Introduction Parastomal hernia (PH) is a frequent complication after end-colostomy formation. PH may negatively influence the quality of life in end-colostomy patients. Our study investigates the quality of life and body image (BI) in patients with an end-colostomy. Methods We conducted a cross-sectional study of end-colostomy patients in two different hospitals. Patients were included if they had received a Hartmann procedure or abdominal perineal resection between 2004 and 2011. Patients were invited to the outpatient clinic for clinical examination to determine if a PH was present and were asked to fill out the Short form 36, EuroQol-5D, and body image questionnaire (BIQ). Results One-hundred-and-fifty patients were eligible for the study; 139 filled out the questionnaires, of which 79 (56.8 %) had developed a PH. A linear multivariate regression showed PH caused a decrease in physical functioning (difference -10.2, p = 0.033) and general health (difference -9.0, p = 0.021), increase in pain (difference -11.3, p = 0.009) and decrease in the overall physical component score (difference -4.8, p = 0.020). The BIQ showed that PH increased the shame of the scar (difference -0.4, p = 0.010). Having an incisional hernia simultaneously decreased patients' scoring of the scar in the BIQ (difference -0.99, p = 0.015). Discussion PHs cause significant decreases in quality of life and BI of patients. Counseling of patients towards PH and prevention of PH should therefore be of more concern in surgical departments.