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Parastomal hernia after APR: the bulge beside the stoma | CION Cancer Clinics
A parastomal hernia is a bulge beside the stoma where bowel or fat has pushed through the weakened tummy wall around the opening. Most are treated without surgery: a fitted support belt, a more flexible bag and care with lifting. Repair is kept for hernias that hurt, trap bowel or make it impossible to keep a bag on. This page explains what it is, the one situation that cannot wait, and how the decision about surgery is made. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is a parastomal hernia, and how is it treated?
- How is a parastomal hernia managed without surgery?
- Words you will see about the hernia, in plain language
- When is surgery for a parastomal hernia considered?
- Four things people believe about a hernia beside the stoma
- Common questions about parastomal hernia
The short answer
What is a parastomal hernia, and how is it treated?
A parastomal hernia is a bulge beside the stoma, where bowel or fat has pushed through the weakened wall of the tummy around the opening. Most are treated without an operation: a support belt, a change of bag and care with lifting. Surgery is kept for the minority that cause pain, block the bowel or make it impossible to keep a bag sealed.
Why it happens after a colostomy
To make a stoma the surgeon has to bring the bowel out through the muscle wall of the tummy. That opening is a permanent weak point. Over months and years, coughing, straining, lifting, weight gain and ageing of the tissue can stretch it. It is one of the most common long-term problems after any stoma, and not a sign that something was done wrong.
What it feels like
Usually a soft swelling around the stoma that is bigger when you stand or cough and flatter when you lie down. Some people feel a dragging ache by the evening. The commonest practical problem is that the bag will not stay on, because the skin around the stoma is now a dome rather than a flat surface.
Many parastomal hernias cause no symptoms at all and are simply watched. A bulge that is soft, painless to press and goes down when you lie flat is not an emergency.
!
The one situation that cannot wait
If the bulge becomes hard, very tender or changes colour, and at the same time the stoma stops passing stool or wind, the tummy swells, or you start vomiting, bowel may be trapped in the hernia. Go to the nearest emergency department the same day and say you have a stoma and a hernia. Do not wait to see if it settles overnight, and do not try to push a painful lump back in yourself.
Not sure whether this applies to you?
Ask an oncologistFirst-line treatment
How is a parastomal hernia managed without surgery?
This is where most people start and where many stay. It does not make the hernia go away; it keeps it comfortable and the bag sealed.
A fitted support belt or garment
A wide elastic belt or a high-waisted support garment with a hole for the bag holds the bulge flat. It should be measured by a stoma nurse, put on while lying down so the hernia is flat, and worn during the day rather than in bed.
Ask the nurse about
- Belts made for the Indian summer
- Whether your scheme or insurer covers it
A different bag
A dome-shaped tummy needs a bag that bends. Soft, flexible baseplates, a larger cut-to-fit size or a barrier ring under the flange often solve the leaking. Firm convex bags, useful for a sunken stoma, can press on a hernia and are usually avoided.
Lifting, coughing and weight
Anything that raises pressure inside the tummy pushes on the hernia. Lift with the legs and a belt on, treat a long-standing cough, keep stools soft, and if you are carrying extra weight, losing some of it takes pressure off the opening.
Watching, not ignoring
A hernia that is being managed still needs checking at follow-up. Tell the team if it is getting bigger, if the ache is new, or if the bag is failing more often. Those are the signs that shift the conversation towards repair.
Gentle tummy exercises taught by a physiotherapist help. Sit-ups and heavy gym work do not.On your report
Words you will see about the hernia, in plain language
- Parastomal
- Beside the stoma. The hernia sits next to the opening, not in the stoma itself.
- Reducible
- The bulge goes back in on its own when you lie down, or can be gently pushed back. This is the usual, safe kind.
- Incarcerated
- The bulge is stuck out and will not go back. It needs to be seen the same day, because trapped bowel can lose its blood supply.
- Mesh
- A soft synthetic sheet stitched in to strengthen the tummy wall around the stoma during a repair. It stays in permanently.
- Re-siting
- Closing the old stoma opening and making a new stoma on the other side of the tummy. Used when the original site is too damaged to repair.
- Recurrence
- The hernia coming back after repair. This is common with every method, which is why surgery is offered carefully rather than routinely.
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When repair is offered
When is surgery for a parastomal hernia considered?
Surgery is considered when the hernia is causing real trouble that a belt and a bag change have not fixed: constant pain, a bag that will not stay on however it is fitted, repeated episodes of the bowel getting stuck, or a hernia so large it stops you working or dressing. It is done as an emergency if bowel becomes trapped.
