HERNIA FORMATION AFTER ABDOMINAL SURGERY IS A MAJOR CONCERN
One of the main consequences of abdominal surgeries is the risk of subsequent hernia formation. According to the review article “Parastomal Hernia: A Growing Problem with New Solutions” from 2014 a hernia around or next to a stoma develops in up to 78% of patients and typically occurs within 2 years of ostomy creation. It may, however, develop as long as 20 or 30 years after surgery. The article also describes that the British surgeon Goligher (1) even went so far as to claim that some degree of parastomal herniation is inevitable given enough follow-up time (2). This type of hernia is also known as a parastomal hernia, PSH, and is broadly defined as “an incisional hernia located at or immediately adjacent to a stoma”.
PHYSICAL IMPACTS OF A STOMA
Some of the more common physical problems many ostomates experience are:
- a heavy/dragging sensation from a pouch filling up
- skin problems caused by stool or urine leakage onto the skin or adhesives being changed too often
- flatulence creating uncomfortable noise
- odour from the content of the pouch
- parastomal hernia formation
These are just a few of the uncomfortable physical problems related to an ostomy.
SUBSEQUENT RISK OF PSH
Both patient and operative technical factors have been implicated in the subsequent risk of PSH. Individual patient characteristics include
- older age
- male gender
- increased BMI
- increased waist circumference
- respiratory comorbidity
- diabetes mellitus
- and the presence of other abdominal wall hernias.
Other factors like malnutrition, smoking status, chronic coughing, chronic constipation, ascites, corticosteroid use, and postoperative wound sepsis may also lead to parastomal hernia formation.
No matter the reason behind the parastomal formation, there is no doubt that a PSH has a negative impact on the person affected by the hernia.
PHYSICAL IMPACT OF A HERNIA
Some of the more common physical problems associated with parastomal hernias are
- trouble keeping ostomy appliances in place
- parastomal skin irritation
- affected stoma size
- affected stoma function alternating between diarrhea and constipation
- stoma retraction
- stoma prolapse
Some of the more common physical problems associated with abdominal hernias in general are
- decreased mobility according to hernia size, limiting activity level
- a heavy and dragging sensation from the hernia
- pain or discomfort related to the hernia
These are just some of the uncomfortable physical problems related to a hernia.
PSYCHOLOGICAL IMPACT OF A HERNIA
The psychological and emotional impacts of having a hernia can be devastating. Having a hernia may potentially decrease quality of life and therefore the emotional state of the person must be regularly assessed and supported.
Not only does the individual with a stoma and a parastomal hernia have to cope with sensitive issues such as trouble keeping ostomy appliances in place, leakage and decreased mobility. They may also experience challenges in their efforts to conceal the ostomy and hernia under clothing.
Some of the more common psychological challenges associated with abdominal hernias in general are problems with:
- body image
- fear of public exposure
- social isolation
- decreased mood
- sexual function
Many of the concerns expressed by individuals with hernias are body image problems. The worries and fears include anxiety around how big the hernia will grow as well as uncertainty about the future in general. Some may also react with disgust and shock at the thought of having not only a stoma, but also a parastomal hernia, as this will be visible.
STUDIES ON QUALITY OF LIFE WITH A PARASTOMAL HERNIA
In a study evaluating the effects of parastomal bulging and quality of life, patients reported significant impairment in quality of life regarding symptom load, worry, and general sense of well-being. In comparison to patients without bulging, patients with parastomal bulging had significantly higher rates of needing to know where the nearest toilet was, concern that the pouch would loosen, worry that their family would feel awkward around them, and fatigue symptoms such as feeling tired or needing to rest during the day (3).
Patients may become increasingly self-conscious and develop a fear of going out into public due to the appearance of a bulge under their clothing or because of frequent appliance leakage (4).
Leakage leads to unpleasant odor, soilage of clothes, and often skin complications, which are both difficult to manage and financially expensive (5).
