also contribute to the weakening of the abdominal wall around the stoma site. Poor nutritional status and certain medical conditions like Crohn’s disease may also impact tissue strength and healing.
Recognizing the Indications
Individuals with a parastomal hernia may experience a range of observable physical signs and symptoms. The most noticeable indication is often a visible bulge or swelling around the stoma. This bulge may become more prominent when standing, coughing, or engaging in activities that increase abdominal pressure. The stoma itself might also change in size or shape, sometimes appearing reduced or retracted.
Beyond the visible changes, common symptoms include discomfort or pain around the stoma site. This sensation can range from a dull ache, particularly at the end of the day or after physical activity, to a sharper pain when lifting or straining. A parastomal hernia can also interfere with the function of the stoma, leading to unpredictable output. Difficulty in securing the ostomy appliance due to the changing shape of the abdomen, along with subsequent leakage and skin irritation around the stoma, are also frequent concerns.
Medical Confirmation and Management
Confirming a parastomal hernia typically begins with a physical examination by a healthcare professional, who can often identify the bulge around the stoma. In some instances, imaging tests like a computed tomography (CT) scan may supplement the physical examination to confirm the diagnosis, assess the hernia’s size, and check for potential complications.
Management approaches for parastomal hernias vary depending on the hernia’s size, the severity of symptoms, and the patient’s overall health. For asymptomatic cases or those with mild discomfort, conservative options are often the first line of management. These can include wearing supportive garments, such as abdominal support belts, which provide compression to the abdominal muscles and help contain the bulge. Watchful waiting may also be recommended, as not all hernias require active intervention.
When symptoms are significant, such as pain, persistent appliance issues, or complications like obstruction, surgical repair may be considered. Surgical options include direct closure of the abdominal wall defect with sutures, though this method carries a higher risk of recurrence. A more common approach involves surgical mesh to reinforce the weakened abdominal wall. Mesh, which can be synthetic or biological, reduces the chance of recurrence. Surgical techniques can be open, involving a larger incision, or minimally invasive (laparoscopic), which uses smaller incisions and may result in faster recovery times.
Strategies for Prevention
Individuals with a stoma can adopt several strategies to potentially reduce their risk of developing a parastomal hernia or prevent its progression. Maintaining a healthy weight is important, as excess weight increases pressure on the abdominal wall, making it more susceptible to herniation. Engaging in regular, appropriate physical activity that strengthens core abdominal muscles can also contribute to abdominal wall integrity. However, it is important to avoid heavy lifting or straining, particularly in the initial months following surgery, to prevent undue stress on the stoma site.
When lifting objects, utilizing proper techniques can minimize abdominal strain. For activities that might increase intra-abdominal pressure, like coughing or sneezing, supporting the abdomen by gently applying pressure can be beneficial. The use of supportive garments, such as abdominal binders or specialized ostomy support belts, can also provide external support to the abdominal wall and may help reduce the risk of hernia formation. Quitting smoking is also recommended, as chronic coughing associated with smoking can contribute to abdominal wall weakening.