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Health condition · Clinically reviewed

Parastomal hernia, the bulge beside your stoma - and what to do about it.

A common long-term complication of stoma surgery. Most cases are managed with support and appliance changes - some need a surgical opinion.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against colorectal surgical and stoma care society guidance you can see at the end.

  • 03

    Current for 2026

    Reflects modern practice including support garments, mesh repair choices and prevention advice.

Key facts

Parastomal hernia at a glance.

The essentials, in plain English - what it is, how it presents, and how it’s managed in the UK today.

  • What it is

    A hernia next to a stoma - abdominal contents bulge through the wall defect created when the stoma was formed.

  • How common

    A very common long-term complication of stoma formation - the risk rises the longer the stoma has been in place.

  • Main sign

    A visible bulge around the stoma, more obvious standing or straining, that often flattens lying down.

  • Appliance impact

    The bulge changes the skin contour, making bags harder to fit and more prone to leaking.

  • Conservative care

    Support garments and stoma nurse input manage most mild, non-urgent hernias without surgery.

  • Surgical repair

    Mesh repair, stoma relocation or local tissue repair for symptomatic or complicated hernias - recurrence is common.

Why this guide matters

A common problem that deserves a considered plan.

Parastomal hernia is often accepted as an inevitable nuisance. It doesn’t have to be managed by guesswork - the three points below shape everything else on this page.

  • It affects appliance function first

    Long before it causes pain, a parastomal hernia often shows up as leaks and fitting problems - worth flagging to your stoma nurse early.

  • Surgery isn’t automatic

    Most mild hernias are managed conservatively - support garments and appliance adaptation come before any conversation about repair.

  • Recurrence is the honest trade-off

    When repair is needed, recurrence rates are notably high - understanding this helps you weigh timing and technique with your surgeon.

How the diagnosis is made

From a noticed bulge to a clear plan.

The steps a UK stoma care team or colorectal surgeon will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Looking and feeling for a bulge

    Examination standing and straining, then lying flat - a parastomal hernia is often more obvious upright and may reduce when lying down.

  2. 02

    Assessing

    Stoma care nurse assessment

    A specialist stoma nurse checks appliance fit, skin condition and how much the bulge is disrupting daily life.

  3. 03

    Confirming

    Symptom and quality-of-life review

    Discomfort, a dragging sensation, and how often the bag leaks or lifts are recorded alongside the physical findings.

  4. 04

    Confirming

    Ultrasound if uncertain

    A quick, low-cost scan when the diagnosis isn’t clear on examination, or to see how the hernia behaves on straining.

  5. 05

    Confirming

    CT for surgical planning

    Used when surgery is being considered, to map the defect size, hernia contents and any loops of bowel at risk.

  6. 06

    Preparing

    Colorectal surgical review

    For enlarging, symptomatic or complicated hernias, a colorectal surgeon weighs repair options against the risk of recurrence.

  7. 07

    Preparing

    Shared decision on repair

    Conservative management, elective mesh repair or relocation is discussed against your symptoms, fitness and priorities.

Typical timeline: a first review to a settled plan across a small number of visits, not months.

Symptoms

What a parastomal hernia actually looks like.

The classic mix of a visible bulge, appliance trouble and discomfort - and the features that mean it’s time to seek urgent help.

  • Visible bulge around the stoma

    A swelling next to the stoma that is most obvious standing, coughing or straining, and often softens lying down.

  • Discomfort or a dragging sensation

    An ache, heaviness or pulling feeling around the stoma, particularly after long periods on your feet.

  • Appliance fitting difficulty

    A changing abdominal contour makes it harder for the flange to sit flat and seal properly.

  • Bag leakage or lifting

    Skin creases and folds caused by the hernia let output track under the flange, causing frequent leaks.

  • Peristomal skin irritation

    Leaks and repeated appliance changes can irritate the skin around the stoma over time.

  • Gradual enlargement

    The bulge tends to grow slowly over months or years rather than appearing overnight.

  • Reduces when lying flat

    Most parastomal hernias can be gently pushed back or disappear when lying down - a reassuring but not universal sign.

  • Red flag - pain, colour change or no output

    Sudden severe pain, a firm irreducible bulge, or the stoma stopping working needs urgent same-day assessment.

Treatment

How a parastomal hernia is managed in the UK.

Conservative support first, surgical repair for symptomatic or complicated hernias - and emergency surgery when bowel becomes trapped.

  • Support garments and hernia belts

    A well-fitted support belt or high-waisted garment eases discomfort and gives day-to-day support for mild hernias.

  • Stoma appliance adaptation

    Convex or flexible flanges, and stoma nurse-guided fitting changes, reduce leaks around the altered contour.

  • Watch and wait

    For a small, asymptomatic hernia, planned monitoring is often reasonable rather than immediate surgery.