In a study by Meisner et al., increasing the frequency of appliance leakage and severity of peristomal contact dermatitis were directly related to stoma cost. Patients with frequent leakage accrued a nearly three-fold increase in treatment and ostomy supply cost compared to those without leakage, while severe skin irritation led to a nearly six-fold increase in cost compared to only mild skin irritation (6).
Therefore, frequent leakage can increase healthcare expenditure drastically, whether it is governmental paid or out-of-pocket for the patient.
This study reinforces the need to redirect our attention to the health and wellbeing of patients with PSH, seeking to identify appropriate solutions to their daily challenges that may reduce health economic costs as well.
According to a study by Kane, McErlean and McGrogan et al., treatment for patients who have relatively mild PSH symptoms should include conservative management with well-made stomal support. The use of skin protective sealants, a flexible appliance, and a stoma or abdominal support belt can often improve appliance security (7).
OSTOMY SUPPORT GARMENTS CAN HELP
Some of the challenges encountered when having parastomal hernias and abdominal hernias in general can be addressed by using support garments.
The garments are well known for their supportive function, and the elastic properties of the fabric ensure that the stoma is able to produce under the fabric. Thereby, stoma flow is not affected by wearing Corsinel Maximum and Medium Support Garments.
For optimal skin friendliness and superior comfort, the garments are knitted in a fabric that is very breathable. This makes them suitable to be worn many hours a day.
With a wide range of underwear, tubes and belts with or without hole, every user need is taken into account. The user can always be sure to get a solution that offers safety and addresses some of the physical and psychological challenges experienced when having any kind of abdominal hernia.
5 PHYSICAL AND PSYCHOLOGICAL CHALLENGES ADDRESSED BY THE CORSINEL MAXIMUM AND MEDIUM SUPPORT GARMENTS
- Trouble keeping ostomy appliances in place
Underwear, tubes and belts without hole support and hold the hernia as well as the pouch, enabling improved fixation of pouch to plate, reducing risk of leakage and thereby skin irritation.
- Affected stoma size, function or stoma prolapse
As the garments offer superior compression to hold, support and add counter pressure to a hernia, problems related to stoma size, function and stoma prolapse may be partially or fully solved.
- Pain or discomfort related to the hernia
Any pain or discomfort related to the hernia may be reduced by use of the garments, as the supportive function of the garments relieves potential physical nuisances.
- Decreased mobility and limited physical activity
The compressive as well as the supportive function of the garments ensure that the hernia is supported optimally, alleviating discomfort and heavy sensation through a partial or full restoration of body profile, making the garments a powerful wearing aid in everyday life, when performing physical activities such as household tasks.
- Challenges related to discreteness, general body image, isolation and depression
The garments restore body profile partially or fully, thereby helping conceal the hernia under clothing. Generally, this discreteness improves challenges with perceived attractiveness, body image and self confidence by reducing fear of public exposure as well as exposure in intimate situations. The smooth body profile and general discreteness also have a motivating impact on the will to socialize, reducing or even eliminating harmful isolation as well as decreased mood or depression.
(1) J.C. Goligher (1912–1998), a British surgeon, who specialised in diseases of the rectum and colon, and who was considered one of the preeminent clinical investigative surgeons of his time.
(3) Kald A, Juul KN, Hjortsvang H, Sjodahl RI: Quality of life is impaired in patients with peristomal bulging of a sigmoid colostomy. Scand J Gastroenterol 2008;43:627-633.
(4) Kane M, McErlean D, McGrogan M, et al: Clinical protocols for stoma care: 6. Management of parastomal hernia. Nurs Stand 2004;18:43-44.
(5) Herbe L: The ostomy files: getting the right body fit. Ostomy Wound Management 2012;58:12.
(6) Meisner S, Lehur PA, Moran B, et al: Peristomal skin complications are common, expensive, and difficult to manage: a population based cost modeling study. PLoS One 2012;7:e37813.
(7) Kane M, McErlean D, McGrogan M, et al: Clinical protocols for stoma care: 6. Management of parastomal hernia. Nurs Stand 2004;18:43-44.
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