The Complications of Colostomy Irrigation and a Parastomal Hernia

I’ve been irrigating largely successfully for over 7 months but there have been some issues as a result and at first I couldn’t pinpoint the cause but it appears that the parastomal hernia may not be helping.

The Decision to Irrigate

Since having the colostomy back in January 2019, I’d not got on too well with it. I’d suffered with the usual side effects that come with the territory — ballooning, leaks, smells, changes at night. All of these things combined were getting to me so my stoma nurse suggested I give colostomy irrigation a try.

I began irrigating in January 2020, almost exactly a year after surgery, and could instantly see the benefits. Nearly all the side effects had largely disappeared and despite the effort of irrigating (performing it around 6am 7 days a week), it was worth it. And since running again, the benefits are even greater.

First Experiencing Issues

The main issues I experience as a result of irrigating with a hernia is discomfort that appears to occur at random. The first time I experienced it, I didn’t know what was happening. Throughout the day I suffered with abdominal pain and didn’t immediately relate it to the irrigation but then wondered if I had let the water in too quickly or was dehydrated which would result in my bowel absorbing too much of the water.

The discomfort would last all day effectively meaning that I would need to restrict what I did to minimise the discomfort. By the morning, things were back to normal.

I couldn’t find a pattern to this happening and it would only happen around once a month but the fact that you couldn’t predict it meant having to write off a day when you had planned to do something.

Is It Getting Worse?

What started as a once a month occurrence had now increased and was occurring once a fortnight or even every week as has happened this month.

The latest incident this week was by far the worst. After what I thought was a successful irrigation I started experiencing discomfort which turned into pain. The pain would come in waves largely located around the hernia but spread across my abdomen and chest.

In the past I’ve just assumed that the pain was caused by the bowel itself but I believe it was being caused by wind not being able to exit the stoma. I could feel a build up of wind, and subsequent build up of pain, and then when it reached the hernia it couldn’t exit it would move back into the bowel — much like when you hold a fart in!

As the day progressed the pain became more frequent and uncomfortable and my productivity was taking a nosedive as I couldn’t concentrate on anything. When I had figured out it was probably wind being trapped I even tried using a finger to open up the stoma but to no avail. I was starting to think that something may be blocked.

By the evening I decided to try to irrigate again to help release the trapped wind. This was new territory for me so I wasn’t sure what to expect. It was a bit of a struggle getting the water to enter and I made sure the water that did go in went at a slow pace. The pain was quite intense as it entered and gradually got worse until I reached around 3/4 litres and had to stop.

During a usually irrigation the water would either instantly start to be ejected or take a few minutes. After 30 minutes I was starting to get worried. There was no sign of movement and I was curled up on the floor trying to get rid of the pain. I was starting to convince myself that I was going to end up in A&E with a blockage.

Eventually there was some movement and water, along with a lot of trapped wind was released. Whilst the irrigation had helped, I was in the same position as before in terms of discomfort. Like before, a night’s sleep would probably get rid of the discomfort, and it did.

Should You Irrigate with a Parastomal Hernia?

According to the Canadian Society of Intestinal Research, “If you have a parastomal hernia, and even if you are able to reduce your hernia, irrigations are generally not recommended to regulate your bowel function. Irrigations with a hernia may result in bowel obstructions or other complications.”

They also suggest that you should stop altogether: “People who have a colostomy and a parastomal hernia, and who manage their stoma with irrigations may need to consider stopping irrigations all together. Irrigations may worsen symptoms and cause further complications.”

My stoma nurse also confirms that a parastomal hernia is a contraindication to irrigating but doesn’t advise against doing it, just to be mindful of the fact it’s there and to take more time when introducing the water.

What’s Next?

Whilst the issues I’ve been experiencing are unpleasant and the frustrating in the nature that they occur, the benefits of irrigation far outweigh them.

After enjoying not having to worry about getting up in the middle of the night to change the bag or always remembering to take spare supplies with me, there’s no way I could go back. If irrigating does cause complications with the hernia in the future, I’ll deal with it then.