The Ostomy Files: Is There a Gap in Ostomy Rehabilitation?

    In a healthcare environment where ostomy patients are admitted the day of surgery and discharged but a few days later, clinicians have little time to obtain a secure seal on an ostomy pouching system and teach self-care “survival skills,” let alone consider a patient’s emotional and psychological needs. When, then, if ever, are these crucial needs being addressed?

    A study of body image conducted by Piwonka and Merino¹ found decreased individual satisfaction with body after ostomy surgery was directly linked to increased concerns about sounds from the stoma, odor, and appearance. The researchers were impressed by the high incidence of depression among patients with an ostomy.

    Similar findings of depression after ostomy surgery have been documented in OWM and other journals. Patients have concerns surrounding the creation of an ostomy: Will I have the ability to lead a “normal” life, have a satisfying sexual relationship, participate socially, maintain employment, pay for ostomy supplies, and have a say in the way the ostomy is managed? Psychological and emotional concerns can occur at any time — before the surgery, immediately afterward, or even years later as their lives evolve. Lingering depression after ostomy surgery must be addressed. The question is: Who is the appropriate healthcare professional to mitigate these issues?

    Because wound ostomy continence (WOC), long-term care, or home care nurses are usually the clinicians with whom the patient has the closest relationships, the emotional and psychological aspects of care must be integrated into pre-operative teaching and counseling and postoperative follow-up, either in the clinic, long-term care facility, or home care. One of the most effective ways of assessing the patient’s emotional well being is to ask direct questions about some of the most common issues, especially if the patient is not forthcoming. Because sharing personal concerns may be embarrassing for the patient, a clinician who offers “permission” by broaching sensitive topics such as sexuality may open the door to a discussion the patient was uncomfortable initiating.

    Some patients may be completely unwilling to discuss personal concerns. In such cases, the nurse should acknowledge the patient’s reluctance and explain that the door is always open to discussion if and when the individual feels more comfortable.² The nurse can suggest that not talking about feelings may make the situation worse; if the person is not comfortable talking to the nurse, other healthcare resources are available. Wound ostomy continence nurses should include a list of local and national resources (eg, sex therapists, family counselors, psychologists, support groups, and psychiatrists familiar with all aspects of ostomy surgery) in the armamentarium they share with patients and other clinicians (ie, long-term care and home care nurses and physicians).

    As clinicians, we often focus our energies and attention on the pouching system, ensuring that the seal is secure and that the patient knows how to care for the stoma. Because we are so rushed, however, we may forget what is happening in the life and mind of the person wearing the pouching system. We have the compassion and the knowledge to help people through the milestones they face after ostomy surgery but limited time and resources make offering our caring expertise difficult. Despite the obstacles, however, this crucial aspect of ostomy rehabilitation cannot be overlooked. Patients’ fear and depression can ravage the valuable quality time the surgery was intended to provide.

    Acceptance and support are key to the patient’s adaptation to living with a stoma.³ Rehabilitation cannot be complete until all aspects of the patient’s well-being — physical, emotional, sexual, social, and psychological — have been addressed and resolved. The relationship between the WOC Nurse and/or the home care nurse and the patient is an exceedingly valuable tool that, when leveraged appropriately, can have a powerful, positive effect on the psychological outcome of ostomy surgery.

    The Ostomy Files is made possible through the support of ConvaTec, a Bristol-Myers Squibb Company, Princeton, NJ.

1. Piwonka MA, Merino JM. A multidimensional modeling of predictors influencing the adjustment to a colostomy. JWOCN. 1999;26:298–305.

2. White CA. Ostomy adjustment. In: Colwell JC, Goldberg MT, Carmel JE (eds). Fecal & Urinary Diversion: Management Principles. St Louis: Mosby, Inc;2004:326–336.

3. Turnbull GB, Colwell JC, Erwin-Toth P. Quality of life: pre- post, and beyond ostomy surgery. Ostomy Wound Manage. 2004;50(7A Suppl):2–12.