Stoma Problems - Parastomal Hernia

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A bulge around the stoma may indicate a parastomal hernia. A parastomal hernia is where part of the bowel pushes through the abdominal muscle to create a swelling under the skin of the stoma and can cause discomfort or pain. A hernia can form at any time during and after surgery. Stoma hernias can develop over time, as the stoma stretches or becomes weaker, and can be caused by a range of contributing factors. These factors include repetitive coughing, being above a healthy weight or developing an infection when the stoma is made.

Stoma Hernia Prevention

If you are waiting for surgery, or have recently had surgery, ask your Stoma Care Nurse for information about parastomal hernias and how to minimise your risk of forming one, including wearing support garments, and exercises that strengthen the abdominal muscles. They will also be able to advise you specifically on how to manage or reduce the stoma hernia pain or discomfort you may be facing.

You may find this video, which demonstrates core exercise techniques for parastomal hernia prevention, helpful:

Products to help with living with a parastomal hernia

Because hernias can be all different sizes and shapes, it can be difficult to get a good seal between the skin and the stoma bag flange. Stoma bags such as Aura Profile colostomy, ileostomy and urostomy bags, with their soft and flexible invertible flange, mould to the shape of your peristomal area to help ensure a leak-free fit for herniated stomas. FreeStyle Oval, with its oval adhesive, may also be an option. If you want extra security, hydrocolloid flange extenders like HydroFrame or UltraFrame can be used to ‘picture-frame’ the flange to aid adhesion.

Skin around a hernia can also be more delicate. You may want to consider using a two-piece system, where the base flange is removed fewer times than in the one-piece systems. Your Stoma Care Nurse may also recommend that you protect your skin using no-sting products like silicone based barrier film, LBF, and medical adhesive remover, Appeel.

Hernia support belts are available on prescription for when you need to do heavy work or lifting, or be particularly active. Discuss with your Stoma Care Nurse if you would like to request one of these, or if you want to wear these belts generally for comfort and support. They can help if you are feeling discomfort or a dragging sensation around the stoma. Stoma hernia support garments (also known as support wear) are also available.

Our CliniMed Careline team are available on 0808 159 6017 for advice on all aspects of stoma care, including all brands of products and problems you might be experiencing.

Video transcript

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Hi, my name is Jay and I'm a qualified clinical personal fitness trainer. Four years ago, I had a colostomy. I'm going to show you some simple exercises today that you can do at home so that you can enjoy the long-term health benefits of regular exercise…

The abdomen is covered by a complex series of core muscles that provide structure and keep the internal organs in place. When performing an ostomy, the surgeon must cut through these core muscles to reach the bowel which causes the muscle to be weakened. This weakness can lead to an increased risk of developing a para stoma hernia where part of the bowel breaks through the weakened abdominal wall. This bulging can stretch the skin and cause problems with maintaining a seal. Exercising the core muscles is one of the best ways of preventing parasternal hernias.

Today I'm going to show you six key exercises that can be performed pre and post-surgery that will help you build strength in this area. We've chosen these particular six exercises because they're suitable to do post-surgery. They emphasize on pulling up towards the abdomen rather than pushing forward which can cause extra strain. Each exercise will contain a variation of difficulty so just do what you can do. Remember gentle exercise is better than no exercise at all, but before we start there are a few things to consider:

Make sure you're comfortable
Don't ever exercise just after eating a meal
Don't overexert yourself
If you feel any pain or discomfort while you're exercising, stop immediately and seek medical advice
Don't forget to breathe
If in doubt, don't.

The Breathing Exercise

The first abdominal exercise we're going to show you today is great for doing for all ages straight after surgery. In fact, it's one of the first ones you will be given in hospital. You can actually do it lying down or you can do it sitting down. Today I'm going to show it to you standing up…

So, I'm now going to turn sideways and demonstrate. I’m going to let my stomach muscles relax a bit, push them out even, so that I can actually show you how much you pull in on this one. Breathe in suck in those tummy muscles and hold. You are waiting for 10 to 15 seconds - that might be a bit too painful straight after surgery, and then relax. This one's not about repetitions, it's about holding, and relaxing, so over time build up to two or three minutes. If you can the longer the better.

