What is Parastomal Hernia?

If there is an abnormal protrusion or outpouching of the bowel from a feeble area in the abdominal wall, this condition is called a hernia. If you are having a hernia then the weeknd area is around the stoma opening in the abdomen. You can observe a slight bulge to a very large protrusion, depending on the size of the weakened area. Sometimes the prostration is so large that it can be noticed easily under the clothes. There are many things that you should know about how to manage a hernia.

Almost 5- 10 % of people with colostomies have chances to develop hernia and almost 3-10% of patients with ileostomy also develop a hernia. However, it is difficult to know who might be affected by parastomal hernia. Some factors can help you to predict it before its development.

• Location of the stoma: Typically, when a new stoma is created, it must be brought through a muscle present in the abdomen that is referred to as rectus abdominis. If the stoma is placed outside this muscle this may develop a hernia.

• Obesity: People with a lot of fats or obesity have more chances to develop a hernia than others.

• Malnutrition: If you don’t take a well-balanced diet or you have a poor diet after the surgery, this will not only affect the healing time but also weaken your parastomal area.

• Age: Advancing age can be the reason for poor muscle tone. This will develop hernia more easily.

• Increased intra-abdominal pressure: The conditions such as severe coughing, severe sneezing, or lifting a heavy object can also weaken the muscles of the abdomen near the stoma; this will be the reason for the increased pressure within the abdomen that can lead to a hernia.

• Infection following stoma surgery: Any kind of infection can weaken the muscles of the abdominal wall and leads to a parastomal hernia.

When does a hernia develop?

Parastomal hernias may occur just after the surgery and in other cases, it takes many years to happen. Usually, people (80%) don’t experience any complications during hernias and recover without any interventions. The rest of the 20% may notice some symptoms that need to be resolved immediately. In some cases, a hernia can be noticed only in a certain position such as if you are standing or sitting. And this will disappear if you lie on your back. In some cases, a hernia can be noticed in any position.

How to manage parastomal hernia?

Abdominal discomfort can be caused due to parastomal hernias. Many people complain about the tightness, tautness, and weight of the parastomal area which is not painful but the patients become uncomfortable. If you will use a hernia belt or an undergarment such as lycra it can help you to avoid this discomfort. The belt should be according to the size of your abdomen, and it must have a hole that fixes exactly around the stoma and allows the Ostomy pouch to connect with the stoma. In case of severe and continuous pain or discomfort, you should call your doctor without wasting any time. Your ET can help you to choose between a Lycra and belt according to your condition.

Main Concerns

The size and shape of the stoma may also be affected by parastomal hernia. The changes in stomal size and shape are more prominent when you are sitting, standing, or lying on your back. In case of a large hernia, it is hard to examine your stoma and you need to struggle for your Ostomy care. These changes in stoma size and shape can also bring leakages in Ostomy bags and can irritate peristomal skin. You should consult with your ET nurse to cope up with this problem.

When surgery is needed?

This can be a reason for abdominal bloating (distention). There can be a need for surgery, that’s why you should consult with your surgeon if you feel any of these signs. Moreover, a hernia can prevent the normal functioning of the stoma. If this happens with you, there is an immediate need to see your medical expert. Patients who have colostomy along with parastomal hernia, and they use an irrigation method, they need to stop irrigation at this point. If irrigation is not stopped it can cause other complications. You can ask for help from your ET about the regular pouching system.

Some people dislike the bulge that occurs due to the parastomal hernia and they want to fix it through surgery. It’s better to discuss with your surgeon whether surgery will work for you. There are different methods to resolve this issue. For example, the stoma can be shifted to the opposite side, closing the hernia or local repair at the stoma site. If surgery is recommended; then the surgeon will discuss with you the basic risk, complication, and procedure.

Ostomy Accessories

You’ve probably been sent home after your ostomy with a paste, powder, and skin wipes.  You may wonder why in the world you are given this? They are different accessories that may not be needed, but there are a lot of reasons for this, and here, we’ll go over the accessories and the uses for each of these accessories. 

Paste 

The paste is usually thick and similar to a toothpaste, and is essentially different in the way that it’s sed. It’s basically a barrier that is a part of the flange system. While it may seem like a “glue” because of the name paste, it’s actually similar to caulking than anything else. Paste is used on the inner part and the edges of you flange, protecting the skin that’s there from stool that’s exposed.

The paste pretty much fills in those gaps left by the flange, in order to protect your skin as well. You also can use this for creases and the like if you have different rivets in the area. Not everyone who has a stoma needs paste, but if you have a colostomy, you may want to consider using this, depending on the barrier that’s employed. 

Powder 

Powder for your stoma is pretty much a ground up version of the barrier parts of the flange. The powder is limited with absorption, and it’s used to help with irritated skin and other issues. When this is sprinkled in the areas affected, you then seal it with a wipe, since if used just by itself, it may not allow for adhesion of the pouch to the skin itself. 

Powder s not always needed in ostomy care, since it’s the same as a barrier, but if you have irritation and the like, it may offer some benefit as well. Routine usage does cost a bit, and it does increase the time between changes, but if you have a skin condition, this will help as well. 

Wipes 

Wipes are another part of this. There are adhesive wipes that are used to remove the paste in the ostomy care, but it may not be necessary. If your skin isn’t irritated, you can gently move the flange pulling I away, helping to take off the pouching system. The adhesive removers work well if you have a lot of adhesive or paste, or if there are fabric fibers which gather near the edge. 

You do need to clean up the skin well after you use this, before you put on a new pouching system, since if you don’t do this, it may cause sensitivity of the skin, and also bad adhesion.They also have skin protector wipes, which when they are applied directly, dries fast, and then from there creates a film or barrier that helps protect the skin, and offers a bit of a stronger adhesive to the system as well. Most ostomy pouches are designed for gentle adhesion though, and not to cause trauma to the body as well.

Routine use of this normally isn’t’ required, as it is costly, it can cause issues with the skin, ad it will not automatically increase overhaul adhesion when applying a new pouching system. Again, all of these are accessories, and not every single person needs these accessories if they’re going to be using a stoma bag and the like. But if you do suffer from skin conditions, r issues with adhesion of the product to the body, you will want to include this in your routine to help better off the results of this as well, for you right now and down the road.