This topic is about managing the challenges that come with having a parastomal hernia, particularly focusing on pain management, dealing with pancaking, and finding the right support garments. The person sharing their experience has had a stoma for six years following colorectal cancer and developed a hernia a year ago. They are seeking advice on how to handle the mild pain caused by stool movement and the issue of pancaking, which is when the output sticks around the stoma instead of dropping into the pouch. Here are some helpful suggestions and insights shared by others:

1. Seek medical evaluation promptly:
- It's important to see a surgeon or stoma nurse early to rule out complications like strangulation, sepsis, or ulceration and to discuss repair options.
- Early advice can help prevent emergency surgery and ongoing issues with appliance leakage or skin damage.

2. Consider irrigation if you have a colostomy and are a candidate:
- Regular colostomy irrigation can help empty the bowel on a set schedule, which can significantly reduce pancaking and make it easier to wear firm support garments or binders.

3. Hernia repair options and expectations:
- Mesh repair is generally preferred over relocating the stoma, with relocation being a last resort.
- A common approach in Australia includes:
1. Using a support belt for a small hernia.
2. Applying an "on-lay" bio-absorbable mesh that dissolves in 3-4 months, though it has a moderate recurrence rate.
3. Using a permanent under-lay mesh if the hernia recurs.
4. Considering stoma relocation only after repeated failures.
- Laparoscopic mesh repairs can be very successful, with some individuals remaining hernia-free for years after surgery.
- Repair failure or recurrence rates can be as high as 40-50%, so lifestyle changes and continuous use of support wear are crucial for prevention.

4. Support garments:
- Wearing a dedicated stoma belt or supportive underwear can help reduce hernia strain.
- Corsinel men's boxers are noted to worsen pancaking, and many suggest discontinuing their use.
- Alternatives include:
- Kool Knit adjustable, flexible parastomal hernia belt, which is moisture-wicking and suitable for hot or sub-tropical climates.
- Standard "binder" style belts available through stoma nurses.

5. Useful information sources:
- For a detailed overview of hernia repair, visit colorectalsurgeonssydney.com.au/?page_id=1080.
- For information on laparoscopic mesh repair, check out the Minimally Invasive Group in Toronto at http://www.misgroup.ca.