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What is a Parastomal Hernia? (An Ostomy Hernia)

What is a Hernia?
A hernia is when there is a rip/tear in muscle tissue that causes a portion of the abdomen (particularly, the intestine) to bulge through. This causes pain when standing up, moving the abdomen, or any kind of tension on the abdomen including coughing, sneezing, laughing, bending over, picking up objects, etc.

What is a parastomal hernia?
Having a stoma can develop into an ostomy specific type of hernia called a parastomal hernia. Since a Stoma passes through the abdomen, it can compromise the strength of the muscular abdomen wall. These weakened muscles can come away from the stoma, weakening its integrity and causing the intestine to bulge.

A stoma hernia is typically not painful, but can be very uncomfortable and unnerving, not to mention more difficult to mange and care for. As the stoma grows, it can become more difficult to attach ostomy wafers and pouches. It can also eventually lead to intestinal twisting/kinking that can cause serious damage to the intestine by cutting off blood vessels. (This, of course, requires immediate medical attention as being left untreated can be very dangerous.)

What Causes Parastomal Hernia?
Coughing, sneezing, heavy lifting and being overweight all put pressure on the abdominal wall & a stoma. Over time, muscles can weaken to the point a stoma begins to protrude and push out due to the pressure of the guts behind it.

There are many possible origins for parastomal hernia to develop. Some are related to surgery and a poorly placed stoma or a developing infection around the border. Other causes are related to an individuals health, such as being overweight, heavy lifting, or any kind of physical strain, or a combination of these factors.

How common is parastomal hernia?
In the 1990′s, the United Ostomy Association found that a hernia is one of the most common complications for Ostomy patients. Ostomy hernias happen to about 30% of all stomas. It’s more common with Colostomy than Ileostomy and Urostomy.

How is Parastomal Hernia treated?
Surgery is the most common repair for any type of large hernia.

Typically, if the hernia is not recurring, doctors will recommend a Hernia Belt and appliance changes before recommending surgery. A hernia belt is designed for individuals with small hernias or those where surgery can be risky or further compromise one’s health. A hernia belt is a firm, wide belt that helps support the stoma and muscle tissue around it externally.

As for surgery, doctor opinions vary based on their preferences for proper care and an individual’s needs. There are two options for the surgeon:

  1. 1) To repair the muscle tissue around the stoma (either with stitching or mesh).
  2. 2) Create a new opening in a health spot and close off the old one.

In some cases, Option 1 isn’t applicable; either hernia is too large or the surgery is too risky. And some surgeons will choose to re-locate the stoma first and install mesh if the problem persists.

However, today, often a mesh is implanted instead of stitches. This is the ideal method of repairing a hernia.

A mesh is laid across the herniated muscle tissue, helping to hold the muscle together and increasing its strength & integrity. The mesh also speeds recovery times over other methods and and reinforces the tissue; patients can often be mobile again within a matter of days.

Summary
An Ostomy certainly increases the risk of a hernia. Discuss with a doctor and nurses for the facts and tips to manage your individual stoma – even if you do not recognize any pain. As with any hernia, this lessens the chances of developing a more cumbersome and large hernia requiring surgery.

Resources:
http://www.o-wm.com/article/2207
http://www.hernia.org/stoma.html
https://health.google.com/health/ref/Hernia

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