These next few exercises require a little bit more energy but can be done in your home. Please check with your stoma care nurse about your level of recovery before attempting any of these exercises.

The Bridge Exercise (hip raise)

With the bridge exercise, as with all tummy exercises, your starting position is really important. Start lying on the floor as I am right now with your feet flat to the floor, knees bent and to flatten out the upper part of your back just pop your arms to the side as so. Just pop this hand underneath the small of your back and make sure that you have your natural arch in place when we start.

We lift slowly up to this position here and slowly back down again. When you're coming up you can actually hold it at the top for a few seconds (that will intensify the exercise) and then back down again. You need to be doing this exercise for 10 repetitions, start off with 3 sets of 10 and then you can slowly build up to 10 sets of 10 repetitions. You can make this exercise more challenging by placing your feet up onto a chair or a box or placing a weight across your hips as I'm showing here.

When you're performing the setup it's really important that you actually honour your own personal healing journey, don't try and do too much too soon.

The Straight Arm Sit Up

Okay, so start with subtle movements build it up gradually, take your time with it and you'll be surprised how quickly you can advance. The straight-arm sit up is an exercise that works all of your tummy muscles.

It's important that you start off with subtle movements start off in this position. Place your hands on your thighs and just lift up, head off the floor, slide up the leg only as far as is comfortable and back down again.

You will find as your healing journey progresses, you'll be able to come up a little bit further so the variation we're going to show in this exercise is one where you actually go all the way up to the knees and when you get stronger you'll be able to go just slightly over the top of the knees. Start off with ten repetitions, three sets and then work up to 10 sets, 10 reps.

The Bicycle Exercise (leg lift)

The bird dog and the bicycle exercises are slightly harder exercises, so make sure you do them at the correct time in your healing process.

Always speak to your doctor and/or your stoma nurse prior to going to an advanced exercise and make sure it's safe to do so. If in doubt, don't, and good luck!

The bicycle leg lift is a great exercise for the abdominal muscles but make sure you're ready to do it in your healing journey. Bring one knee up, lift the other leg gently off the floor, not too high and then literally you just want to go back and forwards in a bicycle movement. Keep your arms down by your side to make sure that your back’s flat and just go nice and slowly. You'll feel that the emphasis here is mainly on the lower abdominals, but it does work all of them. Then again three sets of ten build, it up but only as you're ready. If in doubt don't.

The Bird Dog Exercise (kneeling plank)

The bird dog exercise is a little bit harder so we're starting to put a little bit more emphasis on these abdominal muscles. We want to make sure that our posture is very good before we start, so get onto all fours as I'm demonstrating. Make sure that you are in a good solid position because you need to use your balance for this one. You're going to be lifting up your opposite arm with your opposite leg, so left arm right leg. If you hold, the longer you hold the more you will be exercising the abdominal muscles.

Bring them both slowly back down again and then up with the other arm and leg.

Both sides is one repetition, you want to be aiming at three sets of ten to start with and build up from there. This exercise is a little bit more advanced so remember you must always do it at the right time in your healing process. Speak to your doctor and/or your stoma nurse and make sure you're safe to continue and actually up your exercise.

Flutter Kicks (leg kicks)

Flutter kicks are a great abdominal exercise as you actually move forward with your abs workouts. Make sure you're ready for them!

To get into your starting position bring your knees up, bring your legs up straight down lightly. Make sure before you start that your spine is fully flush with the floor, so push your back into that floor. You want your abdominal muscles to do all of the work and then all you do is kick back, small movements, backwards and forwards. Do not concentrate on the reps with this one, just the amount of time that it's comfortable to work out and remember if in doubt, don't.

We're now going to show you a slightly harder variation. Again, it's best to make sure you push back before you actually start the exercise. Make sure that your back is flush to the floor, it's a little bit harder when it's lower down. Lift up lift up and flutter. Do the exercise for as long as you can comfortably, build up slowly, bring your knees up and stretch before you finish and good luck!

Thanks very much for watching. If you'd like to learn more about hernia prevention and stoma care products and services, you can visit the CliniMed website.