The day I found out I had a parastomal hernia, I was completely caught off guard. I had recently undergone a CT scan, not for my ostomy, but to evaluate a kidney stone that might be too large to pass. As I read through the radiology report, one unexpected line stood out: “New parastomal hernia identified, without evidence of obstruction, incarceration, or associated complications.” I was stunned. I hadn’t noticed a bulge or felt anything unusual, nothing that would have made me suspect a hernia, let alone a new one.
If you have an ostomy or love someone who does, you’ve probably heard the term parastomal hernia. Maybe you’ve noticed a bulge under or around your stoma and wondered what’s happening.
Parastomal hernias are among the most common complications after ostomy surgery, but they’re also among the most misunderstood. Let’s clear up the confusion, discuss prevention and treatment, and what to expect if you need surgery to repair one.
What Is a Parastomal Hernia?
A parastomal hernia happens when loops of bowel or abdominal contents push through the abdominal wall at the site of the stoma. Think of your ostomy as a surgically created hernia (which it technically is), a hole made through the abdominal wall so your intestine can exit the body. Over time, pressure inside the abdomen can cause that opening to widen, allowing other tissues to push through.
You might notice:
- A bulge or swelling around your stoma that wasn’t there before
- A change in stoma shape, often flattening or retracting
- Leaking or shorter wear times with your pouching system
- A feeling of heaviness, pressure, or discomfort, especially when standing or coughing
How Common Are They?
Parastomal hernias are very common. Some studies estimate that up to 50% of people with a colostomy or ileostomy will develop one over time. However, not every hernia causes symptoms, and not every hernia needs surgical repair.
Can They Be Prevented?
While we can’t prevent every parastomal hernia, there are smart steps that can reduce your risk:
1. Wear a Support Belt Early
If you’re at high risk (e.g., larger abdomen, history of hernias, heavy lifting), wearing a support belt or hernia prevention garment after surgery can help reinforce your abdominal wall once cleared by your surgeon.
2. Use Safe Body Mechanics
For the first few months after surgery, avoid straining, heavy lifting, or high-impact core exercises. When you lift, tighten your core and exhale—never hold your breath! Lift with your legs.
3. Manage Chronic Cough or Constipation
Anything that increases abdominal pressure can worsen a hernia. If you have a chronic cough, constipation, or are often straining to empty, talk to your provider.
4. Keep in Touch with Your Ostomy Nurse
Regular check-ins with your WOC nurse can catch early signs of hernia formation or changes in your stoma that impact appliance fit.
What Happens If I Need Surgery to Repair It?
Some hernias can be managed conservatively with belts and pouching adjustments. But if yours is painful, interfering with appliance fit, or at risk for complications (like bowel obstruction), your surgeon may recommend parastomal hernia repair.
Depending on your anatomy and your surgeon’s approach, you may have:
- Mesh repair, often laparoscopic or robotic
- Stoma relocation, sometimes necessary if your hernia is large or complex
- Occasionally, conversion to a different type of ostomy (e.g., end to loop or vice versa)
After Hernia Repair: Your Stoma May Be Different
This is something patients don’t always hear ahead of time: your stoma may look different after hernia repair.
- It may be flatter, more retracted, or located in a slightly different spot
- The diameter of the stoma may change, requiring a new pouch size or barrier shape
- Your old system might not work anymore, and that’s okay!
If your pouch starts leaking post-op or doesn’t seem to fit right, don’t panic. This is normal and fixable. A visit with your ostomy nurse can help you get refitted and back on track.
When to Seek Help
Reach out to your healthcare team if you notice:
- New or worsening bulging around your stoma
- Appliance leaks or reduced wear time
- Pain, nausea, or inability to pass gas or stool
- Sudden change in stoma color or output
These may be signs of a progressing hernia or rare but serious complications like obstruction or strangulation.
Final Thoughts: You Are Not Alone
Parastomal hernias can be frustrating, but they’re also incredibly common, manageable, and treatable. Whether you’re trying to prevent one, navigating new pouching challenges, or recovering from hernia repair surgery, some resources and professionals can help.
Remember: needing a new pouching system isn’t a step backward. It’s just part of adapting to your ever-changing body, and you deserve an appliance that fits your current reality, not your past one.
I hope this helps 🙂
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