Parastomal Hernia Diet Tips: Ultimate Guide to Eating Right and Staying Comfortable

A parastomal hernia is a common complication following ostomy surgery, where a section of the bowel protrudes through the abdominal wall near the stoma. While parastomal hernias are rarely dangerous, they can cause discomfort, pain, and difficulties with ostomy appliance fit. This article provides a comprehensive overview of parastomal hernias, including dietary considerations, lifestyle adjustments, and treatment options.

Understanding Parastomal Hernias

A hernia, in general, is an abnormal protrusion of an organ or tissue through a weakened area in the body. In the case of a parastomal hernia, the weakness occurs around the stoma, the surgically created opening in the abdomen that allows waste to exit the body. This opening is necessary when patients have gastrointestinal problems that prevent normal bowel movements. A parastomal hernia is defined as an abnormal bulge around the stoma, where an extra loop of bowel squeezes through between the stoma and the abdominal wall, sitting between the skin and the muscle of the abdominal wall.

Parastomal hernias can range in size from a slight bulge to a significant protrusion noticeable even under clothing. They occur in approximately 5-10% of people with colostomies and 3-10% of people with ileostomies. The hernia may develop soon after surgery or years later.

Most people (about 80%) will not experience any difficulties with the hernia and will not require any intervention. The remaining 20%, however, may have symptoms that require some help to manage.

Symptoms of a Parastomal Hernia

Parastomal hernias usually develop and grow gradually. You may notice:

Read also: Hiatal Hernia and Diet

A bulge around your stoma, especially when you cough.
Pain or discomfort around your stoma
Trouble keeping your stoma appliance in place

Other symptoms may include:

A sense of fullness or tightness
A heavy weight in the parastomal area
Changes in the size and shape of your stoma
More frequent leaks of your appliances
Peristomal skin irritation
Changes in stoma function and bowel habits
Abdominal distension (or bloating)
The stoma not functioning as often or cramping when it tries to function.

If you experience severe pain related to your stoma or hernia, or if the hernia prevents the stoma from functioning, seek immediate medical attention.

Factors Contributing to Parastomal Hernia Development

Several factors can contribute to the development of a parastomal hernia:

Weak abdominal muscles: Having a stoma sometimes weakens your abdominal muscles, causing them to pull away from the stoma. People with weak abdominal muscles are more likely to develop a hernia.
Site of the stoma: Ideally, when a new stoma is made, it should be brought through a muscle in the abdomen called the rectus abdominus.
Malnutrition
Smoking
Chronic coughing
Chronic constipation
Corticosteroid use
Infection after stoma surgery
Obesity: Carrying weight around your waist, stomach, or hip area increases your risk.
Older age
Cancer
Crohn’s disease
Respiratory diseases with chronic cough
Previous abdominal wall hernia

Dietary Factors and Hernias: A Mendelian Randomization Study

A recent study explored the relationship between dietary factors and the risk of different types of hernias, including parastomal hernias, using Mendelian randomization (MR). MR is a method that uses genetic variations as instrumental variables to identify causal relationships between exposures and outcomes.

The study analyzed the effects of 20 dietary factors on inguinal, umbilical, and ventral hernias (which include incisional and parastomal hernias). The dietary factors included:

Alcohol
Non-oily fish
Beef
Fresh fruit
Oily fish
Salad/raw vegetables
Dried fruit
Coffee
Cereal
Salt
Tea
Water
Cooked vegetables
Cheese
Lamb/mutton
Pork
Poultry
Processed meat
Bread

Key Findings:

Alcohol: Alcoholic drinks per week reduced the risk of inguinal hernia, while alcohol intake frequency increased the risk of ventral hernia (including parastomal hernia). Alcohol intake did not affect the risk of umbilical hernia.
Non-oily fish: Intake increased the risk of inguinal hernia.
Salt: Salt added to food increased the risk of umbilical hernia.
Cheese and Dried Fruit: Intake decreased the risk of ventral hernia (including parastomal hernia).
Cooked Vegetables: Intake increased the risk of ventral hernia (including parastomal hernia).

It's important to note that some of these findings may be influenced by single genetic variations and should be interpreted with caution.

Implications for Parastomal Hernia Diet Recommendations:

Based on the MR study, some dietary recommendations can be suggested for individuals with or at risk of developing parastomal hernias:

Moderate Alcohol Consumption: If you choose to consume alcohol, do so in moderation. The study suggests that the frequency of alcohol consumption may be more important than the quantity in relation to ventral hernia risk.
Limit Cooked Vegetable Intake: High intake of cooked vegetables may increase the risk of ventral hernias.
Include Cheese and Dried Fruit: These foods may have a protective effect against ventral hernias.
Be Mindful of Salt Intake: High salt intake may increase the risk of umbilical hernias.

It's crucial to remember that these recommendations are based on population-level data and may not apply to everyone. Individual dietary needs and tolerances vary.

General Dietary Recommendations After Parastomal Hernia Repair

Repair of your parastomal hernia does not require any dietary restrictions after surgery. However, many patients find that their appetite is poor for a week or two after surgery. This is a normal result of the stress of surgery and manipulation inside the belly and your appetite should return in time. Some patients find that it is easier to eat smaller, more frequent meals early in recovery. Protein shakes such as Boost, Ensure or similar products can be helpful in providing both protein nutrition for healing as well as hydration.

