''WHAT IS A PARASTOMAL HERNIA
WHAT IS AN ABDOMINAL HERNIA
I thought that the best way to cover this subject would be best explained by talking first about a hernia. Anyone who is reading this,and have had a hernia will know it is not something that you can delay having something done about if it looks bad. By this I mean, if the bowel that has herniated has become strangulated, meaning if the blood supply has been cut off. A hernia actually occurs when part of an organ protrudes through a weakend area into the muscles or tissues that surround and contain it. The protrusion becomes a bulge then a hernia which, in your abdomen, may contain fat, intestine or other tissue in its sac.
Different types of hernias in the abdomen are named according to the area where they are located on the abdomen. The names for these (epigastric, umbilical, femoral) and what has caused them( incisional)
A person with a stoma may get any type of hernia, but I want to tell you about the one that I have the unfortunate luck hahaha of being trapped with a Parastomal Hernia. This is a type of incisional hernia, which occurs next to or around your stoma.
HOW WOULD I KNOW WHEN I HAVE A PARASTOMAL HERNIA
When I found this swelling coming up on the right hand side of my stoma, I was not at all sure what it meant. It was very frightning. My first thought, and don't laugh, I thought it was going to burst out of my abdomen. Now, if you have a stoma, one thing you can do to check for a hernia is to stand for fifteen minutes approximately then look down at your stoma, is there a bulge near the stoma making that side of the abdomen look bigger than the other? Just a little bit of advice, not all bulges are already hernias... and this is when a support might help prevent a true hernia occurring! Next thing you do is have a cough and see whether it increases in size. Some hernias can cause mild discomfort, aching and dragging sensation. Some cause nausea when the intestine passes into the sac. Has your stoma changed size in the last little while, by that I mean (has it become bigger in it's diameter) or shape, or does it seem to have moved slightly to another place on your abdomen?
PLEASE, IF ANY OF THESE THINGS I HAVE LISTED LOOK SUSPICIOUS TO YOU ,GO AND SEE YOUR STOMAL THERAPY NURSE OR YOUR DOCTOR.
Sometimes, as with my doctor, they are not sure whether or not it is a true hernia, so they perform a CT Scan to confirm whether the bulge you have is a true hernia. Mine turned out to be positive.
CAN PARASTOMAL HERNIAS CAUSE PROBLEMS
You have to be careful with what you wear because if you have a large hernia, which is like mine, I can tell you now it is no joke. Sometimes, depending on what you are wearing, you might find that you are letting everyone else know that you have this hernia. As well as this, they can be very uncomfortable and cause a dragging sensation, which isn't at all pleasant, or even nausea when part of your intestinal tissue passes in and out of the sac.
You can also have leakages in your appliances if you have large hernias. That is not nice, to be out somewhere shopping and suddenly discover that your appliance is leaking. There could also be skin changes due to the intermittent stretching and relaxation of skin as the hernia goes out then in again. Because intact abdominal muscles play a role in our posture, a large hernia can exacerbate back problems. So if anyone has back problems be aware of this happening. Because abdominal muscles work with the diaphragm in coughing, a hernia can exacerbate respiratory problems also.
ARE PARASTOMAL HERNIAS DANGEROUS
When I asked about this, I was informed that most parastomal hernias are not dangerous unless they develop complications, and fortunately these are rare, mainly because of the size of the hole in the muscle through which the hernia occurs.
Intestine can sometimes become trapped (called "incarcerated") within the hernia causing a bowel obstruction. Trapped or kinked bowel may lose its blood supply (this is known as "strangulation"). This painful condition will require emergency surgery to untwist the bowel and prevent permanent damage or death.
WHY DO SO MANY PEOPLE WITH STOMAS GET HERNIAS?
This was one of the first questions I asked my Colorectal Surgeon went I had my appointment with him. He told me that when the bowel is brought onto the abdominal surface to make a stoma it must first pass thrugh the muscles of the abdominal wall, thus a site of weakness is immediately created. Ideally the bowel should fit snuggly in the opening, and usually it does at the time of surgery, but things change gradually and the gap enlarges allowing first a bulge and maybe later a develops into a hernia.
The recurrence rate of repairing a Parastomal Hernia is very high and every operation and anaesthetic carries risk of other complications. The surgeon must weigh up the possible benefits and risks for each individual case.
WHAT CAN I DO TO PREVENT A HERNIA
There are some factors that you canot change, such as your age or having genetically determined muscle weakness. However, you can wear a support to make up for that weakness.
However, there are some factors though that you can change, and I found out that these might actually lesson your chances of getting a hernia.
- Eat a healthy diet to avoid constipation
- Avoid being overweight because this can put extra strain on your muscles.
- Wear a support garment if you have a muscle weakness
- Use proper lifting methods.
- Avoid pulling, pushing or lifting things that are too heavy for you.
- Don't smoke because chronic coughing can put strain on your muscles.
- Do regular gentle exercises to strengthen and tone your abdominal muscles.
N.B. JUST BECAUSE YOU DO EXERCISES, THEY WON'T MAKE AN EXISTING HERNIA GO AWAY ...... THEY MAY EVEN MAKE IT WORSE DUE TO INCREASING ABDOMINAL PRESURES. IF YOU HAVE A HERNIA CONSULT YOUR DOCTOR BEFORE STARTING AN EXERCISE PROGRAM.
HERE ARE A FEW EXERCISES THAT WERE RECOMMENDED TO ME BY MY PHYSOTHERAPIST:-
Lie on a firm surface with knees
The following parts should be
touching the floor/bed:
• Soles of feet
• Mid/upper back and shoulders
There should be a space under
your neck and lower back so you
can slide your hand between
your lower back and the
Inhale (normally, not deeply)
then as you exhale pull your
tummy down and tilt your bottom
upwards slightly while pressing
the middle of your back down
into the bed/floor.
Hold for 2 seconds.
Let go slowly.
Repeat 10 times daily.
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