Your stoma bulges because the abdominal muscles weaken from the surgery, allowing the bowel to push through the opening, forming a parastomal hernia, a very common issue where internal contents protrude under the skin around the stoma. This bulge can vary in size, change with body position, and may become more noticeable with activities like coughing, straining, or heavy lifting, potentially affecting pouch security and requiring assessment by a stoma nurse.
Your stoma can prolapse if the muscles supporting it are weak. It may also happen as a result of straining the abdominal muscle, for example through lifting. When a stoma has prolapsed once, it is common for it to prolapse again whenever you increase your abdominal pressure.
By feeling, rather than looking, place a finger on the prolapsed end of the stoma and lifting it up, apply gentle downward pressure. If the stoma is not swollen, then the bowel will usually slide back down into the stoma opening.
Although rare, a parastomal hernia may cause the intestine to become trapped or kinked inside the hernia causing intestinal obstruction and loss of blood supply. This is known as a strangulated hernia, a dangerous and life-threatening complication.
This means the bowel pushes through the abdominal wall causing a bulge or bulky like appearance. Studies have shown that around 20% of people with a stoma will develop a hernia causing a bulge to develop around the stoma. The risk increases with age and is more common in people with larger stomas.
In many cases, a parastomal hernia can be treated with lifestyle changes and through supportive clothing. Surgery is usually only necessary in a small number of cases but can be required if the hernia is particularly severe.
Aim: Anecdotally, many ostomates believe that eating marshmallows can reduce ileostomy effluent. There is a plausible mechanism for this, as the gelatine contained in marshmallows may thicken small bowel fluid, but there is currently no evidence that this is effective.
Also, it can be helpful to avoid gas-producing foods for about 24 hours before attending an event. If you encounter ostomy ballooning, make sure your pouch is properly sealed afterward. Patients should talk with their doctor if they continue to have issues with ostomy ballooning.
Some individuals prefer to wear belts during sleep because of frequent position changes and pouch movement. Not all pouching systems will accommodate a belt. If a belt is required for your care, it may limit the type of pouching system that you can use.
Flat Bags: These are more commonly used when the stoma protrudes naturally, and the skin around the stoma is flat and healthy. Concave Bags: Some, but not many, companies offer a concave bag to adhere to the skin better when there is the presence of a hernia.
Colostomies should typically protrude 1.5 to 2.5 cm and stomas of the small bowel should evert 2.5 to 3.5 cm. Stomas that do not evert at least 1 cm above the skin surface 48 hours after surgery have a 35% chance of causing problems.
You may experience some pain and discomfort initially whilst recovering from your stoma surgery. This is a normal part of recovery and you may need to take regular pain relief. There is no need to suffer! Avoid tight fitting clothing during this period as your abdomen may be sore and swollen.
All stomas vary in size and shape. Some protrude outwards and others can be flat or flush to your tummy. No two stomas are ever the same. A colostomy may often appear slightly larger as the surgery has been performed on the large bowel (colon), whereas an ileostomy (small bowel) or a urostomy are smaller in size.
If the skin around the stoma does not appear to be similar to the skin on rest of your abdomen, it is likely that you have a skin issue that needs to be addressed. The skin barrier should protect your skin. If the skin is irritated (red, moist, or sore to the touch), the pouch seal can fail and leakage.
A prolapsed stoma isn't serious. But it can be alarming and upsetting when it happens. Typically, your healthcare provider can move the intestine back where it belongs. Very rarely, you may need surgery to replace the intestine and fix the stoma.
How to prevent ballooning
A peristomal hernia can occur due to a weakened abdominal wall related to the creation of a stoma during ostomy surgery. If you can feel a lump or a bulge around your ostomy it could be a sign that you have developed a hernia. The hernia can vary in shape and size - from a golf ball to a grapefruit or larger.
Most people change their pouching system about every three to four days because the adhesive starts to wear at that time. So you should expect to change your pouch about twice a week. And remember, if you're emptying your pouch, when it's a third to a half full, which could be several times a day, about four to six.
The low fibre versions are better tolerated so try white bread, breakfast cereals like rice krispies or cornflakes, white rice/pasta, and avoid skins on potatoes. These provide protein, vitamins and minerals which is essential for health and repair of body tissues.
If the bag fills unexpectedly then it could be down to a change in diet, a stomach upset or even something like nerves and stress can affect your output.
Heating Pad or Blanket: A heating pad or cosy blanket is wonderful for days when extra comfort is needed. Many ostomates find that heat can ease muscle tension or discomfort around their stoma area.
When the stoma hangs down, fluid goes to the tip of the stoma, causing the swelling. It may be difficult for the stoma to return to its normal size at the end of the day. The prolapse can often be managed by lying down on the bed for about 20 minutes. The abdominal muscles relax and the abdominal pressure lowers.
reducible herniae: the '6–2' rule: – birth–6 wks > surgery within 2 d.
Many people who develop a parastomal hernia don't have any complications. Others find that while their hernia may restrict them from doing certain things, they can still enjoy life. Gentle exercise, a nutritious diet, a good stoma product system, and a hernia support belt or garment can help you manage your hernia.