What the operation involves
The commonest repair places a sheet of mesh around the stoma to strengthen the wall, either through the old scar or by keyhole surgery. Sometimes the stoma is moved to a fresh site on the other side and the old opening closed. Ask which method is proposed for you and why.
Who it does not suit
Repair is a second major tummy operation, so it is offered cautiously to people with heart or lung disease, to those still having chemotherapy, and to anyone whose cancer has come back and needs treatment first. Because the hernia often returns even after a good repair, a hernia that is merely visible is usually left alone.
What this page cannot tell you
It cannot say whether your hernia needs repair. That is a judgement made by the surgeon who examines you, weighing your symptoms against the risks of another operation. Describe exactly what the hernia stops you doing, because that, more than its size, decides the plan.
Commonly believed
Four things people believe about a hernia beside the stoma
"The bulge means the cancer has come back."
A soft swelling beside the stoma that flattens when you lie down is almost always a hernia, which is a mechanical weakness of the tummy wall and nothing to do with cancer. A hard, fixed lump in or around the stoma is different and should be examined, but the two do not feel alike.
"Every hernia has to be operated on."
Most are not. Because repair is a major operation and the hernia often returns afterwards, surgeons usually reserve it for hernias that hurt, trap bowel or defeat every bag. A belt and the right bag are the treatment for most people, and that is not a second-class answer.
"A belt will make the muscles weaker."
A support belt holds the hernia flat so the bag seals and the dragging stops. It does not replace the muscles or weaken them. Gentle core exercises taught by a physiotherapist, worn alongside the belt, are the way to keep the wall as strong as it can be.
"If I had lifted less, this would not have happened."
Lifting is one factor among many, alongside age, weight, coughing and the size of the opening. Hernias happen to people who did everything right. Blame changes nothing; managing it well does.
Questions we are asked
Common questions about parastomal hernia
How do I know if the bulge is a hernia?
A hernia is a soft swelling around the stoma that gets bigger when you stand, cough or strain and flattens when you lie down. If you are not sure, ask your stoma nurse or surgeon to examine it. A scan is sometimes done to confirm it and to measure how large the opening has become.
Can a parastomal hernia be prevented?
Not entirely, but the chance can be lowered. Some surgeons place a preventive mesh around the stoma at the original operation; ask whether that was done or is planned. After surgery, a belt for lifting, treating a cough early, keeping weight steady and avoiding heavy strain in the first months all help.
Will the hernia keep getting bigger?
Many do enlarge slowly over years, which is why it is checked at follow-up rather than forgotten. A belt and care with strain slow that down. If it is growing quickly, becoming painful or making the bag fail, that is the point to ask about repair rather than waiting.
Is the repair operation done by keyhole?
It can be, and it can be open through the old scar. Which is used depends on the size of the hernia, earlier operations and the surgeon's judgement. Ask your centre which methods it offers and why one is being proposed for you. Neither is right for every hernia.
Does the hernia come back after repair?
It can, with every method, and this is the main reason surgeons do not repair a hernia that is only visible. Mesh repairs hold better than stitches alone. A belt after repair, weight control and care with lifting reduce the chance, but no repair comes with a promise.
Can I still wear a saree or a belt over it?
Yes. A support garment goes under the clothes and most people find a saree or loose kurta hides the bulge completely. A trouser belt should sit above or below the hernia, never across it. If you are unsure, take your usual clothes to the stoma nurse and try them on together.
Are the belt and the repair covered by Aarogyasri or insurance?
Hernia repair is a recognised operation and is usually covered under Aarogyasri, CGHS, ECHS, EHS and most cashless policies when a surgeon recommends it. Belts and bags are covered by some schemes and not others. Call the helpline with your card details and we will check before you buy anything.
Should I stop working until it is repaired?
Usually not. Desk work, driving and light duties continue with a belt. Heavy lifting is the one thing to discuss with your surgeon, because it enlarges the hernia. If your job is entirely physical, ask directly what is safe, and whether a repair would change that answer.
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Sources
- Cancer Research UK — Living with a colostomy
- NHS — Colostomy: complications
- Macmillan Cancer Support — Living with a stoma
- American Cancer Society — Colostomy guide
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Stoma siting before APR: why it is markedHow a site through the muscle lowers the chance of a herniaStoma prolapse and retractionThe other two ways a stoma changes shapeWorking and travelling with a permanent stomaLifting, belts and going back to physical workComplications and red flagsEvery same-day warning sign after cancer surgeryAbdominoperineal Resection (APR)The operation this page follows on from
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A bulge beside the stoma that is worrying you?
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