Do I Have a Hernia? What a Parastomal Hernia Is and How to Lower Your Risk

Richard O'Hamill, ostomate and HIRO founder, holding weights | Parastomal hernia guide

Pictured above: me, Richard O'Hamill, ostomate since 2008 and founder of HIRO. Years after surgery, I still train. With healing time, good form and the right support, staying strong is possible. Check with your care team first.

"Do I have a hernia?" is one of the questions I get asked most. Honestly, when I first had my ostomy in 2008, I wasn't even sure what a hernia was. So let's start there, look at how a stoma compares, and then cover what a parastomal hernia is, the signs to watch for, and what you can do to lower your risk. There's a lot of hernia information on social media, TikTok and Instagram, and not all of it is accurate, so I've brought together what I've learned from my own experience with clear, trusted medical sources. My goal isn't to scare you. It's to give you the knowledge I wish I'd had, so you can make the best decisions for your health and your life.

Quick answer: A hernia happens when part of an internal organ or tissue bulges through a weak area of muscle (MedlinePlus, NIH). A parastomal hernia is a hernia next to your stoma, and it's the most common complication after ostomy surgery (Cleveland Clinic). The most common sign is a bulge near the stoma that may get bigger when you stand or cough. Only your doctor or ostomy nurse can tell you for sure.

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What is a hernia?

A hernia happens when part of an internal organ or tissue bulges through a weak area of muscle. Most hernias are in the abdomen (MedlinePlus, NIH; Yale Medicine).

Think of the abdominal wall as layers of muscle holding everything in place. When a spot in that wall weakens or tears, the inner lining can push through and form a balloon-like sac, and a loop of intestine or other tissue can slip into it (Cleveland Clinic Abu Dhabi).

Hernias usually come from a natural weak spot, or from strain on the abdominal wall, such as heavy lifting, weight gain, a persistent cough or straining on the toilet (Cleveland Clinic Abu Dhabi). A past abdominal surgery also raises the risk, because a hernia can form through an old incision that weakened over time. That's called an incisional hernia (Cleveland Clinic).

How a stoma compares to a hernia

This is the part that confused me at first, and it helped once I understood it. A stoma and a hernia both involve the intestine coming through the abdominal wall. The difference is that a stoma is made on purpose and a hernia isn't.

Stoma Hernia
How it happens A surgeon makes an opening in the abdominal wall and brings part of the bowel through it (NIDDK) Tissue pushes through a weak spot on its own (MedlinePlus)
Planned? Yes, a controlled surgical opening No, an unplanned bulge
What comes through A section of bowel, stitched to the skin to let waste out A loop of intestine, fat or other tissue, inside a sac under the skin

Here's the link between them: making a stoma means creating a permanent opening in the abdominal wall. That opening is a natural weak spot. If other tissue starts pushing out through the same opening, alongside the stoma, that's a parastomal hernia (Cleveland Clinic; Colostomy UK). So a stoma isn't a hernia, but it creates the spot where one can form.

What is a parastomal hernia?

A parastomal hernia happens when part of the intestine bulges through the abdominal wall near a stoma (Washington University Hernia Center). Researchers in a UK national study describe it as a type of incisional hernia right next to the stoma, which happens when the band of connective tissue in the abdominal wall (the fascia) splits (CIPHER study, NIHR).

It's very common. It's the most common complication after ostomy surgery, and studies suggest up to half of people develop one (Cleveland Clinic). Reported rates range from 30% to 65%, highest with a colostomy at about 50% (Radiopaedia), and a medical review puts rates as high as 57% (Clinics in Colon and Rectal Surgery, via PMC).

It's often not serious. Most people don't have symptoms, and when they do, they're usually mild and managed without surgery (Cleveland Clinic). Some people only find out they have one from a CT scan done for another reason (IA Support).

It's not your fault. Many people with a parastomal hernia feel they're to blame for it (IA Support). Given how common it is, that's not the case.

