Stoma Hernia

A Hernia is a weakness or split in the muscle wall of the abdomen which allows the abdominal contents (usually some part of the intestine) to bulge out. The bulge is particularly noticeable upon tensing the abdominal wall muscles - such as occurs when coughing, sneezing, straining or simply standing.

Stomas pose an additional problem.

When a stoma is brought out to the surface of the abdomen it must pass through the muscles of the abdominal wall, thus a potential site of weakness is immediately created. In the ideal situation the abdominal wall muscles form a snug fit around the stoma opening. However, sometimes the muscles come away from the edges of the stoma thus creating a hernia - in this case, an area of the abdominal wall adjacent to the stoma where there is no muscle.

Factors that can contribute to causing a stoma hernia to occur include coughing, being overweight or having developed an infection in the wound at the time the stoma was made. The development of a stoma hernia is often a gradual phenomenon, with the area next to the stoma stretching and becoming weaker with the passage of time. This weakness, or gap, means that every time one strains, coughs, sneezes or stands up, the area of the abdomen next to the stoma bulges, or the whole stoma itself protrudes as it is pushed forwards by the rest of the abdominal contents behind it.

As with all hernias the size will increase as time goes by. Stoma hernias are rarely painful, but are usually uncomfortable and can become extremely inconvenient.

They may make it difficult to attach a bag properly and sometimes their sheer size is an embarrassment as they can be seen beneath clothes. Although a rare complication, the intestine can sometimes become trapped or kinked within the hernia and become obstructed. Even more seriously the intestine may then lose its blood supply, know as strangulation. This is very painful and requires emergency surgery to untwist the intestine and prevent the strangulated part of the bowel from being irreversibly damaged. Regardless of inconvenience or pain, hernias are defects in the abdominal wall and should not be ignored simply because they might not hurt.

There are surgeons who advocate that small stoma hernias that are not causing any symptoms do not need any treatment. Furthermore, if they do need treatment it should not be by operation in the first instance but by wearing a wide, firm colostomy/ileostomy belt. This is probably true with small hernias, in people who are very elderly and infirm or people for whom an anaesthetic would be dangerous (serious heart or breathing problems, for example).

We feel that nowadays operative repair of the stoma hernia should be given more serious consideration to improve the quality of life, prevent progressive enlargement of the hernia with time and make it easier to manage the stoma.

All About HIV and AIDS

All About HIV & AIDS

HIV stands for human immunodeficiency virus. AIDS stands for acquired immunodeficiency syndrome. HIV is actually the virus that causes the disease AIDS.

HIV Hurts the Immune System

People who are HIV positive have been tested and found to have signs of the human immunodeficiency virus in their blood. HIV destroys part of the immune (say: ih-myoon) system. Specifically, it affects a type of white blood cell called the T lymphocyte (say: lim-fuh-site), or T cell. T cells are one type of "fighter" cell in the blood that help the body fight off all kinds of germs and diseases.

After HIV enters the body, it piggybacks onto a T cell and works its way inside of that cell. Once inside, the virus completely takes over the T cell and uses it as a virus-making factory to make a lot of copies of itself. The newly made viruses then leave the T cell and go on to infect and destroy other healthy T cells as they continue to multiply inside the body. After the virus invades the T cells, they can no longer properly fight infections.

Someone who is infected with the virus is called HIV positive. But it may take years for the virus to damage enough T cells for that person to get sick and develop AIDS. And thanks to new medications, someone infected with HIV can stay relatively healthy and symptom-free for many years. But these medications are very expensive and not available to everyone in the world.

When the person's immune system has weakened and more of the blood's T cells have been destroyed by the virus, the person can no longer fight off infections. This is when he or she gets very sick. A doctor diagnoses a person with AIDS when the person has a very low number of T cells and shows signs of a serious infection.

How Many People Have HIV and AIDS?

