A parastomal hernia can be one of the most uncomfortable and difficult types of hernias to treat. Generally defined, a hernia occurs when the intestine or some other abdominal content bulges through a weakness in the abdominal muscular wall. A parastomal hernia occurs specifically around a stoma, when the intestines bulge below a medically created hole, such as a colostomy.
This condition is a common colostomy complication due to the nature of a stoma, which is actually an abdominal bulge and therefore creates a weak spot. Optimally, when a stoma is performed, the abdominal walls are allowed to fit tightly around the stoma. In cases where the fit is not tight enough or has loosened over time, a parastomal hernia can form.
Other factors can lead to the formation of a parastomal hernia. These include having an infection at the site during the stoma creation, being overweight, or repetitive coughing, sneezing, or straining. Parastomal hernias often do not form immediately, occurring over time as the muscles around the stoma wear and loosen. Then, the more a person sneezes, coughs, or strains, the greater the risk of abdominal protrusion.
As the muscles around the stoma stretch and a parastomal hernia worsens, complications of the condition can develop. Pain is a rare but potential side effect. Most commonly, the symptom of parastomal hernias is discomfort and a large, embarrassing bulge near the stoma site. In a case where the bulge becomes too large, the parastomal hernia could also interfere with the colostomy or other pouch.
A more serious complication occurs when the intestine becomes pinched within the hernia. Pain and obstruction can occur, which can even lead to the intestine becoming constricted and losing its blood flow. The severed intestine can be permanently damaged if medical help is not sought immediately. A medical professional may recommend surgical hernia repair to prevent further complications.
For other parastomal hernia situations where there are no serious complications, some medical professionals might not recommend surgery. If patients have smaller hernias but also underlying medical problems, or if they are too old for surgery to be dangerous, this may preclude the use of surgery to repair a parastomal hernia. For these patients, a wider stoma belt that is firmly attached may help prevent problems, and a garment may help minimize symptoms.