ORCID: Z. Malaibari
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Parastomal hernia (PSH) is a frequent and challenging complication following stoma formation. While operative repair remains an important option in selected cases, non-operative strategies are essential, particularly for asymptomatic patients or those with significant comorbidities. This narrative review aims to synthesize current evidence on conservative management of PSH and on selected perioperative supportive measures, outlining core components, limitations, and research priorities.
A narrative review of the literature was conducted focusing on non-operative strategies in PSH, including watchful waiting, core training, abdominal support garments, stoma care, and psychosocial considerations. Relevant publications were identified through searches in PubMed and Google Scholar (2011–2025) and supplemented by expert consultation.
In patients with minimal symptoms, conservative approach is widely accepted, given that recurrence rates have been reported to be comparable between elective and emergency repairs. Physical activity and patient education are underexplored yet promising components in enhancing function and improving quality of life. The role of abdominal binders remains empirically supported but lacks high-quality, PSH-specific evidence. Stoma care optimization - and psychosocial support are critical to improving quality of life but remain underrepresented in clinical guidelines. Most available data are extrapolated from ventral and incisional hernia literature, underscoring the need for targeted PSH research.
Non-operative management remains a cornerstone of PSH care, requiring an individualized, multidisciplinary approach. Non-operative strategies should emphasize structured follow-up, abdominal support, guided core training, appliance adaptation, and psychosocial wellbeing. Dedicated prospective studies are urgently needed to define evidence-based protocols specific to PSH.
Parastomal hernias (PSH) are among the most challenging types of hernias to manage, both surgically and non-operatively. They commonly occur after stoma creation, with incidence rates reported as high as 50% within 2 years [
Although surgical strategies have evolved significantly, the risk of recurrence is high. Therefore, non-surgical strategies—such as watchful waiting, stoma care, guided core training, and abdominal binders—are widely used to improve comfort and potentially slow progression, yet consensus remains lacking. Furthermore, comprehensive care should address psychological and social impacts of living with a PSH.
Stoma care and appliance management are central to the daily experiences of individuals with PSH. Herniation can distort the peristomal skin contour, complicating appliance fitting and increasing the risk of leakage, skin irritation, and dermatitis. Ripoche et al. reported that 28% of patients experienced leakage due to appliance-fitting issues, highlighting the importance of effective stoma management, as these complications can significantly impair quality of life and lead to social withdrawal [
This narrative review summarizes current non-operative approaches for the holistic management of PSH, emphasizing physical activity, abdominal support garments, and patient-centered care. It explores the role of guided core training, stoma care strategies, and patient education in enhancing quality of life. In addition to conservative strategies, the review also considers selected perioperative supportive measures—particularly the use of abdominal binders—as these overlap conceptually and remain clinically relevant. Furthermore, the review addresses psychosocial implications and underscores the importance of individualized, multidisciplinary management based on available evidence and clinical expertise.
This work was designed as a narrative review of the literature on non-operative strategies for the management of parastomal hernia (PSH). We performed electronic searches in PubMed and Google Scholar covering the period from 2011 to March 2025. The following keywords and combinations were used: “parastomal hernia,” “conservative management,” “non-operative treatment,” “support garment,” “abdominal binder,” “stoma care,” “core training,” “physical activity,” and “quality of life.”
Studies were limited to the English language. Reference lists of included articles were manually screened for additional relevant publications. In addition, domain experts were consulted to identify key publications that may not have been captured through database searches. Because this is a narrative rather than a systematic review, no formal quality assessment or meta-analysis was performed; instead, emphasis was placed on summarizing available evidence and identifying knowledge gaps.
