Hernia belts – hole or no hole??

In North America, support belts for parastomal hernias typically have holes for the pouch to come through, and elsewhere they don’t. What’s up with that??

Trying to solve the mystery. I called a prominent manufacturer and supplier of hernia belts in the US and learned that although they carry both types of belts, they only recommend the ones with holes (with no explanation). Since then, I haven’t found anyone else saying belts with holes are better, let alone why.

On the other hand, I discovered there are scads of ostomates and qualified medical sources out there who make a good argument in favour of belts without holes. Here’s a sampling:

 “Up until recently most girdles and support belts would come with a reinforced hole for the stoma and appliance to be fitted through. Reports now show that a hole in the corset or belt is unnecessary, as it will only exacerbate the very problem it seeks to correct.”
Julia Williams, Lecturer in Gastrointestinal Nursing, London.
Cited in Colostomy UK’s Tidings magazine, Winter 2008.

 Abdominal supports should not have a hole cut in them so that support is evenly distributed over the whole abdomen.”
Thompson, Mary Jo. Parastomal hernia: Incidence, prevention and treatment strategies. British Journal of Nursing, 2008 (Stoma Care Supplement), Vol 12, No. 2.

 “The hole has to be much bigger than the diameter of the stoma because it must accommodate the area of baseplate or bag adherent to the skin around the stoma, plus a little more to allow bag to slip through the hole. This replicates what caused or contributed to hernia formation.”
Parastoma hernias revisited: A cost-effective analysis. March 2009.
Assoc. Prof. Julia Thompson, RN, PhD, STN.
St Vincent’s Private Hospital, Sydney, NSW, Australia.

“Importantly, it is FAR better not to have a hole in the support garment, because a hole just mimics the situation that caused the bulge/hernia in the first place.”
Queensland Stoma Association, citing Ostomy Australia magazine, August 2009.

“Research indicates that if a hole is cut in the support garment, it will then mimic the situation that caused the hernia in the first place, so it cannot minimize the hernia risk.”
Ottawa Ostomy News, May 2012, citing Australian Council of Stoma Associations Inc “Ostomy Australia”

 “In my experience, if I use a flexible pouching system and a hernia belt with a hole, “coning” or the abdominal wall pushing through the hole develops.  I don’t recommend using a flexible pouching system with a hernia belt with a hole because of this “coning”.  If a person is using a … pouching system with some ‘firmness’ such as convexity, I get very good results with a hernia belt with a hole.”
Andrea Manson RN, BSN, NSWOC, NCA.
Ask an Ostomy Lifestyle Expert, Ostomy Canada Society.
January 2020.

Julia Thompson’s 2009 article goes on to suggest that not only do belts with holes risk the hernia worsening, they also risk the stoma being pushed so far outwards that it can prolapse (!!).

In posts in online ostomy groups, the only argument against hole-less belts seems to be that they can restrict output from falling into the pouch. But several ostomates who use them say this isn’t a problem. They might have to discreetly “massage” the output downward sometimes, but most consider it a minor inconvenience – especially compared to the more serious risks of belt with holes.

I like nurse Andrea Manson’s suggestion (January 2020) that if you wear a rigid baseplate, like a convex one, you can use a belt with a hole. But I use a flexible, concave baseplate. So bottom line: I’m going to switch to a belt with no hole next time. I’ll keep you posted.

In the meantime, if you have experience or an opinion one way or another, or know of a study I’ve missed – please let me know. It seems like an important topic and I’d really like to know more about it.