Ostomy: Concerns, Adapting and Psychosocial Issues
Author: Thomas C. Weiss : Contact: Disabled World
Published: 2015-10-08 : (Rev. 2017-07-17)
Synopsis and Key Points:
Changes in appearance and functional ability may change the way a person with an ostomy internalizes their body image and self-concept.
The reaction to intestinal or urinary diversion (ostomy) surgery differs from one person to another. To some people it will be an issue, to others - a challenge. While one person may perceive the surgery as life-saving, another person finds the surgery to be a devastating experience. Each individual will adjust or adapt in their own way and in their own time.
An ostomy pouching system or colostomy bag is defined as a prosthetic medical device that provides a means for the collection of waste from a surgically diverted biological system (colon, ileum, bladder) and the creation of a stoma. Pouching systems are most commonly associated with colostomies, ileostomies, and urostomies.
Body Image and Self-Esteem Concerns
Permanent and notable changes in the body's appearance and functional ability may change the way a person with an ostomy internalizes their body image and self-concept. Fear of loss is expected and facing any loss is hard. What are people giving up by having this operation? Is there any gain? How changed will the person be? Thoughts such as these might lead to weeping or depression, or the person may deny them.
It is important to understand the impact of the ostomy surgery on a person's change in self-image and how they perceive themselves. It might be accepted as the less of two evils, or the person might refuse to acknowledge its existence. A person may also hold onto the belief that it is a temporary situation. Within the rehabilitation process there are times when people should have the chance to express or deny their feelings, about the surgery, the changes to their body, or their self-image.
Concerns About Self-Care
People have to be reassured that they will be taught self-care and that they will gain the ability to master the management process. Basic anatomy and physiology should be explained to people with a new ostomy so they can better understand the extent of their surgery. The person should be offered management options.
People with a new ostomy should start to assist the ostomy nurse with caring for their ostomy as soon as they can. Becoming involved in the process will help the person to build confidence and help them to regain control of the situation.
Concerns About Various Relationships
People with a new ostomy might be afraid that their social role may be changed and that other people may not accept them as they did in the past. One of the first concerns appears to be how to tell others about their surgery, who to tell and at what time. The person should be prepared to explain their surgery with a few brief statements such as, 'An ostomy is a surgical procedure for the diversion of a person's bladder or bowel.'
The person should understand that they do not have to tell everyone about the surgery. They need to be selective about who and how much to tell others. It might be only to friends who will be supportive throughout the process of rehabilitation.
Returning to work may present a concern about restroom facilities, feelings of being watched, as well as interactions with co-workers. A few of the person's co-workers might need to know in case of an emergency. Employability and insurability are issues for some people with an ostomy. If the issues develop, it is important for the person to pursue assistance from health care professionals, and/or communicate with others who have found solutions to any of these issues.
Sexuality issues are common concerns for people with a new ostomy. Linked closely to our feelings concerning sexuality is how we think about ourselves and our body image. Any sexuality concerns should be discussed between the person and their partner. It is likely that the partner will experience anxieties because of a lack of information. An intimate relationship is one in which it matters how well two people can communicate about the most personal of human functions; bodily elimination and sexual activities.
Ostomy surgery may present more concerns for people who are single. When to tell depends on the relationship. Brief, casual dates may not need to know. If the relationship grows and leads to intimacy, the person's partner needs to be told about the ostomy before a sexual experience.
Phases of Adapting to Ostomy Surgery
Nearly everyone with a new ostomy goes through four phases of recovery after an illness or accident that results in loss of function of an important part of the body. The person, along with their family members, goes through these phases - varying only in the time needed for each phase. People might experience the various phases of adaptation in a different order and at various rates. Some people might skip certain phases entirely, while others may move up and down at different times. The phases are shock, denial, acknowledgment and resolution.
- Shock or Panic: Shock or panic happens immediately after surgery. The person is unable to process information and might be anxious, tearful and forgetful. The phase may last from days to weeks.
- Defense/Retreat/Denial: The phase may last for weeks or months and delays the person's adaptation process. During this phase, the person denies or minimizes the significance of the event and defends him/herself against the implications of the crisis. The person may avoid reality and pursue wishful thinking.
- Acknowledgment: As the person moves to the next step of acknowledgment, they start to face the reality of the situation. As the person gives up the existing old structure, they might enter into a period of apathy, depression, agitation, high anxiety, and/or bitterness.
- Adaptation/Resolution: During this phase, the acute grief starts to subside. The person copes with their situation in a constructive manner and begins to establish new structures. The person develops a new sense of worth. The adaptation/resolution phase may take one to two years.
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