Do I have a hernia? Signs to watch for

The most common signs are (Washington University; Cleveland Clinic; IA Support):

  • A visible bulge or swelling near or behind your stoma
  • Swelling that gets bigger when you stand up or cough
  • Trouble keeping your pouch in place, such as frequent leaks
  • Bowel blockage symptoms that come and go, or changes in your usual output

If you notice any of these, book an appointment with your ostomy nurse or doctor. They can usually tell from an exam, and may order a scan (IA Support).

Dealing with leaks. UOAA notes that leaks are one of the most frustrating parts of a parastomal hernia. Every hernia is a different shape and size, so finding the right pouching system matters (UOAA). Your ostomy nurse can help.

Get urgent care if you have severe abdominal pain, nausea, vomiting, a swollen belly, no output from your stoma, or a change in your stoma's colour (University Hospitals Birmingham NHS).

This article is for general information and isn't medical advice. Your surgeon and ostomy nurse know your case best.

How to lower your risk

Not every parastomal hernia can be prevented, but these steps help reduce the chances (Colostomy UK; Cleveland Clinic):

  • Go easy for the first three months. Avoid heavy lifting, heavy pushing and overstretching while you heal.
  • Lift smart. Feet apart, back straight, knees bent, and keep the load close to your body.
  • Wear a support garment (a belt or support underwear) when lifting, doing heavy work, or twisting and stretching.
  • Keep a healthy weight and stay active. Being overweight and a lack of appropriate exercise are both risk factors. One NHS hospital advises keeping a steady weight within a BMI of 20 to 25 (University Hospitals Birmingham NHS).
  • Follow your care team's advice and learn how to look after your stoma.

Build up slowly. In my experience, strength comes back with patience. Once your surgeon clears you, start light, focus on good form, and add weight gradually and consistently over weeks and months, wearing a support garment when you lift (Colostomy UK). What I'd avoid is pushing too hard, too soon. Your care team can tell you when and how much is right for you.

Where a support belt fits in. Support belts are a common non-surgical way to manage symptoms (Pfizer Health Answers). A belt can make an existing hernia more comfortable, but it won't repair it, so talk to your ostomy nurse or surgeon if you think you have one.

HIRO ostomy belt worn horizontally under everyday clothing for stoma support

I've lived with an ostomy since 2008, have been designing ostomy belts since 2009, and designed the HIRO belts for everyday wear and active days. See the HIRO Performance Vertical and HIRO Performance Horizontal, our Parastomal Hernia Belt page, and how an ostomy hernia belt may support parastomal hernia care. New to all this? Start with What Is a Stoma and What to Expect in the Early Days.

Frequently asked questions

What is a hernia in simple terms?

A hernia is when part of an internal organ or tissue bulges through a weak area of muscle (MedlinePlus, NIH).

Is a stoma a hernia?

No. A stoma is an opening a surgeon makes on purpose to bring part of the bowel through the abdominal wall (NIDDK). A hernia is an unplanned bulge through a weak spot. But the stoma opening is a weak spot where a parastomal hernia can form.

What is a parastomal hernia?

A hernia where part of the intestine bulges through the abdominal wall near a stoma (Washington University). It's the most common complication after ostomy surgery (Cleveland Clinic).

How common are parastomal hernias?

Reported rates range from 30% to 65%, highest with a colostomy at about 50% (Radiopaedia).

How do I know if I have a hernia near my stoma?

Look for a bulge near your stoma that gets bigger when you stand or cough, or trouble keeping your pouch sealed (Washington University; IA Support). Your ostomy nurse or doctor can confirm it.

Does a parastomal hernia need surgery?

Usually not. Most people have no or mild symptoms that are managed without surgery; surgery is an option if symptoms worsen or complications develop (Cleveland Clinic).

How can I lower my risk of a parastomal hernia?

Avoid heavy lifting for the first three months, lift with good form, wear a support garment for heavy work, and keep a healthy weight (Colostomy UK; UHB NHS).

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