This topic is about understanding the difference between a parastomal hernia and other causes of stoma pain. The person is experiencing deep, internal pain around their stoma and is unsure if it indicates a hernia, especially since a recent weight gain makes it difficult to notice any external bulge. They are seeking advice on whether a hernia is always painful and what else might cause such pain when the skin looks fine and the stoma output is normal or even increased. They also wonder if a day of heavy output could leave the bowel or stoma feeling sore. The situation is more challenging due to limited medical support.

Here are some insights and advice shared by others:

1. Internal muscle obstruction can mimic hernia pain:
- A stoma nurse found that a faecal lump could be intermittently blocked by a strong circular muscle, causing sharp, deep pain. This can happen even if output is normal at other times.
- Gently inserting a lubricated, gloved finger into the stoma can help check if the passage is clear, which might relieve pain once the muscle relaxes or the obstruction clears.
- If the pain is severe or persistent, consulting a stoma nurse is recommended to differentiate between muscle spasm/blockage and a true parastomal hernia.

2. Irrigation, if allowed, or an extra session can help flush out trapped stool or gas, relieving pain. Keeping a consistent routine can help train the bowel.

3. Gas-management options:
- A "stoma plug," which is a small tampon-like insert, can help by allowing gas to escape gradually, preventing painful build-up.
- Reviewing previous discussions on gas control can provide additional techniques, such as dietary changes, vented pouches, and filters.

4. Ongoing self-monitoring:
- Regularly feeling inside the stoma helps learn its normal shape, allowing early detection of any new lumps, narrowing, or changes.
- As the interior contours change over time, repeated checks can help adjust management practices like pouch fit, irrigation schedule, and use of plugs.

5. Diagnostic tools:
- While home endoscopic cameras are available, interpreting results accurately requires medical training. If finger exploration suggests an abnormal obstruction, it's best to leave invasive imaging to professionals.

These insights aim to help manage and understand stoma-related pain better, especially when medical support is limited.