Quality of Life with an Intestinal Stoma

Abstract

This article reviews 30 papers (1984-2007) on quality of life (QOL) for people with intestinal stomas. In literature, a clear consensus exists that having a stoma allowing involuntary discharge of feces constitutes a major change in appearance and bodily function. The resulting problems are specific to the condition and need to be measured by specific tools because generic tools such as Short Form-36 are not sensitive to measure the impact of these daily challenges. However, it remains a methodological problem to distinguish stoma patients' general health-related QOL, especially the impact on QOL of the underlying disease leading to stoma surgery, from the stoma-specific QOL. General consensus is that QOL in most patients decline in the first months after stoma surgery with gradual improvement from 6 months and on. However, some patients are coping fast and well with their stomas, and others find them permanently distressing. The pouching system constitutes a major factor in ostomate's daily life, due to the importance of ensuring protection against leakage and skin problems as well as discretion toward sounds, odors, and visual appearance. Furthermore, poor function of pouching systems may lead to sleep disturbances and related daytime symptoms of fatigue. Having a stoma also affects sexual life, and especially having a large parastomal hernia seems to increase the feeling of not being sexual attractive. However, a methodological problem in research of QOL is that patients with a stoma are reluctant to answer questions related to sex. Geographic factors have in recent studies been shown to have a significant impact on QOL in stoma patients. Patients in Scandinavia and Northern Europe have an increased overall QOL compared with Southern/mid-European countries. Besides surgical technique and cultural reasons or religious taboos, simple climatic reasons have been proposed, leading to difficulties in hiding and maintaining the ostomy appliances in warm, humid weather. Preoperative counseling, postoperative care, and long-term follow-up have all been practiced as methods aimed at improving QOL. However, regular irrigation seems to be the best documented intervention to improve QOL, as it leads to less time dealing with feces and pouches, fewer daily life problems, fewer bowel function and skin problems, and better rehabilitation.