Parastomal Hernia: Things To Know

Parastomal hernia is a condition that can occur in people with stomas. A stoma is a surgically created opening in the abdomen to allow the removal of intestinal wastes, bypassing the lower intestinal tract. A patient is a candidate for stoma surgery if he is unable to have normal bowel movements due to an underlying bowel health condition.

According to a survey, about 78% of people with stomas develop parastomal hernias. This complication occurs within two years of surgery.

Symptoms of parastomal hernia

Parastomal hernias develop and grow gradually but consistently. You may notice the following conditions as the hernia develops.

• Discomfort and pain around your stoma
• Bulging around the stoma
• Trouble keeping the ostomy pouch in place

Reasons for parastomal hernia

Having a stoma could mean a weakness in your abdominal muscles. This muscle-weakening allows the formation of this hernia. Factors that can contribute to the formation of parastomal hernia may include the following.

• Smoking
• Malnutrition
• Chronic constipation
• Chronic coughing
• Infection after stoma surgery
• Obesity

People who get these hernias

Some people are generally at a higher risk of developing a parastomal hernia. Common risk factors in this regard may include the following.

• Obesity
• Older age
• Diabetes
• Cancer
• Respiratory issues
• High blood pressure

Repairing parastomal hernia

In many cases, this problem is treatable through lifestyle changes such as quitting smoking and losing weight. Wearing an ostomy belt can also contribute to the reduction of the symptoms.

In some cases, parastomal hernias can be severe enough to need surgical intervention. Surgical options in this regard may include the following.

• Closing the stoma: If you have a parastomal hernia, your surgeon will see if you are fit enough to undergo stoma reversal surgery. He will check if your bowel has recovered enough to perform after the bowel reconnection. It is, by far, the best option to treat a parastomal hernia.
• Repairing the hernia: During this procedure, the surgeon opens the abdominal wall over the hernia and secures the weakened muscle by stitching it.
• Relocating the stoma: In some cases, the surgeon may find it more appropriate to close a stoma site and create a new stoma at a new site on the abdomen.
• Mesh: Another very common treatment for a parastomal hernia is the use of mesh inserts. While this option can be more expensive, it is more comfortable than other forms of parastomal hernia treatments. The surgeon generally places this mesh under the abdominal wall. It then incorporates into the surrounding tissues, creating a strong barrier that keeps the bowel from pushing through the abdominal muscles.

Complications

Parastomal hernias can result in a lot of complications. For instance, it can cause the intestine to become twisted or trapped in the hernia. It can result in intestinal blockage. It can also cause the loss of blood supply. The twisting of the bowel often results in its strangulation, which becomes a medical emergency. Surgical intervention may be required to untwist this troubled part of the bowel.

Living with a parastomal hernia

A parastomal hernia is not always painful. You may not even require any medical intervention if you manage it properly. You can discuss with your nurse the types of products and supplies needed to facilitate stoma care when there is a parastomal hernia.

Tracheostomy Stoma Care

Tracheostomy is a life-saving procedure, which results in an opening or stoma in the neck to allow the placement of a tube in the patient’s windpipe. Aside from the ability of this diversion to help a patient get back to a healthier lifestyle, it can also result in some complications. It is crucial to take care of the skin around the stoma to prevent irritation, infection, and odor. For this purpose, you will need to clean the stoma and the skin around it at least twice a week. It will help clear the buildup of mucus and rubbing of the tracheostomy tube.

Equipment that you will require for the cleaning procedure may include:

• Facecloth
• Cotton-tipped applicators
• Normal saline
• Hydrogen peroxide
• Telfa or sof-wik 2x2 dressing

The procedure of cleaning involves the following steps.

• First and foremost, clean your hands by washing them thoroughly.
• If there is any dressing around the stoma, remove it. You will not need to remove the tubing, though.
• Dip the cotton-tip applicators in the peroxide solution and start cleaning the stoma and the skin around it. You can use saline if peroxide is too irritating. You will need to start close to the tracheostomy tube and then work away from it.
• Repeat the process above until the debris and mucus are cleared.
• To dry the skin around the stoma, use a facecloth or cotton tip applicator.
• Unless your treating physician recommends, avoid putting gauze under the trach tube. If there are areas of skin irritation or secretions, you can consider placing a dry dressing. You can discuss with your physician how to apply the dressing.

Daily care

The skin around the stoma can develop irritation due to rubbing of the trach tube or secretions. If you want to prevent infection and skin breakdown under the tracheostomy site, you will need to stick to a daily care routine. Make sure to practice daily care steps at least once a day. Patients with new tracheostomies or ones on ventilators may need to trach care more often during the day. Tracheostomy dressing can be quite beneficial if there is excess drainage from the tracheostomy site. This dressing also reduces the rubbing of the tube on the skin.

Equipment required for daily care may include the following.

• Cotton tipped applicators
• Trach gauze
• Sterile water
• Hydrogen peroxide
• Sterile cups
• Trach ties and scissors
• Towel roll or small blanket

Here is the procedure involved in the daily care.

• Start by washing your hands.
• The patient should lie back in a comfortable position. The body should be covered in the blanket or towel roll, extending the neck to allow easier visualization.
• Open the tip applicators, trach gauze, and regular gauze.
• Cut trach ties in lengths that seem appropriate.
• Pour sterile water in a cup and hydrogen peroxide in the other.
• Clean the skin around the stoma using tipped applicators. Perform the cleaning using a rolling motion to avoid rubbing. You may need to change the swabs. Make sure that o liquid gets into the trach tube or stoma under the tube.
• Rinse the area using a water-soaked cotton-tipped applicator.
• Pat the skin dry.