Lifestyle Adjustments for Managing Parastomal Hernias

In addition to dietary considerations, several lifestyle adjustments can help manage parastomal hernias:

Strengthen abdominal muscles: Maintain strong muscles that help you lift and move more safely, therefore protecting your abdomen.
Maintain a healthy weight: Losing excess weight, especially around the abdomen, can reduce strain on the abdominal muscles. Consider incorporating gentle exercise and a healthier diet to manage your body weight.
Quit smoking: Smoking increases the risk of developing an incisional hernia.
Use proper lifting techniques: When lifting or carrying anything, be sure to do it safely with good form.
Wear an abdominal support belt: Supporting the hernia with a special elastic hernia belt or with a lycra type undergarment may provide enough support to eliminate that feeling. The binder will help support your abdomen and relieve pressure on your back. Belts need to be measured or sized to appropriately fit your abdomen, and to ensure correct placement of an opening within the belt that allows for the ostomy appliance to come through.
Adapt exercises and daily activities: Make sure they’re appropriate.

Here are some core exercises that may be helpful:

Standing single knee lift.
Holding a plank position.
Stomach crunches.

Post-Operative Care After Parastomal Hernia Repair

Plan to stay in the hospital as an inpatient for 5 - 7 days after your procedure. The length of time that you spend in the hospital depends on how quickly GI function returns (passing gas), food tolerance, adequate pain control on oral medications and your ability to move around safely.

When you get out of surgery you may have one or more drains inserted near your incision. The drains provide suction to drain excess fluid from around the surgical area, promote healing and reduce the risk of infection. The drain or drains may be removed before you leave the hospital or you may be discharged with it/them in place. If you are sent home with one or more drain(s), follow the instructions provided for caring for and emptying your drains and keep a record of how much fluid is extracted each day. After the drains are removed by your doctor, some fluid leakage may continue around where the drain was located.

Depending on your procedure you may have staples and/or nylon sutures to close your incision. These will remain in place for the first 2 - 3 weeks after surgery and be removed at a post-op office visit.

We ask you to wear your abdominal binder for the first two weeks as much as possible, including while sleeping. At times back pain can develop from overuse due to painful abdomen muscles. It is also important to reduce the fluid that accumulates above the mesh after the repair. After two weeks, you can reduce how often you wear the binder and do not need to wear it during sleep.

There are some restrictions on your activity after your parastomal hernia repair. While every person recovers differently, most people require at least six full weeks for recovery. You should plan on taking it easy, especially in the first few weeks after surgery. In general, all strenuous and exerting activity should be avoided until you are told you may do so. Make sure to ask for help with basic activities such as grocery shopping, cooking, and yard work.

Everyone returns to work at different times. As a rough guide, most people take at least 4-6 weeks off prior to returning to work, depending on the physical requirements of their job.

You may be given clearance to drive once you have not needed the narcotic (prescription) pain medications for two consecutive days. You should be able get in and out of the car without discomfort and brake without difficulty or pain.

For patients with colostomies or ileostomies, the first stoma output (bowel movement) may occur anywhere from 1-5 days after surgery. Provided you are not nauseated or having abdominal pain, this is an acceptable time range. Some patients will have diarrhea for a week or two after their hernia repair. Constipation can become a problem for some patients, particularly those taking narcotic pain medications. You will be prescribed medications like Milk of Magnesia to help alleviate the problem and avoid straining which can increase abdominal pain. This can be continued until you are off narcotics and your bowels have returned to normal.

For patients with ileal conduits and other ostomies related to the urologic tract, urine output should resume almost immediately.

You should be able to pouch your stoma without difficulty after a parastomal hernia repair. Stoma nursing will be consulted for most patients while you are in the hospital in case your pouching needs change after surgery.

Some patients find that their hernia “returns” right after surgery. Don’t worry - this is a normal feeling and/or appearance. It is very unlikely that the hernia repair failed so soon after surgery. Much more commonly, the place where the hernia contents were can sometimes fill up with post-operative fluid, a condition called a seroma. This fluid collection is a normal result of surgery and will usually be absorbed by the body over time. This can take up to around 3 months.

Treatment Options for Parastomal Hernias

In many cases, parastomal hernias are treatable with lifestyle changes. But some parastomal hernias are severe enough to need surgical repair.

Different approaches can be taken to repair the hernia, including a local repair right at the stoma site, or resiting the stoma to the other side of the abdomen and closing the hernia.

There are several surgical repair options for a parastomal hernia, including:

Closing the stoma: This is the best option for repairing a parastomal hernia. It’s only an option for a small group of people who have enough healthy bowel left to reattach the end that forms the stoma.
Repairing the hernia: In this type of surgery, a surgeon opens the abdominal wall over the hernia and sews the muscle and other tissues together to narrow or close the hernia. This surgery is most successful when the hernia is small.
Relocating the stoma: In some cases, a stoma with a parastomal hernia can be closed and a new stoma can be opened on another part of the abdomen.
Mesh repair: Mesh inserts are currently the most common type of surgical parastomal hernia repair. Either synthetic or biological mesh can be used. Biological mesh is often considered more comfortable, but is much more expensive. In this type of repair, the hernia is repaired using the same technique as in other surgeries. Then, mesh is placed either over the repaired stoma or below the abdominal wall. Eventually, the mesh incorporates into the tissue around it. This creates a strong area in the abdomen and helps prevent the hernia from forming again.

Elective surgery may be considered for patients who have chronic obstruction, pain, appliance leakage, discomfort from an ill-fitting appliance, or peristomal skin breakdown.

In some rare cases, the intestines can become trapped or twisted in the hernia. This blocks the intestine and can lead to loss of blood supply. This is known as strangulation, which is a very painful condition. Strangulation requires emergency surgery to untwist the intestine and restore blood supply. This is so that the obstructed part of the intestine isn’t permanently damaged.

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