What is Parastomal Hernias?

A hernia is an abnormal growth of the bowel at the abdominal wall. It occurs on a weak part of the walls. It mainly affects the stomach or the intestines. A large protrusion often forms around and the intestines. The size of this protrusion depends on the size of the area, which was weak, and the stoma came through. If the size of the weakened area is small, then a small protrusion forms, but if the size of the weakened area is big, then a big protrusion that is noticeable will form. A hernia around the stoma is what we refer to as parastomal hernias.

This condition affects 5% to 10% of people with colostomies and 3% to 10% of people with ileostomies. It is difficult to tell who can get parastomal hernias and who can't. However, some factors make people vulnerable to contracting this complication. They include;

Site of the stoma

When a stoma is made outside the rectus abdominus muscle, then you can get a hernia around the stoma.

Age

The older you become, the weaker your muscles become. When this affects the abdominal muscle, then herniation can happen at any given time.

Obesity

People with excess weight are more vulnerable to getting a hernia because their weight puts too much pressure on abdominal muscles, making them weaker hence the possibility of a hernia.

Malnutrition

Poor eating habits especially lack of a balanced diet during the stoma surgery recovery period, is dangerous. This is because it might delay the normal healing of the abdominal wall, which is a sign of weakness.

Infection after stoma surgery

An infection might eat up muscles and eventually create a weakness on the abdominal walls.

Increased intra-abdominal pressure

This pressure exerted on the abdominal muscles might come from frequent severe sneezing, lifting of heavyweights, and chronic coughing. This pressure, especially from the heavyweights, is dangerous because it can even cause muscles to tear.

Parastomal hernias may develop very soon after surgery or may take years to build these depending on the patient's condition. 80 % of people who have undergone surgery do not struggle with a hernia. People with a hernia learn how to deal with it after medical intervention.

People often describe Parastomal hernia through its abdominal discomfort. It causes a feeling of fullness in the parastomal area that is not painful but is however uncomfortable. This is dealt with by supporting the hernia with a unique elastic hernia belt. A lycra-type undergarment can also help to make you comfortable. Belts need to be measured accurately to fit your abdomen. If you are having severe pain resulting from the stoma or hernia, you should seek help from an Enterostomal Therapy nurse. The nurse helps you to choose between a belt and a lycra undergarment.

According to your movements, a parastomal hernia can also change the size and shape of the stoma. This may cause a leak in your appliances and even lead to skin problems. When you cannot see your stoma to take care of it, you should contact your nurse for assistance. The hernia affects the normal functioning of the stoma.

In conclusion, the parastomal hernia can be avoided, and in case you get it, it can be dealt with well with the help of medical professionals.

How does it actually work for Ulcerative Colitis? J-Pouch the life savior

The type of Inflammatory Bowel Disease (IBD) that leads to the inflammation in the lining of colon and rectum is called Ulcerative Colitis.

Mostly the patient with ulcerative colitis doesn’t need a surgery .But people who have been suffering from UC for 30 years or more need a surgery.

It has been studied and observed by Crohn’s and Colitis foundation that J pouch is the only procedure in which ulcerative colitis does not react with any medication.

This article will basically tell you how J pouch actually works for UC and what to expect after and before the surgery among the risks and benefits.

What actually a J-pouch is, and what is it’s the working mechanism?

Another name for J-pouch is protocolectomy with ileal-anal anastomosis (IPPA).

After the removal of large intestine (Colon and rectum), the surgeon creates a J-pouch in the body. Just after the removal of large intestine, the surgeon folds small intestine into J shape. This pouch helps to collect the waste, which is then connected with anus, the opening of rectum.

A pair of sphincter muscles that surrounds the rectum remains in the same position even after the surgery. These muscles allow controlling the feces.

The anus also remains on its place even after the surgery. There is no need for long term ostomy pouch or stoma, if a person has gone through the J-pouch procedure.

What happens during the surgery?

The surgery mainly consists of two to three processes.

In the beginning, the surgeon removes the rectum and colon leaving the anus and the sphincter on their place. Then they use small intestine and convert one of its end into a J shape pouch, and then attach it to the anus.

The first process is termed as ileostomy. In this surgery, a hole is created in the wall of abdomen and one end of small intestine is connected to the opening of this hole. This aids feces to reach the ostomy bag; meanwhile the sphincter and small intestine are under healing process.

The second procedure is performed after 8 to 12 weeks of the first surgery .In this operation the ileostomy is reversed by using small intestine and connecting it back. This will allow the normal bowel movement.

In some cases surgeons needs to perform surgeries in three different steps:

• Removing of colon and forming ileostomy

• Removing of rectum and formation of J –pouch with the help of small intestine.

• Reconnecting the intestine and reversal of ileostomy

The people with following issues have higher chances to have three surgeries:

• Poor health conditions

• An emergency case that needs to stop the bleeding

• Toxic megacolon

• Taking high dose steroids

What happens after the surgery?

A patient needs to be in hospital for the recovery and in order to learn the basic care for UC.

After the second and third procedure, a patient will need a short stay at the hospital till the doctors allow him to leave.

The signs that are observed by the patients during healing are:

• Diarrhea

• More number of bowel movements, which is due to loose feces

• More urging need to pass feces at night

• Tiredness, which will get better with healing time. 

• Blood seen in feces

• Loss of water (Dehydration)

• Every surgery has some risks. The risks that are associated with J-pouch surgery are:

• Fastulas and pelvic abscesesses

• Failure to make a pouch

• Defect in pouch orientation

• Pouchitis

It is also reported by American College of Gastroenterology that may be hard for a patient to conceive or get pregnant naturally, following this surgery.

Pouchitis is the most known issue. It can be treated by completing a course of antibiotics.

If the surgery is performed by an expert and an experienced surgeon then there are less chances to have any other complexities.

Advantages:

J-pouch procedure frees a person from life time need for an ostomy bag. Psychologically, it’s also beneficial to pass feces normally through the anus instead of the stoma.

It also does not have any significant effect on the current medication of the patient. Many people will feel a reasonable reduction in the pain level, urgency to pass stool, and diarrhea.

Conclusion:

J-pouch surgery basically involves formation of a colon by folding small intestine into a j-shaped pouch, with the removal of large intestine. This surgery allows a person to pass out feces normally and significantly reduces the discomfort levels and pain. It’s a very common and reliable procedure for the patients who are under a stress regarding their ileostomy.