This Month's Focus: Parastomal Hernias
Hello — this month we're focusing on a common yet challenging area of ostomy care: parastomal hernias (PSH). Parastomal hernias may affect pouch security, wear time, peristomal skin integrity, and patient quality of life. Early identification, patient education, and conservative management strategies can help reduce complications and improve outcomes.

What We See: A Patient Example
Setting: Home | Consult Type: Live Visit

A 35-year-old female with a parastomal hernia presented with persistent pouching difficulties and would benefit from ostomy revision evaluation.

Clinical Presentation:

Asymmetric bulging around the stoma when standing
Hernia reduced when supine; increased with cough
Appliance changes up to 3x daily for 2 years
Increasing peristomal irritation and mild bleeding
Multiple interventions attempted without success
Clinical Review & Recommendations:

Surgical evaluation recommended
Flexible pouching systems advised
Avoid rigid convexity
Stool consistency management emphasized
Hernia support garment evaluation discussed
The outcome: improved pouch wear expectations, reduced peristomal trauma risk, improved body image and confidence, and connection to ongoing ostomy support resources.

Myths, Challenges, and Common Mistakes
Myth: "I cannot exercise because the hernia will worsen." Reality: Appropriate core strengthening and PT/OT guidance may support abdominal strength and mobility.

Myth: "Surgery is always required." Reality: Many patients remain on conservative management unless complications develop.

Common mistakes we see include rigid convex pouching systems, pre-sized products used instead of cut-to-fit systems, pouch openings cut too small, poor constipation management, and pressure or trauma to the hernia surface. These missteps can lead to stoma trauma, skin injury, hernia progression, reduced pouch wear time, and negative body image.

PSH Management Checklist
Effective management focuses on controlling key factors:

Early identification of bulging
Assess stoma size, trauma, and bleeding
Evaluate peristomal skin
Maintain soft stool output
Prevent constipation
Ensure proper pouch fit
Hernia belt fitting
Patient education and exercise guidance
Clinical tip: Pouch wear time is commonly reduced in PSH patients. Avoid cutting the opening too small, since stoma shape may fluctuate.

Clinical Pearl
Parastomal hernias affect nearly 50% of ostomy patients within 1–3 years following surgery, and become more common over time. Early pouching adjustments and specialist support can significantly improve wear time, skin protection, patient independence, and quality of life.

Where Corstrata Fits
Corstrata supports ostomy management across the care continuum:

Acute Care — supporting inpatient teams with stoma and peristomal complication management
Hospital at Home — providing virtual WOC expertise for complex patients at home
Home Health — partnering with clinicians to optimize outcomes and reduce readmissions
Post-Acute & SNFs — aligning treatment plans with patient goals and reducing complications
Our virtual wound & ostomy specialists help optimize pouching systems and wear time, reduce leakage and skin injury, support conservative management strategies, and guide escalation decisions and surgical referrals. Consults are available via store-and-forward image review or live video.

When to Consider a Corstrata Consult
Persistent leakage or poor wear time
Suspected parastomal hernia
Peristomal irritation or trauma
Difficulty fitting appliances
Questions regarding conservative vs. surgical management
Have a patient facing any of the above? Reach out to the Corstrata Clinical Team for a consult.