One condition that new colostomy patients should be aware of is the development of a parastomal hernia (sometimes referred to as a peristomal hernia). The British Journal of Nursing (BJN) reported 20-50% prevalence in patients with stomas in 2008 indicating the extent of the problem. It is important for ostomy patients to know the signs, treatment and the best practices to prevent a parastoma hernia. As one of the more common problems associated with ostomy surgery, any bulge around or near the stoma may be a sign of this condition. Always consult your doctor or nurse if you believe that you have any symptoms of a hernia.
What is Parastomal Hernia?
After the formation of a stoma in the stomach, a line of weakness develops due to the surgical dissection of muscle in order to externalize the bowel. A hernia is a split or weakness that develops on the muscle wall of the abdomen thus causing the abdomen content to bulge out. This situation develops when abdominal muscles tense during coughing, sneezing, or any other form of straining.
Parastomal Hernia (PSH) presents a challenge to patients in form of poor body image especially when one or more loops of the bowel pass through the fascia defect around the stoma into the subcutaneous tissues leading to a distended bulge. Stoma hernia formation is usually gradual and might not be painful. However, complications can occur if the intestines get trapped and obstructed within the hernia essentially strangulating blood supply and causing a lot of pain.
Parastomal Hernia Contributing Factors
Incidence rates according to recent surveys indicate PSH occurs in 2-18% of patients with end ileostomies, 4-48% of patients with end colostomies, and 0-38% of patients with loop colostomies among others. Furthermore, obese and overweight patients are also at a higher risk while cases of herniation have also been associated with old age. This is because with age, the rectus abdominal muscle is weakened and cannot provide enough support for the stoma.
Stoma placement, type of surgical procedure used in ostomy construction and general weakness of the abdominal walls are also risk factors. In addition, substantial weight gain after ostomy surgery increases risk of occurrence. Other factors include poor nutrition, emergency stoma construction, and use of immunosuppressant drugs.
Diagnosis and Treatment
Some of the signs and symptoms used to detect PSH include a large bulge during coughing, intermittent bowel obstruction especially in patients with a stoma, peristomal skin breakdown, stoma appliance dysfunction and chronic back and abdominal pain. To prevent PSH after surgery, you are advised to avoid heavy lifting, maintain a good posture always, use a support belt or girdle, and support your stoma while coughing. If you already have stoma complications and identify some of these symptoms, it is imperative to consult your doctor. Diagnosis of peristomal hernia involves physical examination after removal of the stoma appliance while you are in a standing position. You will be required to perform the valsalva maneuver in the position for a conclusive opinion. Other tests include diagnostic imaging, and digital exploration.
Colostomypatients diagnosed with a hernia that does not cause them any pain or those more at risk should look into buying a hernia belt. A lot of ostomy supply stores carry these. Along with avoiding heavy lifting, wearing a hernia belt can go a long way towards preventing the condition.
Treatment options for PSH are wide and varied though they all fall within surgical and non-surgical remedies. Due to the high recurrence rates, non-surgical management options are chosen when the symptoms are mild and they involve teaching you all about PSH and any symptoms that might require immediate surgery. There are some appliances used by surgeons which mold to the peristomal skin and create a secure and comfortable fit.
Surgical hernia repair techniques include direct repair of the fascial defect, relocation of the stoma, and use of a prosthetic mesh which is the approach used by the British Hernia Centre (BHC). High rates of failure associated with direct fiscal treatment necessitated the development of the prosthetic mesh option. The use of a mesh over the hernia is recommended regardless of whether the stoma is moved or left intact and it helps to reinforce the entire weakened muscle fabric. This mesh is incorporated into the muscle and surrounding tissue thus creating a stronger abdominal wall. Another benefit of the mesh is the fact that unlike the use of stitches, it will not be pulled away from the other tissue leading to recurrence.
Read more about parastomal hernia repair.
Always keep track of your stoma and the area surrounding it. Any bulging or anything concerning should be conveyed to your doctor or ostomy nurse, especially if there is any pain. Hopefully, with this information in mind new and old colostomy patients alike will be in a better position to prevent and effectively deal with a parastomal hernia.