I asked the online ostomy community what they would like to read stoma-related blogs about, and hernia prevention was one of those topics. So, here we are – let’s get started!
What is a parastomal hernia?
During stoma formation, the surgeon has to cut a hole in the abdominal wall to pull the intestine through. This causes weakness and puts patients at risk of developing a parastomal hernia. This is when an abnormal protrusion (usually the intestine) pushes through the weakened area in the abdominal wall, which can happen shortly after surgery, or many years later.
Depending on how large the weakened area is and how much bowel protrudes through, it’s possible for a hernia to be anywhere between tiny, causing only a small lump, to large, causing a significant one which can be seen under clothing. Some people have no symptoms at all, and others experience several, such as abdominal pain and discomfort, a change in bowel habits and sometimes even bowel obstruction or strangulation. It may also change the shape and size of your stoma, and can also make it difficult to see/access during bag changes. A parastomal hernia can also make it difficult to get a good fit of your appliance, leading to frequent leaks and skin irritation, especially if the hernia shape changes as you move around.
Who is at risk?
It is difficult to predict who will develop a parastomal hernia, but according to research, there are many factors which are thought to contribute, including:
- Stoma placement
- Obesity
- Malnutrition
- Muscle weakness due to ageing
- Smoking
- Post-op infection
- Chronic constipation
- Corticosteroid use
- Increased pressure within the abdomen; chronic coughing, severe sneezing, or lifting heavy objects
How do you prevent a hernia?
So, you’d think preventing a hernia would just involve not doing any of the things that increase the risk, right? Well, take a look at the list above and think about how many of those factors you actually have full control of.
For many of us, not doing particular forms of exercise aren’t too much of an issue, but for others, that exercise is part of their lifestyle or even their job, and nobody wants to feel like having a stoma prevented them from being able to do the things they love!
I had a quick chat with Zoey Wright, most commonly known for being a bodybuilding ostomate, to ask what her top tips for parastomal hernia prevention are. These are the four tips she wanted to share with you:
- Know your limits when it comes to day to day tasks that involve lifting
- Think about incorporating exercises to strengthen your core/pelvic muscles
- Invest in using hernia support wear
- Everybody is different when it comes to prevention, it’s about what works for you as an individual
Generally speaking, maintaining a healthy weight (excess can put additional strain on your abdominal muscles), and exercising regularly will help, and let’s be honest, if we’re able to, we should all be trying to live our healthiest life anyway – the health benefits are a ten-fold!
Here are some things that you can be thinking about pre and post-op. I do understand that all of these things may not be possible due to disease and general health, but doing what you can do is better than doing none of it!
Pre-surgery
- Eat well – a balanced healthy diet will put your body in the best place to support wound healing after surgery. If you can’t tolerate the “good stuff”, consider seeing a dietician for supplement advice.
- Focus on strengthening your stomach muscles – this will increase the chances of them healing well.
- Stop smoking – excessive coughing after surgery will increase the risk of damaging your muscles when they are trying to knit back together, plus, smoking slows wound healing.
Post-surgery
- Gradually build your strength and activity – pushing too hard too fast can do you much more harm than good. Slow and steady definitely wins the race here!
- NO heavy lifting or vigorous exercise which puts additional strain on your abdominal muscles for 3 months.
- Support your abdomen when you sneeze, cough or vomit – using a folded towel/blanket or sturdy cushion can help.
Ongoing
Wear a specifically designed hernia prevention support garment when doing physical activity which involves heavy lifting or straining – whether that’s for your job or simply doing some gardening.
Learn how to lift “properly” – feet apart with 1 leg slightly forward to maintain balance. Keep your back straight, bend your knees, and keep the load close to the body.
What if I get a hernia anyway?
The best laid plans of mice and men, huh? Sometimes, a hernia will happen no matter how much effort you put into avoiding one. You can’t always control post-op infection, being malnourished or what medications you need to take, and you certainly can’t avoid ageing – I’m sure you’d be a millionaire by now if you could!
Living with a hernia can be as simple as using a hernia support belt or underwear, and in worst case scenarios can require surgery which usually involves the insertion of a mesh to help the muscle knit back together.
The support is out there, so if you think you may have a parastomal hernia, reach out to your stoma nurse who can tell you what to do next. If the pain is severe and deemed more urgent, seek immediate medical attention!
If you’re looking for an exercise routine to build your core strength, Simple Steps is a Pilates based programme created by Fittleworth’s Clinical Nurse team with The Mindful Physios.
It’s a great guide for building your core muscles pre and post stoma surgery. Download a free Simple Steps guide or request a printed version from the Fittleworth website. There is also a video series to accompany the guide.
We hope you enjoyed this article from our guest blogger. They are expressing their views or knowledge on a topic because of their experience and background. Some of the opinions expressed may not reflect the views of Fittleworth or your NHS professional.
It goes without saying, but this is not clinical advice. Each person will have an individual set of medical factors to consider. So please do not to make significant changes to your diet, exercise or treatments before consulting with an NHS professional.
Sahara was admitted to hospital and diagnosed with Ulcerative Colitis at the age of 19, 
after just two weeks of being incredibly unwell. One week later, she had emergency surgery to remove her colon and rectum, and had her first ileostomy. A turbulent journey followed; a multitude of treatments, complications, seven surgeries, a failed J-Pouch, and three ileostomies later, she is living with a permanent stoma and is a pro-active IBD and ostomy advocate.
Sahara joined the online IBD and ostomy community in 2014, and it very quickly became apparent to her that whilst awareness is important, even more important than that is providing support to others as they navigate the stormy waters of life with IBD, or an ostomy.
She runs #IBDSuperHeroes fundraising and awareness campaign, and the Facebook support group. She is a blogger for InflammatortyBowelDisease.net and an IBD Patient Consultant for merakoi – bridging the gap between patients and healthcare. She gets involved with research whenever she can, and is a volunteer for Cure Crohn’s Colitis, where she donates her time and expertise in social media marketing and content creation.