This topic is about someone who has been living with a colostomy for three years and is also dealing with a parastomal hernia. They are experiencing a painful indentation in the skin next to their stoma and are seeking advice from others who might have faced a similar issue.

Here are some helpful suggestions and insights shared by others:

1. Hole size and fit: It's possible that the opening of the pouching system is too small. Try cutting the wafer or appliance opening slightly larger. Even if the stoma size hasn't changed, swelling or the hernia might affect the fit.

2. Parastomal hernia effect: A hernia can change the shape of the area around the stoma, making a previously correct precut size no longer suitable. It's a good idea to re-measure the stoma size periodically.

3. Appliance choice and routine:
- Consider using convex wafers, which can help accommodate the hernia and flatten the area.
- When removing the appliance, such as during showers, allow 20-30 minutes for the indentation to disappear before applying a new wafer.

4. Skin protection and infection watch:
- Be alert for signs of infection like burning, pain, or pus, which could indicate cellulitis. If you notice these symptoms, consult a surgeon promptly and consider antibiotics if necessary.
- Ensure the opening is just slightly larger than the stoma, about the width of a dime, to prevent output from contacting the skin while avoiding pressure that could cause indentation.

5. Filling an indentation: You can cut a small piece from a barrier ring or a straight rubber strip and glue it over the indentation to level the surface before applying the wafer.