For patients with minimal symptoms, watchful waiting remains the common practice. Current evidence indicates that most PSH do not progress rapidly to severe complications, such as bowel obstruction or strangulation, allowing many patients to maintain good quality of life without surgical intervention for extended periods [
Nevertheless, surgical outcomes highlight the trade-offs between elective and emergency repair. In a large cohort study of older adults, elective PSH repair was associated with a 40.2% complication rate, a 21.1% 5-year reoperation rate [
However, emergency presentations, although infrequent, are associated with substantial complication rates of approximately 62% [
Evidence regarding physical activity in patients with a stoma remains limited and generally of low quality. Most studies focus on cancer survivors and emphasize basic functional outcomes, with scarce data on optimal exercise regimens or broader quality of life parameters [
Several stoma-related factors may restrict physical activity. For example, stoma prolapse often compromises appliance adhesion, while skin discomfort further discourages mobility and exercise [
Among patients who are not surgical candidates or choose conservative management, fear of worsening the hernia or causing complications often leads to a sedentary lifestyle. This fear is well-documented and associated with physical deconditioning and social withdrawal [
In patients undergoing surgical repair—whether through local fascial approximation, mesh reinforcement, or stoma relocation—postoperative activity guidance is essential to support healing, reduce recurrence risk, and restore functional independence. Unlike groin or small ventral hernias, the abdominal wall surrounding the stoma is structurally compromised and subject to complex, multidirectional stressors that challenge rehabilitation and long-term recovery [
Patients are typically advised to avoid heavy lifting, core straining, or high-impact movements for 2–4 weeks, with a gradual return to full activity based on individual healing and clinical judgment [
Targeted education about safe lifting techniques, optimal posture, and core-friendly exercises significantly reduces patient anxiety and enhances recovery outcomes, proving cost-effective in practice [
The use of abdominal binders or support garments is more prevalent and clinically significant in patients with PSH than in those with other types of hernias [
Support garments are commonly used as a conservative approach for symptom relief in patients managed without surgery. They are designed to provide targeted external compression around the stoma and hernia site, aiming to reduce protrusion, improve comfort, and enhance a sense of security during physical activity. Garments vary in form and compression level, with multiple types reported in the literature [
A recent scoping review found that binders are the most commonly recommended conservative treatment for PSH [
Belt–appliance compatibility is crucial to avoid pressure ulcers, and in irreducible hernias, use should be cautious due to strangulation risk [
Proper application technique is important: belts should ideally be applied while lying down with the hernia reduced, although this may be challenging for some patients [
In the postoperative phase, abdominal binders or support garments are often employed to protect the surgical repair site during the early healing, although this practice is supported mainly by evidence from incisional and ventral hernia repair literature, with limited data available for PSH. Several studies have suggested potential benefits of binder use, including reduced postoperative psychological distress [
However, evidence remains mixed. A patient survey following incisional hernia repair reported that although abdominal binders were frequently associated with reduced pain, approximately one-third of patients experienced decreased mobility. Notably, neither binder use nor prolonged physical rest appeared to significantly affect postoperative morbidity [
From randomized data of patients undergoing laparoscopic umbilical or epigastric hernia repair, binder use did not significantly influence postoperative pain or seroma formation, despite 86% of patients reporting subjective benefits [
Thus, although binders may not decrease risk of surgical complications there is indications that they improve patients’ satisfaction which is considered a core outcome in non-malignant surgery, including ventral hernia repair [
Education on garment use is essential in both the conservative and perioperative settings. Patients should ideally be assessed and fitted by a trained stoma care nurse or clinical specialist, in line with the recommendations of the Canadian best practice (2024) and recent rapid review [
PSH present a distinct array of challenges that extend beyond the visible protrusion at the stoma site. These include stoma-related complications, cosmetic and negative body image issues, psychological distress, and functional limitations [
The psychosocial impact of PSH is profound yet often under-recognized. Patients frequently report anxiety, shame, and concerns about body image related to visible bulging or the potential for appliance leakage [
Quality of life assessments and symptom scores—such as the Colostomy Impact Score or Hernia-Related Quality of Life (HerQLes) questionnaire—can serve as helpful tools to identify patients whose symptoms interfere with daily life [
Despite advancements in surgical techniques, non-operative management remains essential, particularly for patients with minimal to moderate symptoms or significant comorbidities [
Practical Recommendations of the non-operative consideration regarding Parastomal Hernia.
| Domain | Practical recommendations |
|---|---|
| Watchful waiting | Conservative approach is a widely accepted strategy as surgical repair is associated with high recurrence and complication rates |
| Physical Activity | Encourage guided core training and gradual return to activity to preserve abdominal wall function |
| Abdominal binders | Use in symptomatic patients for comfort and mobility; exercise caution in non-reducible PSH, ensure specialized stoma nurse assessment, check appliance compatibility, and provide education on correct use |
| Stoma care and appliance management | Ensure individualized fitting and education by a specialized stoma nurse, with appliance modifications to prevent leakage and skin complications |
| psychosocial impact | Offer counseling to address emotional distress and utilize validated QoL assessment tools |
| Multidisciplinary care | Foster collaboration among surgeons, physiotherapists and specialized stoma nurses |
PSH, parastomal hernia, QoL: quality of life.
