By Karen Bruton RN BScN MCISc-WH WOCC(C). Originally published in the Fall 2024 issue of Ostomy Canada Magazine.
One of the most common ostomy complications is the parastomal hernia. The literature varies greatly on the incidence of developing a parastomal hernia, as well as having mixed reviews for identifying risk factors that could lead to developing a hernia. In addition to its medical consequences, parastomal hernias have a significant impact on a person’s psychological health, everyday activities, and quality of life, including their financial situation.
Ostomy Canada defines a parastomal hernia as: “A portion of the intestine that bulges out of a weakened area of the abdominal muscle wall. Some individuals with an ostomy may be susceptible to hernia formation around the stoma.”
Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) has written the following Canadian Best practices, Parastomal Hernia Prevention, Assessment, and Management: Canadian Best Practice Recommendations which can found on the NSWOC website. Research shows the incidence for developing a parastomal hernia is between 25.6% to 58%.
Even though parastomal hernias usually develop within two years after a stoma is created, diagnosis may not happen for up to twenty years after surgery.
Hernia Prevention, Assessment,
and Management: Canadian Best
Practice Recommendations, 2023
Some of the predisposing risk factors for developing a parastomal hernia include:
- 70 years of age and older
- Obesity
- Manual labour occupation
- Moderately active, including physical exercise
- Lifting young children
- Previous history of a parastomal hernia repair
- Certain diagnoses (e.g. malignancy, connective tissue disorders, diabetes)
- Conditions causing increased intra-abdominal pressure (e.g. Congestive obstructive lung disease, constipation)
- Smoking
- Steroid medications
The type of ostomy surgery may also impact developing a parastomal hernia, but ultimately all persons undergoing ostomy surgery are at risk. There is no standardized method to diagnose a parastomal hernia except by undergoing a thorough examination by a healthcare professional, computed tomography, and an ultrasound.
Reducing the likelihood of developing a parastomal hernia may be accomplished through changing one’s modifiable risk factors.
Preventative measures may include:
- Pre-operative stoma ostomy siting by a NSWOC or a qualified health care professional
- Pre-operative and post-operative education covering the following subjects:
- Smoking cessation programs
- Avoiding intra-abdominal pressure (e.g. acute or chronic cough, vomiting, and conditions causing intra-abdominal pressure)
- Weight management
- Increasing physical activity gradually post-surgery
Most people can manage their parastomal hernias with lifestyle changes, which include losing weight, smoking cessation and wearing an abdominal support belt. Some will require hernia repair because symptoms affect their quality of life or in emergency cases when the hernia becomes strangulated or incarcerated. Not everyone is an appropriate candidate for hernia repair due to pre-existing health conditions (e.g. respiratory, cardiovascular).
Surgical candidates should meet with the surgeon to discuss and weigh the benefits and potential negative outcomes. Hernia repair literature states that it is highly likely the hernia will develop again.
Surgeons will consider hernia repair for those with:
- Urgent issues (e.g. bowel obstruction, strangulated bowel, ischemic bowel)
- Symptomatic concerns (e.g. pain or discomfort, inability for appliances to adhere or constant leakage from appliance)
- Complications (e.g. vomiting, chronic skin breakdown)
For a non-surgical approach or while waiting for hernia repair, one may consider purchasing and wearing a hernia ostomy belt, also known as a hernia support garment. These are supporting devices that help to compress and support the stoma site, improving the adherence of the appliance and reducing pain. Hernia support garments come in different widths and sizes and offer different degrees of support. The kind of clothing a person wears might vary depending on their stoma type, function, pouch type, stoma size and shape, as well as their personal traits and comorbidities. These clothes should ideally fit well, be comfortable, offer the required amount of support, and be tailored to the wearer’s needs.
