UNASSIGNED: This United Kingdom study aimed to explore people\'s experiences of living with, and self-managing parastomal bulging.
UNASSIGNED: Seventeen people were interviewed and 61 people completed an online survey.
UNASSIGNED: Parastomal bulging has a detrimental impact on quality of life including a negative impact on stoma function, daily activities, body image, physical intimacy, and socialising; access to specialist information and support for addressing the problem of bulging was inequitable; support garments were the most common self-management intervention; there was confusion about what exercise would be beneficial or how being active would help in terms of parastomal bulging self-management; peer support is no substitute for high quality specialist support.
UNASSIGNED: People need equitable access to information and support to self-manage and treat parastomal bulging. Research about other types of self-management interventions, for example, exercise is required so that people do not have to rely solely on support garments to self-manage parastomal bulging.

OBJECTIVE: To investigate patients\' experiences of the assessment of support garments in relation to a parastomal bulge.
METHODS: We conducted a qualitative study with semi-structured interviews preceded by field observations. The 11 in-dept interviews were analysed using interpretative phenomenological analysis.
RESULTS: In the assessment process patients lacked information from professionals on the advantages, disadvantages as well as criteria for choosing between garments.Garments had to fit patients\' needs and personal preferences; being comfortable, flexible and user-friendly. The garment created new possibilities and challenges; well-assessed garments reduced symptoms while poorly assessed worsened or induced symptoms and ended up unworn. When comorbidities were not accounted for, garments were unmanageable to patients. Patients needed guidance on how to apply and use the garment. Lack of hands-on-guidance left patients confused and helpless with unworn garments. Re-assessment of a garment before it could be worn was time consuming, stressful and required patients\' physical and mental resources.
CONCLUSIONS: Exploring patients\' expectations, symptoms, needs and comorbidity was vital for patients\' subsequent use and benefit of garments. Tailor-made information, hands-on-guidance and professional assistance are important in the assessment process. Interventions to support a patient centred, individual and systematic approach is warranted.

The aim of this work was to examine (1) the incidence of primary repair, (2) the incidence of recurrent repair and (3) the types of repair performed in patients with parastomal bulging.
Prospectively collected data on parastomal bulging from the Danish Stoma Database were linked to surgical data on repair of parastomal bulging from the Danish National Patient Register. Survival statistics provided cumulative incidences and time until primary and recurrent repair.
In the study sample of 1016 patients with a permanent stoma and a parastomal bulge, 180 (18%) underwent surgical repair. The cumulative incidence of a primary repair was 9% [95% CI (8%; 11%)] within 1 year and 19% [95% CI (17%; 22%)] within 5 years after the occurrence of a parastomal bulge. We found a similar probability of undergoing primary repair in patients with ileostomy and colostomy. For recurrent repair, the 5-year cumulative incidence was 5% [95% CI (3%; 7%)]. In patients undergoing repair, the probability was 33% [95% CI (21%; 46%)] of having a recurrence requiring repair within 5 years. The main primary repair was open or laparoscopic repair with mesh (43%) followed by stoma revision (39%). Stoma revision and repair with mesh could precede or follow one another as primary and recurrent repair. Stoma reversal was performed in 17% of patients.
Five years after the occurrence of a parastomal bulge the estimated probability of undergoing a repair was 19%. Having undergone a primary repair, the probability of recurrent repair was high. Stoma reversal was more common than expected.

The aim was to investigate the incidence and risk factors for parastomal bulging, a clinically important complication, in patients with an ileostomy or colostomy.
The Danish Stoma Database Capital Region prospectively collects data on patients with a stoma up to a year after surgery. Stoma care nurses clinically assessed the main outcome, parastomal bulging. We linked data from the Stoma Database to data from the Danish Anaesthesia Database. Cumulative incidence of parastomal bulging over the first year was calculated with death and stoma reversal as competing risks. Risk factors were investigated using an exploratory approach.
In a study population of 5019, the cumulative incidence (with competing risks) of parastomal bulging was 36.2% at 400 days after surgery. Age, colostomy, male gender, alcohol consumption and laparoscopy were associated with an increased risk of parastomal bulging. Compared with cancer, inflammatory bowel disease was associated with a lower risk of parastomal bulging, and diverticulitis was associated with a higher risk. Peristomal mesh and stomas placed through a separate incision were associated with a reduction in risk. There was neither increased nor decreased risk of parastomal bulging for body mass index, American Society of Anesthesiologists score, smoking status, emergency surgery and preoperative stoma site marking.
Parastomal bulging is a common complication affecting one in three patients within 1 year of surgery. Along with previous findings, there is now considerable evidence for age and colostomy as being risk factors for parastomal bulging.

OBJECTIVE: To investigate experienced symptoms of parastomal bulging in relation to an ileostomy or colostomy.
BACKGROUND: Parastomal bulging is a common complication of stoma formation that can affect patients\' physical, psychological and social function. Symptom burdens reported by health professionals vary from asymptomatic to high symptom load; however, patients\' experiences of symptoms are lacking.
METHODS: A qualitative design with focus group interviews was chosen for data collection. Twenty patients participated in five semi-structured interviews. Analysis was performed using a phenomenological-hermeneutic approach.
RESULTS: The bulge caused different unfamiliar bodily sensations that interacted with patients\' everyday lives. Some but not all of these sensations were modifiable. As the bulge and the ostomy changed size and shape, patients had to adjust and readjust stoma care continuously. The physical change called for patients\' awareness and posed a threat to patients\' control of the ostomy and challenged stoma self-care. The bulge caused a bodily asymmetry that deformed the patients\' bodies in a way that exceeded the perceived alteration already caused by the stoma. To cover the physical disfigurement, new clothing solutions, garment wear and creativity were essential in everyday life. Patients gradually adapted to the bulge over time. Easy access to professional help was crucial in order to find the best appliance and garment solution in relation to the bulge.
CONCLUSIONS: Various symptoms related to the parastomal bulge affected patients\' everyday lives in different ways and underpinned that an individualised approach is important when addressing patients\' problems and complaints. Research into nonsurgical treatments and patient perspectives is limited and highly warranted to improve clinical outcome.
CONCLUSIONS: The ever-changing bulge posed a threat to patients\' control of the ostomy and required specific care from the stoma therapist. Needs-based access to counselling, advice and supplementary materials is important.