Watchful waiting is widely accepted as a reasonable initial strategy for patients with minimal or no symptoms, based on current evidence suggesting slow progression and minimal immediate risk of severe complications. This is also emphasized by the high recurrence rates after surgical repair, typically in the range of 21%–40% [
Physical activity constitutes an essential yet under-investigated aspect of non-operative PSH management. Despite limited direct evidence for PSH, cautious extrapolation from ventral and incisional hernia literature suggests that targeted physical activity—guided by safety principles and gradual progression—can support recovery and reduce recurrence risk. Patient counseling should emphasize the high recurrence rates post-surgical intervention, reinforcing long-term strategies for core protection and activity modification [
The use of abdominal binders or support garments presents another critical aspect of non-operative PSH management, relevant both conservatively and perioperatively. Conservative use aims primarily at symptom relief and improved comfort during daily and physical activity, yet selection and adherence challenges persist. There is currently no evidence that wearing a belt affects the progression of a parastomal bulge over time, nor regarding optimal wear duration, compression level, or whether the belt should have a hole for the stoma [
Although tapering strategies have not been formally studied, the limited duration of demonstrated benefits—such as reduced pain and reduced infection risk early after repair—suggests that gradual tapering of binder use may be reasonable as healing progresses, helping to minimise dependency. This approach is particularly important given individual variations in stoma location, mesh placement, and postoperative abdominal contour.
Beyond physical support, effective appliance management and stoma care, facilitated by skilled stoma nurses, significantly influence daily experiences and quality of life for individuals with PSH. Appliance modifications—including convex wafers, barrier rings, or custom-fitted pouches—are essential to mitigate complications such as leakage, skin irritation, and dermatitis, which significantly impair quality of life [
Although the psychosocial impact of PSH is increasingly acknowledged, it remains inadequately addressed in clinical guidelines, which predominantly focus on surgical outcomes [
Finally, elective repair should be carefully considered in light of recurrence rates that are comparable to emergency repairs [
It is noteworthy that most available evidence on non-operative strategies stems from incisional hernia repairs, which differ anatomically and biomechanically from PSH. As such, direct extrapolation should be approached with caution until PSH-specific trials are conducted. Management decisions must account for heterogeneity in hernia morphology and patient presentation. The European Hernia Society classification, which stratifies PSH by defect size (using 5 cm as a threshold) and the presence of a concomitant incisional hernia, offers a clinically relevant framework for individualized assessment [
Non-operative strategies for PSH management represent a critical component of personalized care and offer meaningful symptom relief, promote patient autonomy, and support quality of life, particularly for individuals not suited for immediate surgical intervention. However, standardized protocols and high-quality, PSH-specific research are clearly needed. Until then a holistic, multidisciplinary approach and collaboration is considered vital for optimal outcomes.
JR and MC conceptualized and designed the review and drafted specific sections. JR, NH, ZM, and RA carried out the literature search and data extraction. FH, KA, and MC provided methodological input and critically reviewed the content. JR, NH, KA, MK, FH, ZM, and RA critically revised the manuscript and contributed to interpretation. JR provided senior supervision and carried out critical appraisal. All authors contributed to the article and approved the submitted version.
The author(s) declare that no financial support was received for the research and/or publication of this article.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The author(s) declare that Generative AI was used in the creation of this manuscript. ChatGPT (OpenAI, GPT-4o and 5) was used solely for language refinement and improving clarity. No scientific content or data interpretation were generated by AI. All references, results, and analyses were provided and verified by the authors, who reviewed all AI-assisted text and take full responsibility for the publication’s content.
Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors, and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.