About Parastomal Hernia
Parastomal hernias occur when there is a protrusion of tissue or organs through the abdominal wall around a stoma. The causes of a parastomal hernia include:
- Weakness in the abdominal muscles: Having a stoma can weaken the abdominal muscles, causing them to pull away from the stoma and creating a space for herniation.
Non-modifiable risk factors are factors that cannot be changed or controlled. The non-modifiable risk factors for parastomal hernias include:
- Older age: The risk of developing a parastomal hernia increases with age.
- Cancer: People with cancer who have undergone stoma surgery are at higher risk.
- Previous abdominal wall hernia: Having had an abdominal wall hernia in the past increases the risk of developing a parastomal hernia.
Modifiable risk factors are factors that can be influenced or changed. The modifiable risk factors for parastomal hernias include:
- Obesity: Carrying excess weight, especially around the waist, stomach, or hip area, increases the risk.
- Smoking: Smoking can weaken the tissues and impair healing after stoma surgery.
- Crohn's disease: People with Crohn's disease have an increased risk due to inflammation and weakened tissues.
- Respiratory diseases with chronic cough: Chronic coughing can strain the abdominal muscles and increase the risk of herniation.
It's important to note that these risk factors may vary from person to person, and individual circumstances should be discussed with a healthcare provider.
Early symptoms of a parastomal hernia may include:
- Pain or discomfort around the stoma
- Trouble keeping the stoma appliance in place
- Bulging around the stoma, especially when coughing
As a parastomal hernia progresses or becomes more severe, additional symptoms may occur including:
- Increased pain or discomfort around the stoma
- Difficulty emptying or changing the stoma appliance
- Skin irritation or breakdown around the stoma
- Leakage of stool or urine from the stoma appliance
- Changes in the size or shape of the bulge around the stoma
It's important to note that some people with a parastomal hernia may not experience any symptoms, while others may have more pronounced symptoms. If you suspect you have a parastomal hernia or are experiencing any concerning symptoms, it's best to consult with your healthcare provider for an accurate diagnosis and appropriate management.
To diagnose a parastomal hernia, several examinations, tests, and procedures are commonly performed including:
- Physical examination: A healthcare provider will conduct a physical exam, looking for physical signs such as pain, swelling, or the presence of masses around the stoma.
- Imaging tests: These tests help visualize the hernia and its severity. Common imaging tests include:
- Ultrasound: Sound waves are used to create an image of the hernia.
- CT scan: A detailed X-ray that provides cross-sectional images of the hernia.
- MRI scan: Uses magnetic fields and radio waves to produce detailed images of the hernia.
To determine the stage or severity of a parastomal hernia, additional examinations, tests, and procedures may be performed including:
- Clinical examination: The healthcare provider may perform a clinical exam in both upright and supine positions. They will digitally palpate the stoma at rest and during maneuvers like the Valsalva maneuver to assess for bulging or herniation.
- Computerized Tomography (CT): CT scans can be used to evaluate the hernia in more detail. It may be performed with or without intravenous contrast.
Remember, these are general descriptions, and specific recommendations may vary depending on your individual situation. It's important to consult with your healthcare provider for personalized advice.
The goals of treatment for a Parastomal Hernia include creating a durable repair and improving the patient's quality of life. Here are some treatment options and how they work towards achieving these goals:
Lifestyle changes: Losing weight, quitting smoking, and wearing an abdominal support belt can help ease uncomfortable symptoms and reduce the risk of developing or worsening a parastomal hernia.
- Diet and exercise: If you're overweight, your doctor may recommend a diet or exercise program to help you reach a moderate weight, which can alleviate symptoms.
- Smoking cessation: If you smoke, participating in a smoking cessation program can improve healing and reduce the risk of complications.
- Stomal support belts: These compression belts support the abdominal muscles, secure the stoma, and conceal the appliance, providing relief from symptoms.
- Surgical repair: In some cases, surgical repair may be necessary, especially for strangulated or incarcerated hernias. Elective surgery may also be considered for chronic obstruction, pain, leakage, discomfort from an ill-fitting appliance, or peristomal skin breakdown.