The Ostomy Files: The Modernity of Ostomy

There is nothing past for which one may yearn, there is only an eternal newness which is shaped by the wider elements of the past and true nostalgia has always to be productive to create a new excellence. — Johann Wolfgang von Goethe

   A few weeks ago, my husband and I were driving back to Canada after visiting our family in the US. As usual, we tuned into talk radio. After listening to a lecture on “modernity” — a completely new term for me — I began to ponder how the term could be applied to ostomy supplies and the way individuals with an ostomy live in the 21st century.

   Hooker¹ defines modernity as the sense or idea that the present is discontinuous with the past. Due to a process of social and cultural change (either through improvement or decline) life in the present is fundamentally different from life in the past.¹ This is the opposite of tradition, which is simply the sense that the present is continuous with the past, repeating its forms, behavior, and events.

   We experience modernity as a “proliferation of alternatives”¹ which may be associated with changes in lifestyle, social mores, or technology. This vast menu of alternatives creates an enormous sense of anxiety that can lead to social attempts to restrict alternatives. Hooker¹ states, “It is not the alternatives themselves which create this anxiety — it is the sense that the proliferation of alternatives has become unmanageable.”

The Past

   Before 1960, only 25 companies (mostly small, entrepreneurial ventures) manufactured ostomy supplies.² In 1920, the Koenig-Rutzen rubber pouch was introduced.² Another 20 years elapsed before disposable plastic pouching systems, skin-friendly adhesives, and skin protection became available. By 1950, more companies had entered the market and innovation took flight. However, extensive use of “permanent” (re-usable) heavy rubber pouches, rigid faceplates, and glue remained the norm. Vinyl re-usable pouches were introduced in the early 1970s but were ineffective at odor management. Karaya’s capabilities as a “skin barrier,” discovered in the mid-1960s, quickly moved it into a position of dominance in the US ostomy market.^2,3 Later that decade and early into the next, larger manufacturers entered the field, producing more advanced skin barriers and disposable, light-weight, odor-resistant pouching systems.

   Not so many years ago, ostomy surgery was considered the only alternative to death for many patients.⁴ Surgical techniques were fraught with postoperative complications, hospital stays were weeks or months long, and patients were left mostly on their own to find solutions to managing themselves if they survived the surgery. In the early 1950s, ostomy surgery techniques took an enormous leap forward. No longer considered the last resort, ostomy surgery became a cure or at the very least a way to improve a person’s quality of life. However, it remained “the secret surgery” because society was not yet ready to discuss it openly. Surgical options remained limited (ileostomy, colostomy, urinary diversion), however, until the “continent ileostomy” was developed in Sweden in the 1960s.⁵

   Until 1958, physical and emotional rehabilitation of the person with a stoma was pretty much left to the patient or another person who had undergone the same type of surgery. But in that year,³ the first Enterostomal Therapist was trained at the Cleveland Clinic. Still, patients remained in the hospital for weeks and months after their surgery. The cost of care had no boundaries and no regard for financial or clinical outcomes data.

Modernity

   Today, options proliferate among ostomy supplies, support groups, surgical techniques, caregivers, and even the location where treatment and education are available. If Hooker’s hypothesis is correct, could these alternatives truly be “unmanageable”? If so, what could be construed regarding the anxieties caused by these alternatives? What could society be doing, if anything, to limit alternatives?

   Modern culture has changed over the past 50-plus years and is much more open regarding sexuality. Diseases and conditions once considered socially taboo (eg, erectile dysfunction and prostate, colon, rectal, bladder, and breast cancer) are now discussed freely in a variety of media. Eminent individuals who have undergone ostomy surgery provide inspiration and hope for others facing such treatment. Thanks to the bravery of these individuals and changes in society, ostomy surgery is no longer “the secret surgery.”

   The profession of Enterostomal Therapy now spans the globe, expanding the services available, as well as the specialty’s scope of practice, to a larger population. However, due to the expansion of ET/WOC practice, the limited number of specialized ET/WOC Nurses available, and cost of medical care/length-of-stay restrictions, the bulk of ostomy care and education is taking place in the patient’s home (not in the hospital) and delivered by non-specialized home care nurses.  
The breadth and quality of ostomy supplies and accessories also has grown exponentially, making it possible to meet most of the needs of an individual living with an ostomy. Improved quality of life after ostomy surgery remains the chief goal for patients.

   Surgical techniques also have advanced, leading to sphincter-sparing surgeries and continent procedures that afford patients more options as to how they cope with their disease and — for a certain population of patients — to live pouch-free.

   Perhaps the best approach to melding the old and the new is to bond them together. Change is never easy. Holding onto the past in the new world of healthcare can be detrimental to patients as well as healthcare professionals. Every ET/WOC Nurse needs to realize that patients deserve and desire choice in how they will manage themselves after surgery. Because supply of specialized ET/WOC Nurses does not meet demand, the most effective way to reach the greatest number of patients is to teach non-specialized nurses (in home care and outpatient clinics) about best practice ostomy care — ie, how to provide options and the right pouching system for the right patient at the right time, allowing the patience to define “right.” Best practice also means treating the whole patient from a psychosexual, emotional, financial, and physical standpoint. This may be the origin of our angst regarding the seemingly unmanageable number of alternatives. Certainly, it is an issue we need to ponder.

Summary

True modernity is a positive acknowledgement of one’s time. This does not mean blind enthusiasm and uncritical support — rather, modernity infers awareness of the difference between this time and times before without implying that what had gone before should be rejected.

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

This article was not subject to the Ostomy Wound Management peer-review process.

1.    Hooker R. Modernity: Crisis of modernity. Available at: www.wsu.edu/~dee/GLOSSARY/MODERN.HTM.

2.    Davidson W, Fischer J. History of ostomy products manufacturers. In: Erwin-Toth P, Krasner D (eds). Enterostomal Therapy Nursing: Growth and Evolution of a Nursing Specialty Worldwide: A Festschrift for Norma N. Gill-Thompson, ET. Baltimore, Md: Halgo, Inc;1996:55–73.

3.    Turnbull RW, Turnbull GB. The history and current status of paramedical support for the ostomy patient. Seminars in Colon and Rectal Surgery 1991;2(2):131–140.

4.    Brooke BN. Historical perspective. In: Dozois RR (ed). Alternatives to Conventional Ileostomy. Chicago, Ill: Year Book Medical Publishers, Inc.;1985:21–28.

5.    Koch NG. Historical perspective. In: Dozois RR (ed). Alternatives to Conventional Ileostomy. Chicago, Ill: Year Book Medical Publishers, Inc.;1985:133–145.