  • Weight and core advice

    Weight management and gentle, guided core strengthening reduce strain on the repair site and may slow progression.

  • Mesh repair

    Synthetic or biological mesh reinforces the abdominal wall defect - open or laparoscopic, chosen on individual anatomy.

  • Stoma relocation

    Moving the stoma to a new site on the abdominal wall, usually reserved for recurrent or complex hernias.

  • Local tissue repair

    Suture repair without mesh - a simpler option in selected cases, though recurrence rates are higher than with mesh.

  • Emergency surgery

    Urgent operation for incarceration or obstruction, when bowel becomes trapped and cannot be reduced.

What this guide is based on

The sources behind every claim on this page.

UK colorectal surgical and stoma care society guidance, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your stoma care nurse or colorectal surgeon knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • Association of Coloproctology of Great Britain and Ireland (ACPGBI). Guidance on parastomal hernia.

  • European Hernia Society. Guidelines on the prevention and management of parastomal hernia.

  • Royal College of Nursing. Stoma care standards and guidance.

  • World Council of Enterostomal Therapists (WCET). Parastomal hernia consensus statement.

Red flags

When a parastomal hernia needs urgent attention.

Most parastomal hernias are manageable and unhurried. These are the situations that aren’t - and where emergency assessment is needed.

  • Sudden, severe pain at the site

    New, intense pain around the stoma or hernia is not typical of a simple bulge and needs prompt assessment.

  • A firm, irreducible bulge

    A hernia that suddenly becomes hard and cannot be gently pushed back may signal incarceration.

  • Stoma stops working

    No output, or a sudden change from normal stoma function, alongside a bulge, is an emergency presentation.

  • Nausea, vomiting and bloating

    Together with a firm bulge, these suggest possible bowel obstruction requiring urgent hospital review.

  • Colour change of the stoma or skin

    A stoma that looks dusky, dark or unusually pale, or overlying skin that reddens rapidly, needs same-day attention.

  • Fever with abdominal symptoms

    Fever alongside worsening pain or a tense bulge raises concern for strangulation and needs emergency care.

  • Rapid enlargement

    A hernia that grows noticeably over days rather than months should be reviewed sooner rather than later.

  • Persistent leakage despite adaptation

    Ongoing leaks despite appliance changes point to a hernia that is affecting quality of life and worth a surgical opinion.

  • Skin breakdown around the stoma

    Non-healing irritation or ulceration from repeated leaks needs stoma nurse and possibly surgical input.

Living with it

A manageable condition, with the right support.

Four things that make the biggest difference day to day - a proper support garment, close stoma nurse contact, sensible activity, and knowing your warning signs.

A quiet reminder

A bulge doesn’t automatically mean an operation.

Many people live comfortably with a small parastomal hernia for years with the right support and monitoring.

  1. 01 Support

    Wear a properly fitted belt

    A hernia support garment, correctly sized and positioned, reduces bulging and discomfort during activity.

  2. 02 Appliance

    Keep your stoma nurse in the loop

    Regular review helps adapt your appliance as the abdominal contour changes, cutting down leaks.

  3. 03 Activity

    Stay active, lift sensibly

    Gentle core work and sensible lifting technique help rather than strict bed rest - ask for tailored advice.

  4. 04 Watch

    Know your red flags

    Understand what sudden pain, a hard bulge or loss of stoma output means, and who to call if they happen.

Frequently asked

Everything we get asked about parastomal hernia.

Quick answers on causes, appliance issues, surgical options and prevention.

  • What is a parastomal hernia?

    It is a hernia that develops next to a stoma - colostomy, ileostomy or urostomy - where abdominal contents push through the wall defect created when the stoma was formed. It is one of the most common long-term complications of stoma surgery.

  • How common are parastomal hernias?

    They are very common, and the risk increases the longer a stoma has been in place. Many people develop some degree of bulging over time, though not all need treatment.

  • Do I need surgery for a parastomal hernia?

    Not always. Small, asymptomatic hernias are often managed conservatively with support garments and stoma appliance adaptation. Surgery is considered for hernias that are symptomatic, enlarging or complicated.

  • Why do parastomal hernias come back after repair?

    The abdominal wall around a stoma is inherently weakened, so recurrence rates after repair are notably higher than for other hernias. Mesh repair generally has lower recurrence than tissue repair alone, but recurrence remains a real possibility.

  • What is incarceration and why is it urgent?

    Incarceration is when a loop of bowel becomes trapped in the hernia and cannot be pushed back. It can progress to obstruction or strangulation, cutting off blood supply, and needs emergency surgical assessment.

  • Can I prevent a parastomal hernia?

    Careful stoma siting at the time of surgery, maintaining a healthy weight, and core strengthening advice can reduce the risk, though not eliminate it. Support garments from early on may also help in those at higher risk.

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