Parastomal hernia: symptoms, treatment and when to get help

University Hospitals Birmingham says a parastomal hernia causes a bulge or bulky appearance around the stoma. In most cases hernias do not cause pain, though they can be uncomfortable at times. You may feel a dragging or pulling sensation, and some patients say they look and feel lopsided.

Because the shape of the abdomen changes, the leaflet says you may have leaks from your stoma bag and difficulty getting the pouch to stay stuck to the skin, and depending on the size and shape of the hernia, friction from clothing may irritate the skin. The Ileostomy Association says many people live with a hernia and ordinarily it is not a problem, and that the bulge may be more prominent when standing but should disappear when lying on your back.

You may not even realise you have one until you see your stoma nurse or surgeon, the Birmingham leaflet says.

• A bulge or swelling around the stoma, often more obvious when standing.

• A dragging or pulling feeling.

• Leaks, or a bag that will not stick well.

• Skin irritation from clothing friction.

• Feeling lopsided or self-conscious about body shape.

The Birmingham leaflet lists the signs of obstruction as severe abdominal pain, nausea, vomiting, abdominal distension, nil output from the stoma and change of stoma colour, and says surgical intervention is required if these develop. It explains that in some cases the stoma can become strangulated or twisted by the hernia, obstructing the bowel, so the stoma may stop functioning.

The Ileostomy Association says that if the bowel does not drop back in when you lie down, becomes painful or you think it is stuck, seek medical guidance, and that in extreme cases the bowel can become trapped, which can be life threatening if it cuts off blood flow. For a stoma that has stopped working, with bloating, tummy pain or sickness, it says to stop eating but keep drinking in sips, and to phone NHS 111 or go to A&E if symptoms persist, worsen or you cannot keep anything down.

The NHS page on hernias says to get help from NHS 111 if you have a hernia and pain in or around it, a bloated tummy, nausea or vomiting, constipation, a high temperature or sudden confusion.

The sources used here do not describe a specific diet that prevents or treats a parastomal hernia. They do link weight to risk. The Birmingham leaflet lists obesity among causes and says keeping your weight steady within a body mass index of 20 to 25 will minimise the risk of a hernia developing. The NHS hernia page also advises trying to lose weight if you are overweight, keeping to a healthy weight and being physically active.

For general stoma eating advice, the Ileostomy Association says diet is a very individual choice, encourages a healthy eating regime, and says most people may follow a low-fibre diet for a few weeks after surgery and then gradually introduce more foods. It says you can eat fruit and vegetables with a stoma, introduce new foods gradually, chew well, and it notes that foods such as nuts, sweetcorn, peas, celery and popcorn carry a slightly increased risk of blockage in some people.

If you are worried about eating with a hernia, or have had a blockage, ask your stoma nurse or a dietitian for advice that fits your type of stoma.

The Birmingham leaflet says management depends on the severity of the hernia. Conservative management starts with a review of your appliances by your stoma nurse, to ensure the pouch will stick and mould to your skin; a pouch with a larger flange may accommodate the size and shape more effectively.

Your stoma nurse will measure you for an appropriate hernia support belt, to reduce the dragging sensation and give a better body shape, and the leaflet recommends using a support belt for at least 12 months after surgery. A UK survey of 1,528 people with a stoma, published in Gastrointestinal Nursing, notes some evidence that support garments reduce the risk of a parastomal hernia developing or getting worse. A third of respondents had received no expert information about support garments, and the main source of information for those who did was a stoma care nurse.

Surgery might be indicated in some cases to correct the defect in the abdominal muscle, and a recurrence can result in the need for surgery. The leaflet describes two ways of doing it: laparoscopic parastomal hernia repair with prosthetic mesh, or laparotomy with relocation of the stoma (open abdominal surgery). Both options are discussed by your surgeon.

A stoma is an opening on the surface of the abdomen through which bowel waste leaves the body into a bag. University Hospitals Birmingham describes a parastomal hernia as weakening of the abdominal muscles around the stoma due to abdominal surgery, so that the bowel pushes through the abdominal wall. The NHS lists a stoma hernia as a type of hernia occurring under or near a stoma.

The leaflet says parastomal hernias are common clinical problems, and the severity determines how they are managed.

The Birmingham leaflet lists obesity, age, coughing, straining of abdominal muscles, poor stoma siting, abdominal surgery and poor recovery after the operation, for example a wound infection delaying healing. It says there are no specific reasons why a hernia may develop.

To minimise the risk, the leaflet advises supporting your abdomen, especially within the first few months after surgery, by avoiding lifting heavy objects, rolling onto your side while supporting your abdominal muscles when getting out of bed, and gently applying support with a rolled-up towel when coughing and sneezing. It also advises keeping weight steady within a BMI of 20 to 25.

On the NHS your stoma nurse is the usual first contact. The Birmingham leaflet advises that if you are concerned that you have developed a hernia, that it has increased in size, or you are worried about a recurrence, you should consult your stoma nurse for an appointment. They can review your appliance, fit a belt and arrange a colorectal surgical opinion.

Private stoma and colorectal surgical care is available, but your stoma nurse and the team that made your stoma remain the best source of advice for appliances and follow-up. Charities such as Colostomy UK and the Ileostomy Association offer support to people with a stoma.