What Is a Parastomal Hernia?

A parastomal hernia occurs when part of the intestine or other abdominal tissue pushes through the weakened abdominal wall muscle around the stoma site. It typically appears as a bulge or lump beneath the skin, next to or around the stoma itself.

It is one of the most common long-term complications of stoma surgery, occurring at different rates depending on stoma type and individual factors. While not always causing serious symptoms, parastomal hernias can affect pouching system fit, cause discomfort, and in some cases lead to more serious complications.

Why Do Parastomal Hernias Develop?

The stoma is created by pulling a section of intestine through an opening (aperture) made in the abdominal wall. This opening is a point of structural weakness — the abdominal muscles cannot fully close around the bowel, and over time, intra-abdominal pressure can push tissue through this gap.

Risk Factors

  • Heavy lifting or straining, especially in early recovery
  • Obesity — excess abdominal fat increases internal pressure
  • Chronic cough (e.g. from smoking or lung conditions)
  • Constipation and straining at the toilet
  • Wound infection after surgery, which can weaken the repair
  • Steroid use, which impairs tissue healing
  • Malnutrition or poor tissue integrity
  • Age — older age is associated with weaker abdominal wall tissue

Colostomies tend to have higher hernia rates than ileostomies, though all stoma types carry some risk.

Signs and Symptoms

Parastomal hernias can range from barely noticeable to quite significant. Common signs include:

  • A visible bulge around or behind the stoma, often more obvious when standing, coughing, or straining
  • A feeling of heaviness or aching around the stoma
  • Difficulty getting a good seal with your pouching system, leading to more frequent leaks
  • Changes in stoma output or discomfort during output

When to Seek Urgent Medical Attention

Most parastomal hernias are not emergencies, but some complications require prompt care:

  • Incarceration: The herniated tissue becomes trapped and cannot be pushed back — causes significant pain and may reduce or block output
  • Strangulation: Blood supply to the trapped tissue is cut off — a surgical emergency with symptoms including severe pain, nausea, vomiting, and redness over the bulge

If you experience sudden, severe pain around the hernia or notice your stoma has no output along with cramping, seek emergency medical care immediately.

Prevention: Protecting Your Abdominal Wall

While no strategy can guarantee prevention, these measures significantly reduce risk — particularly in the first year after surgery when the abdominal wall is still healing:

  1. Wear a supportive abdominal hernia support belt or support garment — especially during activity. These provide external support to the abdominal wall around the stoma
  2. Avoid heavy lifting in the first 8–12 weeks post-surgery; ask your surgeon what your specific limit is and adhere to it
  3. Use proper lifting technique — exhale and brace your core when lifting anything; avoid holding your breath
  4. Manage chronic constipation to avoid straining
  5. Maintain a healthy weight where possible
  6. Stop smoking — smoking impairs healing and causes chronic cough
  7. Begin pelvic floor and gentle core strengthening exercises — as guided by a physiotherapist experienced in abdominal surgery recovery

Treatment Options

Conservative Management

Many parastomal hernias are managed non-surgically, especially if they are small, not causing serious symptoms, and the pouch system can still be fitted adequately. Conservative management includes:

  • Wearing a hernia support belt or wrap daily
  • Adapting the pouching system to accommodate the changed contour (e.g. more flexible or convex barriers)
  • Avoiding triggers that worsen the hernia
  • Regular monitoring with your stoma care nurse or surgeon

Surgical Repair

Surgery may be recommended when the hernia is large, causing significant symptoms, creating unmanageable pouching difficulties, or showing signs of incarceration. Surgical options include:

  • Local repair: The hernia is repaired at the same site, often with mesh to reinforce the abdominal wall
  • Stoma relocation: The stoma is moved to a new site on the abdomen

It is worth noting that hernias have a meaningful recurrence rate even after surgical repair. This is one reason surgeons and stoma nurses often prefer conservative management for less severe cases. Any decision about surgery should involve a thorough discussion with your colorectal or general surgeon about risks, benefits, and your individual circumstances.

Living Well with a Parastomal Hernia

A parastomal hernia can feel disheartening, but many people live comfortably with one for years using the right support and management strategies. Working closely with your stoma care nurse to maintain a good-fitting pouching system — and being proactive about abdominal support — makes a significant difference to quality of life.