12 May, 2020
Lisa Tate National Support Manager CUI International Limited
As readers will know, stoma surgery involves bringing the intestine out through the abdominal muscles. By its very nature this type of surgery creates a potential weakness, which can lead to a hernia forming. Parastomal hernias are where the edges of the stoma come away from the muscle, allowing abdominal contents to bulge out through the abdominal wall. An incisional hernia is caused by a surgical wound that has not completely healed and occurs at, or in close proximity to, the surgical incision, through which intestine, organ or other tissue protrudes. Hernias usually develop gradually and increase in size over time. If you suspect you have a hernia, it is very important to consult your stoma care nurse, as a hernia can affect stoma function and, in rare cases, lead to complications that require emergency surgery.
If you have a hernia, your stoma care nurse will carry out an assessment, using this to formulate an individual management and treatment plan. This may include a referral for a professional support garment fitting/consultation. As well as being invaluable for the management of parastomal and incisional hernias, support garments also help with hernia prevention. They can be worn during exercise or activities such as lifting, gardening and housework, to improve comfort and support the weight of an existing hernia. They also help to conceal the hernia/stoma. This can help with the wearer’s body confidence, by bringing an added sense of security when going about daily life. Support garments can also be used as a discretion belt during intimate moments.
Most support garments are available on NHS Prescription, but prior approval is required from your stoma care nurse or GP. If it is decided you would benefit from a support garment, then a hernia ‘fitting assessment’ will be carried out. This is usually done by either your stoma care nurse or one of the manufacturer’s trained support garment fitting specialists. The assessment includes a measuring service, trying on a sample garment and learning how to apply, wear and remove it. Patients are also told how to care for the garment. Only one garment should be ordered initially, to ensure it fits and is comfortable to wear. This also helps to reduce wastage to the NHS. You will also be advised of the average lifespan of your garment and how to reorder if required.
A follow up call is recommended after you have taken delivery of your support garment. This is to check fit and comfort and to identify and resolve early any issues. Some manufacturers include this follow up as part of their customer care service. It is also recommended that an annual review is carried out to take into account any changes since the last garment fitting took place (such as changes in weight!). Some stoma care nurses and fitting specialists recommend cutting a hole in the garment, although medical opinion differs on this matter. Most ostomates can wear a support garment fitted over their stoma. This offers an even distribution of support to the area of weakness (where the stoma is sited). For the small percentage that cannot tolerate the garment over their stoma due to excessive pancaking, leakages or wearing a convex appliance, a hole cut option will allow the stoma pouch to sit on the outside of the garment and still offer support for a hernia.
There are various support garments available: support bands, adjustable belts, girdles, boxer shorts and support briefs. Support belts are available in variety of standard depths and lengths. Tubular or pull on belts/bands offer a more seamless type of support and again are available in a variety of sizes and depths. Female and male girdles are usually available in low and high waist with a wide range of sizes to meet individual needs. Some manufacturers also offer a bespoke service if a standard garment does not fit a person’s needs. Different support levels are widely available and appropriate level of support will be recommended by your stoma care nurse or support garment fitting specialist. Ostomy underwear is also available for men and women, with a range of styles and designs to choose from. This comes with an internal pocket to hold and support a stoma bag. Underwear may be available on prescription but this will depend on local policy and prescription costs. Support underwear is also available to purchase direct from manufacturers. Prices are usually competitive (with the high street) but come with the added features and benefits for an ostomate.
If you have wondered about support garments, or are perhaps about to have an assessment for one, then I hope you have found this short article useful. At CUI, we like to think that we are here to support you!