About the disease

Parastomal hernia is a condition whereby bulge develops near the stoma which results in swelling. In complicated cases problems with stoma can develop. In most cases parastomal hernia develops gradually and does not manifest itself for a long time. As a result of parastomal hernia part of the bowel can also bulge out. Overall, stoma is an opening. When there is opening in the intestines, hernia can develop.

There are many causes which can lead to the development of parastomal hernia. Continuous coughing which leads to straining of the bowel can lead to development of parastomal hernia. Strenuous physical activities, such as lifting of heavy objects or straining the bowel continuously, can also lead to the development of this condition. If the person had an abdominal wound or developed an infection where the stoma opening had been, the risk of developing hernia increases. Also, with age the abdominal muscles tend to become weaker, that's why the elderly are more at the risk of developing parastomal hernia, especially if they lead sedentary lifestyle and do not exercise. Women who gave multiple births or who had twins are also at the risk of developing parastomal hernia. Also, obesity can become the cause of parastomal hernia, especially if the amount of visceral fat is much bigger than normal. Visceral fat is located around the abdominal area. This is also the most common site where fat accumulates if the person has tendency of overeating.

Very often parastomal hernia can develop as a result of colostomy, which is a procedure whereby the surgeon makes the opening in the large intestine or the colon. People who had colostomy need to be careful about lifting heavy objects and need to be checked up regularly.

Symptoms

• Abdominal pain
• Bulge from the intestines
• The bulge may disappear when lying down
• Pain may intensify when coughing or lifting heavy objects

Diagnosis

• During a general examination the doctor will ask the patient about their medical history to determine if they had colostomy in the past or any other conditions which could weaken their abdominal muscles and intestines.
• If the patient is a woman, the doctor will ask about previous pregnancies to determine if there had been any problems during prenatal development or birth.
• The doctor will palpate the abdominal area to determine the exact location of pain and will ask the patient to sit in special position to see if hernia will bulge out.
• Imaging tests, such as an ultrasound or MRI, can show the exact location of the hernia.

Treatment

• Conservative treatment uses wearing special clothes and bandages that support the stoma and also prevent hernia from bulging out. Special physical therapy is also advised in some cases. In cases parastomal hernia does not disturb the patient and is not painful, surgery is not recommended.
• Surgical treatment is used to push back the hernia and also prevent the hernia from bulging out again. 

Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed