Parastomal Hernia

What is a parastomal hernia?

A parastomal hernia is a type of incisional hernia that occurs at the site of a stoma (such as a colostomy or ileostomy). It develops when the muscles of the abdominal wall weaken over time, allowing a portion of the intestine or other abdominal contents to bulge out under the skin next to the stoma. This creates a visible bulge around the stoma. It is one of the most common long-term complications of having a stoma, with some studies reporting that up to 50% of patients may develop one. While often not dangerous, a large hernia can cause discomfort and make it difficult to maintain a good seal with the ostomy appliance, leading to skin irritation and leakage.

What are the symptoms?

Many parastomal hernias are asymptomatic, especially when they are small. When symptoms do occur, they can include:

• A noticeable bulge around the stoma, which may be more prominent when standing, coughing, or straining.
• Discomfort or a dragging sensation around the stoma.
• Difficulty with pouching: The bulge can change the contour of the abdomen, making it difficult for the ostomy appliance to stick properly, leading to frequent leaks.
• Skin irritation from the leakage of stool.
• Pain: A dull ache is common. Sudden, severe pain could be a sign of a serious complication like strangulation.
• Intermittent cramping or obstruction: In some cases, the hernia can cause a partial blockage of the intestine.

What causes a parastomal hernia?

A parastomal hernia is caused by a combination of factors that lead to the weakening of the abdominal wall around the surgically created stoma opening.

• The Stoma Itself: The creation of a stoma requires making a permanent hole in the abdominal wall, which inherently creates a point of weakness.
• Increased Intra-abdominal Pressure: Anything that increases pressure inside the abdomen can strain the abdominal wall. This includes obesity, chronic coughing, heavy lifting, and straining with urination or constipation.
• Patient Factors: Factors such as advanced age, malnutrition, smoking, and the use of steroids can impair wound healing and tissue strength, increasing the risk.
• Surgical Technique: A larger opening in the fascia and placement of the stoma outside of the rectus muscle have been associated with a higher risk of hernia formation.

How is a parastomal hernia diagnosed?

The diagnosis of a parastomal hernia is most often made by a physical examination. Your doctor will examine your abdomen while you are lying down and while you are standing or coughing to see the bulge. In some cases, a CT scan of the abdomen may be ordered to confirm the diagnosis, to see the size of the hernia defect, and to check for any other associated hernias.

How is a parastomal hernia treated?

Treatment for a parastomal hernia depends on the severity of your symptoms and how much it impacts your quality of life.

Non-Surgical Management:

• Observation: If the hernia is small and not causing any problems, it can often be safely watched.
• Support Garments: An ostomy support belt or a specialized hernia belt can provide external support to the hernia, reduce discomfort, and improve the seal of the ostomy appliance.
• Pouching Adjustments: A stoma nurse can help you find a pouching system that will conform to the new shape of your abdomen, often using a convex skin barrier.

Surgical Management:
Surgery is typically reserved for patients with severe symptoms, such as pain, obstruction, or intractable pouching problems. Surgical repair is challenging and has a high risk of recurrence.

• Hernia Repair with Mesh: The most common surgical approach involves repairing the hernia with a piece of surgical mesh. The mesh can be placed in different layers of the abdominal wall. The stoma may be brought out through a hole in the mesh (keyhole technique) or lateralized to the mesh (Sugarbaker technique).
• Stoma Relocation: In some cases, especially with a very large hernia or after a failed repair, the surgeon may close the old hernia site and create a new stoma in a different location on the abdomen.

Prevention is also a key strategy. The use of prophylactic mesh at the time of the initial stoma creation has been shown in some studies to reduce the risk of developing a parastomal hernia.

Do all parastomal hernias need to be repaired?
No. In fact, most parastomal hernias do not require surgery. Surgical repair is usually only recommended for hernias that are causing significant symptoms that cannot be managed with supportive measures like belts and specialized pouches.

Can a parastomal hernia be prevented?
The risk can be reduced but not eliminated. Maintaining a healthy weight, avoiding heavy lifting, and treating conditions that cause chronic coughing or straining can help. There is growing evidence that placing a prophylactic piece of mesh at the time the stoma is first created may reduce the risk of hernia formation.

What are the risks of parastomal hernia surgery?
The main risk of parastomal hernia surgery is that the hernia can come back (recurrence), which can happen in up to 50% of cases. Other risks include wound infection, mesh infection, and damage to the stoma or bowel.

• Petro CC, Prabhu A, Rosen MJ. Abdominal Wall Reconstruction and Parastomal Hernia Repair. In: Steele SR, Hull TL, Hyman N, Maykel JA, Read TE, Whitlow CB, eds. The ASCRS Textbook of Colon and Rectal Surgery. 4th ed. Springer; 2022:947-959.
• United Ostomy Associations of America. Do I Have a Parastomal Hernia?. Accessed September 28, 2026. https://www.ostomy.org/do-i-have-a-parastomal-hernia/
• Antoniou SA, et al. European Hernia Society guidelines on prevention and treatment of parastomal hernias. Hernia. 2018;22(1):183-198.