Move the Stoma or Repair Hernia? Seeking Advice

Need some advice. I have a parastomal hernia that has caused periodic prolapse in my stoma. As a result, I have switched to a convex Coloplast appliance, which is causing some pressure sores. I am managing this with hydrocolloidal barriers. The surgical solution recommended by the general surgeon is to resite the stoma and move it higher. That makes me nervous. The stoma is in line with my belly button currently, and I have become a stylish suspender wearer. Is resiting the best solution or just a hernia repair? Do stomas higher on the abdomen present their own unique problems?

If the hernia is causing your stoma to stick out more (prolapse), why use a convex bag that's designed to kind of pull the stoma out anyway? You also might try cutting the hole just a tad bigger to relieve some of the pressure around your stoma as it varies in size throughout the day.

All good questions. I have a colostomy, level with my belly button, and a parastomal hernia. By prolapse, do you mean your stoma sticks out more? Mine sticks out from 1 to 2 inches.

I wear a hernia support belt all the time. To alleviate pressure damage, I use a moldable barrier ring under the wafer. I cut the wafer hole much larger than recommended. This distributes support belt pressure farther away from the stoma base. The moldable ring provides some cushioning.

I have different width belts. I'll wear a 4-inch wide for a couple of days. Change to a 2-inch wide, then a 1-inch. Then use a 3-inch. I've found the variety of widths is best for my skin.

I change the wafer every 7 days. Or if I'm lazy, 12 days. My peristomal skin looks excellent, even after 12 days, with no pressure damage.

A couple of general thoughts:

If possible, seek advice from a surgeon who specializes in moving your stoma rather than a general surgeon. I thought about moving my ileostomy stoma; the stoma shape and its close proximity to my navel were causing periodic leaks. I do not have a hernia. I went to a specialist who recommended against more surgery. His specialty? Fixing the mistakes of general surgeons.

Also, remember that no surgery is risk-free. Will it make your quality of life much better? A good number (maybe up to 40 percent, though I could be wrong here) of abdominal surgeries result in hernias.

By the way, the specialist I saw looked at my stoma and said if his surgical team ended up with a stoma looking like mine, they would be high-fiving each other in the operating room. I stopped the leaks with the help of my stoma nurse by switching products.

Usually, this results in moving the stoma to the opposite side, not higher. Appliances don't stick to skin surface scars and will leak, so any move needs to be nowhere near a previous site or where folds appear in the abdomen. Seek an experienced surgical team; they should know these things.

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You've received excellent advice on the re-siting surgery. I really can't add to that.

However, both of my stomas are well above the belly button, roughly 2 inches above. I don't believe I have any special problems with the stomas sited so high. After working through the initial learning curve, I have not had any leaks. I wear a hernia support belt with no problems.

Advantages are that it's easy to slide a seat belt under the bottom of the bags, and my pants will never interfere with the stoma. I also don't need to worry about bending, etc., causing problems.

However, I agree with the advice about seeing a specialist for a second opinion before going under the knife.

Hi there,

I have had two that were higher, and it didn't pose any issues for me. Just remember that when you empty, you will have to bend over a bit more since you're higher up. But other than that, no problems. Quick question, though: why are you in a convex wafer if you have prolapsed? And pressure sores and/or bruising are not uncommon with some people and convex.

Axl, I have to disagree. They will move it higher. I say this from personal experience. My third stoma was moved higher, and my fourth was higher and on the opposite side. Actually, if they choose the right site spot, which they should but seem not to, it should be on the flattest spot on your abdomen, which for some is higher. However, I have noticed they don't quite mark the sites the way they are supposed to.

I used the term incorrectly then; the stoma recedes to become flush with my abdomen periodically. My stoma normally protrudes a bit over an inch. I think it is pressure changes in the intestine due to the hernia. That is why I have to use convex, and I am getting better about the appliances with more practice. Cool-last has been really responsive. My flat barriers and appliances were Hollister. My general physician is really the mesh expert there to repair the hernia; he is consulting with my colo-rectal surgeon for a treatment plan.

I am sorry you are having to deal with this and it messing up your preferences for products. I had my first SX to remove my bladder in November '23, and the stoma was woefully misplaced, low, and in a crease. When I stood up, it completely inverted, gone. How the heck was I going to finagle... For. The. Rest. Of. My. Life. this? I insisted that I have a revision so I could have an accessible stoma with no issues. I had a new surgeon do the second SX, and she put it above my first one. I would do it again; it would seem like you will still be able to wear suspenders too. Good luck!

It seems you are beginning to learn how to manage your stoma better. What you are describing does not seem to warrant hernia surgery and stoma relocation. One thing to keep in mind about having your stoma relocated is that you will now have three sources of hernia recurrence: the new stoma site, the old stoma site, and the incision site. The chances for a recurrence are fairly high since you have introduced another weakness in the abdominal wall. If you proceed with the stoma relocation, it is normally placed higher on the same side (ipsilateral) since the surgery is less complicated. Although the ipsilateral surgery is easier, the hernia recurrence rate is higher (up to 86%). Relocating the stoma on the opposite side (contralateral) is more complicated, but the stoma recurrence rate is lower (up to 57%).

All convex barriers are not the same; for example, Coloplast has convex light and convex deep barriers. You want to get the minimum amount of convexity to do the job. Too much convexity can be injurious to the skin.

Finally, you should consider getting a hernia support belt. The use of a belt augments/improves the efficiency of the convex barrier. A belt enhances the convexity by providing more barrier depth. "The belt is worn snug to the body to apply pressure to the pouching system, increasing the depth of the convexity and enhancing the seal." The belt should fit snugly but not too tight, as this can damage the skin. Nu-Hope makes good hernia support belts — probably covered by your insurance.

Good answer! That is the way to move.