This topic is about dealing with recurring hardness around a colostomy stoma, along with leaks and the possibility of a hernia. Here are some helpful insights and advice for managing these issues:

- The colostomy has been in place since May 2016. Since September, there have been episodes where the area around the stoma becomes "rock-hard" for several days to a week. These episodes are sometimes accompanied by nausea and sharp, brief pains near the stoma. Despite this, normal stool output and gas passage continue.

- An enterostomal therapy nurse has identified a parastomal hernia but couldn't explain the hardening, suggesting the area might just be "full and working." Each hard phase leads to daily pouch leaks, requiring frequent appliance changes. This issue is unfamiliar to the local support group, leaving uncertainty about how to proceed.

- The support group recommended requesting an abdominal ultrasound. The patient is not on any medications. The hardness lasts several days to a week, causing constant appliance cleanup and emotional exhaustion. Limited phone communication is due to a voice disorder. An upcoming joint appointment in Toronto with a surgeon, GI, and ET nurse is scheduled, with a support-group friend attending to ensure questions are addressed.

Advice and insights include:

1. Escalate care:
- Schedule an appointment with a gastroenterologist or colorectal surgeon for a thorough evaluation. It's important to keep seeking answers beyond the nurse's advice.
- Write down all symptoms and concerns to communicate with healthcare professionals, especially if voice communication is challenging.

2. Diagnostic suggestions:
- Request abdominal imaging, like an ultrasound, to check for hernia size, obstruction, or other issues.
- Consider evaluation for peristomal Ulcerative Colitis, as similar symptoms in another member were caused by UC around the stoma.

3. Output and dietary tips:
- For a colostomy, 1–2 bowel movements per day might be on the low side. Increasing motility and output could help reduce abdominal pressure.
- Try drinking 8 oz of prune juice daily to encourage more regular evacuation, as suggested by a group member.

4. Hernia and wind management:
- Hard and painful sensations can sometimes precede gas release. One member found that colostomy irrigation significantly reduced gas, abdominal hardening, and pain. Consider exploring irrigation if eligible.

5. Emotional and practical coping:
- Frequent leaks can be frustrating. Finding better-fitting clothing and continuing peer support can boost morale.
- Use written communication to overcome the vocal disorder and persistently contact healthcare providers until satisfactory answers are obtained.