Question

I’ve learned that in Europe, hernia support belts with holes for the pouch are generally not recommended and are actually uncommon. The reverse seems to be true in North America. The argument against holes is that they recreate the situation that gave rise to the hernia in the first place and can make the hernia worse. I’ve spoken to users of hole-less belts and some say the flow of output into the pouch can be restricted at times, but they just discreetly “massage” the output down when necessary.

Response

Thank you for your excellent question about the hole or no hole hernia belt debate.

From the NSWOC ( Nurses Specializing in Wound Ostomy and Continence) website under parastomal hernia, information is this excellent article.  Please see the references at the end of the article for more studies that are quoted in the article.

https://nswoc.ca/wp-content/uploads/2015/02/caet-parastomal-hernia-01.pdf.  

The NSWOC website parastomal hernia information is https://nswoc.ca/parastomal-care/

WOCN ( American Wound Ostomy Continence) nurses website provides this guideline.

https://cdn.ymaws.com/www.wocn.org/resource/resmgr/Publications/Stoma_Complications_Best_Pra.pdf.

Again please see the references at the end. 

One of the main differences is the type of pouching system used.   For example, the Thompson and Trainor article recommends no hole but recommends using a flexible pouching system.  

In my experience, if I use a flexible pouching system and a hernia belt with a hole, “coning” or the abdominal wall pushes through the hole develops.  I don’t recommend using a flexible pouching system with a hernia belt with a hole because of this “coning”.  If a person is using a 2 piece pouching system or a one-piece pouching system with some “ firmness’ such as convexity, I get very good results with a hernia belt with a hole.  Some other important considerations when fitting a belt with a hole is to ensure the hole opening is the correct size for the pouching system, also if using a convex pouching system and any hernia belt, the peristomal skin must be monitored for pressure injury due to the pressure of the convexity against the skin with the pressure of the hernia belt. 

I hope these resources are helpful.

Andrea Manson
RN, BSN, NSWOC, NCA
All-round nice person, now retired ????

Our friends over at Nurses Specialized In Wound, Ostomy And Continence Canada (formerly called The Canadian Association for Enterostomal Therapy (CAET)) have renamed their handy look-up page on their website. It was formerly called “Find An ET Nurse” and is now called “Find a NSWOC“. Click on the image to the left or link here to go to their site.