Can we prevent or reduce the effects of peristomal and incisional hernias after ostomy surgery? Statistics suggest that many ostomates, perhaps most of us, will eventually experience a hernia. Hernias commonly occur during the first weeks or months after surgery but can also form later and expand in size. Although hernias may occur more often with some types of ostomy surgery than others, there’s no surefire surgical method yet for preventing or permanently repairing all hernias.
Even so, medical research and patient follow-ups have identified a number of factors that are considered to increase or reduce the risk of hernias. Some of this is within our own control, and some is not. This article reviews information gleaned from the medical literature, published patient advisories, and experiences by the author and other ostomates. Taken as a whole, it suggests that there are things that we can do to reduce our own risk of hernia complications.
Simply put, hernias occur when the pressure inside our abdomen exceeds the resistance provided by body tissues and musculature, and external pressures. If that occurs, internal body pressure can force body fat or intestinal tissues through any opening or weak spot in the abdominal wall. (The medical terms peristomal, incisional, umbilical, inguinal, and hiatal hernia relate to which area is affected.) We’re at higher risk of herniation after ostomy surgery than we were before, because our stomas now protrude through a weakened part of our abdominal musculature.
So, what can we do about that? First of all, we always need to follow our doctor’s orders, paying particular attention to any post-surgical restrictions on lifting and other activities. Beyond that, we can reduce our hernia risks by 1) providing appropriate external resistance, 2) strengthening our core abdominal musculature, and 3) reducing internal abdominal pressure. What does that mean?
1. Providing External Resistance
Protect the stoma. My nurse recommended quickly placing a pillow over my stoma and bandages when I felt a cough, sneeze, or laugh coming on. I couldn’t always reach a pillow in time, but I could firmly place the palm of my hand there in time. Smokers cough also greatly increases the risk of damage from coughing and it interferes with wound healing, so if you haven’t stopped smoking yet, today would be a good time to stop.
Wear supporting garments. There are a wide variety of abdominal wraps and support belts available, but I haven’t found clear consensus on which types or what level of resistance is most effective for hernia prevention. From my own experience, I feel that
the ideal belt, band, or wrap would be comfortable to wear all-day long, provide firm resistance over the entire peristomal area (including surgical incisions) and would not interfere with stoma/pouch drainage. They don’t all do that. Experienced ostomy nurses (WOC Nurse) are best qualified to help select and fit a custom-fitted device, but I’ve listed a few different types below, as examples.
2. Strengthening Our Abdominal Musculature
Resume low-stress activities and regular gentle exercise. Rest and recuperation are important parts of the healing process, but activity also plays a part. Strengthening our core abdominal muscles and upper arms helps to prevent damage from exertion. After our surgical scars are fully healed, we should be able to resume almost any safe activity that we did before - with appropriate protection and precautions. Walking, swimming, light weights and gentle floor exercises are a good start, with guidelines provided below. An experienced physical therapist can also help adapt our previous workout routine or create a new one. Consider using hard stoma protection before engaging in contact sports or other activities that might impact, puncture or rip the ostomy appliance.
Nutrition matters. Proper nutrition and hydration are important for healing, for scar strength, and for avoiding constipation – a common and sometimes difficult situation after surgery. It’s important to return to a healthy diet as soon as our body is ready, but specific dietary advice will likely vary for an ileostomy, colostomy, or urostomy. Be sure to discuss diet, hydration, and what to do about constipation or diarrhea with your medical staff before leaving the hospital. UOAA has a comprehensive nutrition guide for ostomates, listed below.
3. Reducing inter-abdominal pressure
Control constipation and avoid straining during bowel movements. Drinking plenty of water can help to ensure regular soft bowel movements. The UOAA nutrition guide also provides a list of helpful foods for constipation relief. Stool softeners and soluble fiber supplements may help but contact your doctor before taking any laxatives or if you feel you have a blockage.
Maintain or achieve a healthy weight. Body mass index correlates with increased hernia incidence. Overweight and obese individuals are at significantly greater risk of hernia complications than are people of average weight. Hernia repair surgery is also more successful after we’ve dropped excess weight.
Protect the stoma while pregnant. Everything else that we’ve already said applies even more so during pregnancy, when a growing baby seems to crowd out everything else in the body cavity. If pregnancy is in your future, be sure to talk early and often with both your urologist and your obstetrician.
There’s no guarantee that we can avoid the discomfort and difficulties of a hernia, but experience suggests there may be a lot we can do to reduce overall hernia risk and severity. The following websites contain additional information and details about topics mentioned above:
Diet and Nutrition for Ostomates
Patient Guides to Exercising after Ostomy Surgery https://meplus.convatec.com/articles/about-meplus-recovery-series
Ostomy Resistance Bands and Belts (examples listed in alphabetical order)
Brava Ostomy Support Belts: https://products.coloplast.us/coloplast/ostomy-care/brava/belt/brava-ostomy-support-belt/
Everydayostomy Waistband: www.everydayostomy.com/waistband
Stealth Belt: www.stealthbelt.com/ostomy-hernia-belt#How%20to%20Choose%20An%20Ostomy%20Hernia%20Support%20Belt
Preventing Peristomal and Incisional Hernias © 2024 by Robert A. Winfree, PhD is licensed under Creative Commons Attribution-ShareAlike 4.0 International
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