Since the discovery of the virus more than 20 years ago, millions of people throughout the world have been infected with HIV. Most are adults, but there are kids and teens who have HIV, too. In the world today, AIDS remains an epidemic (say: eh-puh-deh-mik), which means that it affects a large number of people and continues to spread rapidly.

Right now, about 40 million people in the world are living with HIV infection or AIDS. This estimate includes 37 million adults and 2.5 million children. In the United States alone, more than 1 million people are living with HIV.

How Is HIV Spread?

HIV infection isn't like a cold or the flu. A person cannot get HIV by hugging or holding the hand of, sharing a school bus or classroom with, or visiting the home of someone who has HIV. HIV is passed only through direct contact with another person's body fluids, such as blood. The majority of people in North America get infected with HIV by:

• having sexual contact with a person who has HIV
• sharing needles or syringes with a person who has HIV

Other ways of getting HIV can occur when:

• an infected pregnant woman passes it to her unborn child. (This can be prevented by treating the mother and child around the time the baby is delivered.) Because of the risk to an untreated baby, every pregnant woman should be tested for HIV.
• a person has a blood transfusion (say: trans-fyoo-zhun) from a fairly large volume of blood. But in North America today, all donated blood is tested for HIV, so the risk of getting HIV is less than one in a million.

What Are the Symptoms of HIV and AIDS?

Most people don't feel any different after they are infected with HIV. In fact, infected people often do not experience symptoms for years. Some people develop flu-like symptoms a few days to a few weeks after being infected, but these symptoms usually go away after several days.

Most of the children who have HIV got it because their mothers were infected and passed the virus to them before they were born. Babies born with HIV infection may not show any symptoms at first, but the progression of AIDS is often faster in babies than in adults. Doctors need to watch them closely. Kids who have HIV or AIDS learn more slowly than healthy kids and tend to start walking and talking later.

How Are HIV and AIDS Diagnosed?

A person can be infected with HIV without even knowing it. So doctors recommend that anyone who thinks he or she may have been exposed to the virus get tested - even if the chance of having been infected seems small. Doctors test a person's blood to find out if he or she is infected with HIV.

People who are HIV positive need to have more blood tests every so often. The doctor will want to check on how many T cells the person has. The lower the T cell count, the weaker the immune system and the greater the risk that someone will get very sick.

How Are HIV and AIDS Treated?

Right now there is no cure for HIV or AIDS, but new medicines can help people live longer lives. Scientists are also researching vaccines that may one day help to prevent HIV infection, but it's a very tough assignment, and no one knows when these vaccines might become available. It's up to everyone to prevent AIDS by avoiding the behaviors that lead to HIV infection.

Can HIV and AIDS Be Prevented?

People can help stop the spread of HIV by avoiding sexual contact with infected people and by not sharing needles or syringes.

Health care workers (such as doctors, nurses, and dentists) help prevent the spread of HIV by wearing plastic gloves when working on a patient. Hospitals have strict procedures for handling samples of blood and other body fluids to prevent others from coming in contact with HIV.

Living With HIV and AIDS

New drugs make it possible for people who are HIV positive to live for years without getting AIDS. They can work or go to school, make friends, hang out, and do most of the things other people can do. They will have to take certain medicines every day and see their doctors pretty often, and they may get sick more than other people do because their immune systems are more fragile.

When HIV infection gets worse or turns into the disease called AIDS, life really changes. The person may need to spend a lot of time in bed or in the hospital because of serious illnesses. He or she may feel very tired or weak most of the time. The person also might lose weight.

Hope for an HIV-Free Future

Maybe one day, with time and research, a cure for HIV infection will be found and AIDS will no longer exist. Until then, the smartest thing to do is to know the facts and not put yourself at risk.

If you have more questions about HIV or AIDS, talk to an adult you trust - a parent, doctor, school nurse, or guidance counselor. Don't depend only on your friends for information about HIV and AIDS because they may not know all the right answers.