It is wise to investigate and ask questions when purchasing a hernia belt because there are many varieties on the market. It can be difficult to find a vendor that sells hernia ostomy belts and may be even harder to find qualified experienced fitters for measuring a person for a hernia ostomy belt. Researching what vendors are available in your area is important to ensure you purchase the right product. Consider searching for companies such as home medical sales stores, online ostomy sales sites, and pharmacies.
When considering purchasing a hernia ostomy belt, the following questions should be asked:
- Type of material, breathability, lightweight and comfort level
- Adjustability and customizable straps
- Durability and the garment’s lifespan
- No hole vs hole for ostomy appliance
- Cost (varies)
Hernia ostomy belts vary in size depending on the manufacturer and design; some require specific measurements, while others sell them in general sizes based on hip and waist dimensions. Researching the best possible product that suits your needs is important to ensure a positive quality of life.
Living with a parastomal hernia can be managed effectively with lifestyle changes, but at times surgical intervention is warranted, especially when it affects your quality of life. Complications caused by parastomal hernias can cause emotional turmoil, so it is important to reach out to family members, NSWOC and/or Ostomy Canada (Chapter or peer group) for support.
References
- Antoniou, S. A., Agresta, F., Garcia Alamino, J. M., Berger, D., Berrevoet, F., Brandsma, H. T., Bury, K., Conze, J., Cuccurullo, D., Dietz, U. A., Fortelny, R. H., Frei-Lanter, C., Hansson, B., Helgstrand, F., Hotouras, A., Jänes, A., Kroese, L. F., Lambrecht, J. R., Kyle-Leinhase, I., López-Cano, M., … Muysoms, F. E. (2018). European Hernia Society guidelines on prevention and treatment of parastomal hernias. Hernia : the journal of hernias and abdominal wall surgery, 22(1), 183–198. https://doi.org/10.1007/s10029-017-1697-5
- Haas, R., Horton, J., & Hamson, A. (2024). Hernia Support Garments for Parastomal Hernia Following Ostomy Procedure: Rapid Review. Canadian Agency for Drugs and Technologies in Health. https://pubmed.ncbi.nlm.nih.gov/38564550/
- Manole, T. E., Daniel, I., Alexandra, B., Dan, P. N., & Andronic, O. (2023). Risk Factors for the Development of Parastomal Hernia: A Narrative Review. Saudi journal of medicine & medical sciences, 11(3), 187–192. https://doi.org/10.4103/sjmms.sjmms_235_22
- MyOstomy.ca. https://myostomy.ca/
- Nightingale Medical Supplies Ltd. https://nightingalemedical.ca/
- Nurses Specialized in Wound, Ostomy and Continence Canada. (2023, May). Parastomal Hernia Prevention, Assessment, and Management: Canadian Best Practice Recommendations. 1st Ed. https://www.nswoc.ca/
- Ostomy Canada. https://www.ostomycanada.ca/
About Karen Bruton
Karen is a registered nurse with over 29 years of experience across diverse healthcare settings, including acute care, community, and long-term care. She has held roles such as Clinical Nurse Specialist, Clinical Educator, and Team Leader, and is passionate about supporting healthcare professionals through education and knowledge translation. Karen has maintained frontline nursing practice throughout her career and believes this is essential to understanding and supporting patient care. She also served as long-time Team Lead for Ostomy Canada’s Medical Lifestyle Advisory Committee, stepping down in 2025.
This story was sourced by Lisa Gausman, Ostomy Canada Senior Editor.
2 Responses
I have an ileostomy created during my surgery for ovarian cancer 18 months ago. I am in surprisingly good health, though of course a new normal, but strong enough to be playing my French horn in community band and orchestra, as well as singing in a church choir.
I am wondering if ostomates who play wind instruments requiring controlled deep breathing, use of abdominal muscles, etc. are more likely to develop hernias or other problems with their ostomies. I was especially cautious as I began to play again, but to play well, Uttar important to support the air with those abdominal muscles.
I live in the Yukon Territory, so there are not many supports locally.
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