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Parastomal Hernias.. how do we prevent them?

Warning.. soapbox topic.

How do we prevent a parastomal hernia? Basically THE question on every ostomates’ lips.

Well... I’m not sure we can.

But hang on.. before you fall into a state of despair. Hear me out..

I believe we need to stop talking about ‘parastomal hernia prevention’ and change the narrative around parastomal hernias.

I don’t believe that we (as patients) can prevent them at all.

Parastomal hernia is complicated and multifactorial and shrouded in shame and embarrassment. How bad do we feel when a nurse or surgeon examines us and declares ‘oh it looks like you’ve got a hernia.. what have you been doing?’.. like it’s our fault.

Instead of talking about ‘prevention’, I believe we should be talking about how we can ‘reduce the risk’ or learn how to live with them or manage them if we develop one.

Because the reality is that we (as healthcare professionals) know very little about them. There is very little research and evidence and actually very little consensus about why some people get them (and some don’t) and worse.. how to manage and treat them.

What little research there is, shows that around 50-70% of people with a stoma will develop a hernia. And some surgeons I’ve talked to say that hernias are probably inevitable for almost everyone with a stoma in time.

Whilst this sounds depressing, it doesn’t have to be that way.

In a research project I did for ConvaTec, we found that the majority of people (around 67%) diagnosed with a hernia actually have minimal or no problems at all. Don’t get me wrong, I’m not diminishing the fact some people have a terrible time with hernias.. if that’s you then you really do have my sympathy because I know from others how debilitating it is.

So if we can’t prevent them.. what can we do?

What we DO know is that there are several factors associated with an ‘INCREASED RISK’ of developing a hernia.

Some of these factors are within our control and some are not. Let’s take a look...

This doesn't mean that you WILL develop a hernia if you have lots of these factors, nor does it mean that if you don't have any of these factors that you won't.. it's just a list of THINGS (based on the little research that we have) that shows increased chance of hernia.

For example, we have no control over our medical condition/diagnosis that led to our stoma, so if you had diverticulitis, or AAA or cancer or IBD (and then years on steroids) that could increase the likelihood of a hernia.

We also have no control over the surgery technique, how skilled our surgeon was, how many surgeries we’ve had or whether we had post operative infection or delayed wound healing. These are all factors that are thought to increase our chance of hernia, although exactly how and by how much no-body really knows.

We can’t do anything about being male, or having a colostomy or a loop ileostomy or (sadly) getting older.

I could go on.. but you get the picture.

As I said, it’s complex and multifactorial. And so to solve a ‘multifactorial problem’ we need a multifactorial solution.

So let’s focus on the things we CAN control and influence.

And instead of fretting about trying to prevent hernia (when really we probably can’t), let’s focus on reducing our chances, doing what we can to minimise risk and learning to live our lives without fear and constraint.

Because actually the ‘fear’ of hernia is one of the things that stops people being active, living their lives and doing the things they love.. and that’s NOT OKAY.

So here’s the list of factors we ‘may’ be able to influence and control which may REDUCE our risk.

Think of ‘hernia management’ a bit like a jigsaw. Everyone will need different pieces and to focus on different aspects.

Instead of worrying about what we need to AVOID.. try to reframe it as things we CAN do.

What lifestyle choices can you make to reduce your chance of hernia? Can you stop smoking? Get treatment for your chronic cough or asthma? Reduce your alcohol consumption ? (by the way we don’t really know WHY alcohol increases risk, but some Danish research showed that it did). Could you work on getting fitter and being more active?

By the way.. none of these things alone necessarily CAUSE hernia.. and I'm not judging anyone.. it's all part of the jigsaw of risk management.

What things can you put in place to reduce your risk.. or even to stop your hernia getting bigger? Can you learn how to strengthen your abdominal muscles? (hint.. I can help you with that).

I've been doing this work for nearly a decade, and for a while I wanted to believe that core exercises could prevent a hernia. But we don't have the evidence for that yet and I doubt we ever will.

But can we reduce the risk of hernia with a good core exercise programme? yes we probably can.

Can we manage a hernia, perhaps even stop it getting bigger with core exercises? yes we probably can.

But can we PREVENT a hernia with abdominal exercises? No. I don't think we can say that. Nor should we. But there are a million other reasons why we do core exercises and that's not a reason not to do them!

So - we control the controllables. Because that’s all we can do. Right?

Working on your core function, deep inner core control and abdominal muscle strength is probably one of the most ‘controllable’ things you can do to reduce risk.. as well as improving your confidence, feel good about yourself and improve general physical function.

We do know that this may have an impact on reducing the risk.. AND managing a hernia when you have one. In fact, I'd go as far as to say that learning to do correct diaphragmatic breathing is probably THE most important thing to manage 'internal pressure' and reducing risk of hernias.. and so if you do nothing else.. learn how to do diaphragmatic breathing. Here's a link.

But knowing how to do core exercises safely and in a ‘stoma safe’ way is one way you can really help yourself.

Check out my videos, classes and blogs at The Ostomy Studio Classes and videos designed specifically for people with stomas and hernias BY someone (that’s me) with a stoma.

But let me leave you with this final thought.

Let go of the ‘fear’ of hernia.. or the fear of making one worse.

And let go of the notion that you can ‘prevent’ a hernia. You may not be able to. And that's ok.

But what you CAN do is limit the risk factors, do everything you can to REDUCE your risk, but do not stop it from living your life the way you want to.

See I told you it was my soapbox topic.. 😊

I'll write more on hernias in the next few months so look out for my blogs and join my email list to get notification.

Sarah Russell MSc

Clinical Exercise Specialist

Clinical Pilates Teacher

Cancer Rehabilitation Specialist

Global Exercise Consultant for ConvaTec

Stoma since 2010

Founder of The Ostomy Studio

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