Rethinking recovery: rehabilitation and intra-abdominal pressure management to reduce the risk of parastomal hernia

A parastomal hernia is a common complication associated with the creation of a faecal or urinary abdominal stoma (colostomy, ileostomy or urostomy). Parastomal herniation occurs when a loop of bowel protrudes outside the muscular abdominal wall, through the gap created to allow the passage of the stoma (Figure 1). This presents as a bulge under the peristomal skin, which may change in size or disappear and reappear as the ostomate moves.

Ostomates may be distressed by the visual appearance of the hernia, compounding the body image issues associated with having a stoma. The bulging also creates an uneven abdominal surface, making it more difficult for a stoma appliance to form a tight seal. A poor seal increases the risk of leakage and, consequently, peristomal moisture-associated skin damage (MASD), which is often a source of considerable discomfort, pain and distress. Consequently, parastomal hernias can have a profound negative impact on a person's psychosocial wellbeing and overall quality of life, as well as limiting their activities of daily living, with financial implications. This all also increases the care burden and financial costs for the healthcare system (Shiraishi et al, 2020).