Skip to main content
PMC home page
Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 1997 Jan;79(1):3–7.

Psychological factors in postoperative adjustment to stoma surgery.

C A White 1, J C Hunt 1
PMCID: PMC2502633  PMID: 9038488

Abstract

Around one-quarter of stoma patients experience clinically significant psychological symptoms post-operatively. Psychological disorders are often not detected by those involved with the care of stoma patients. Past psychiatric history, dissatisfaction with preoperative preparation for surgery, postoperative physical symptomatology and the presence of negative stoma-related thoughts/beliefs have all been shown to be significantly associated with psychological morbidity after surgery. These findings suggest that healthcare professionals (especially surgeons involved with this patient population) should ask all patients about these factors before and after surgery. Questionnaires could be used to screen for difficulties and/or staff could undertake training aimed at improving the detection of psychological morbidity and endeavour to strengthen links with liaison mental health services. Future research in this area should be prospective, using psychometrically valid measures and be focused on the prediction, prevention, detection and treatment of poor psychological adjustment after stoma surgery.

Full text

PDF
5

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Awad R. W., el-Gohary T. M., Skilton J. S., Elder J. B. Life quality and psychological morbidity with an ileostomy. Br J Surg. 1993 Feb;80(2):252–253. doi: 10.1002/bjs.1800800247. [DOI] [PubMed] [Google Scholar]
  2. Bekkers M. J., van Knippenberg F. C., van den Borne H. W., Poen H., Bergsma J., vanBergeHenegouwen G. P. Psychosocial adaptation to stoma surgery: a review. J Behav Med. 1995 Feb;18(1):1–31. doi: 10.1007/BF01857702. [DOI] [PubMed] [Google Scholar]
  3. Bridges K. W., Goldberg D. P. Psychiatric illness in inpatients with neurological disorders: patients' views on discussion of emotional problems with neurologists. Br Med J (Clin Res Ed) 1984 Sep 15;289(6446):656–658. doi: 10.1136/bmj.289.6446.656. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Burnham W. R., Lennard-Jones J. E., Brooke B. N. Sexual problems among married ileostomists. Survey conducted by The Ileostomy Association of Great Britain and Ireland. Gut. 1977 Aug;18(8):673–677. doi: 10.1136/gut.18.8.673. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Cohen A. Body image in the person with a stoma. J Enterostomal Ther. 1991 Mar-Apr;18(2):68–71. [PubMed] [Google Scholar]
  6. Devlen J., Maguire P., Phillips P., Crowther D., Chambers H. Psychological problems associated with diagnosis and treatment of lymphomas. I: Retrospective study. Br Med J (Clin Res Ed) 1987 Oct 17;295(6604):953–954. doi: 10.1136/bmj.295.6604.953. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Devlin H. B., Plant J. A., Griffin M. Aftermath of surgery for anorectal cancer. Br Med J. 1971 Aug 14;3(5771):413–418. doi: 10.1136/bmj.3.5771.413. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Druss R. G., O'Connor J. F., Prudden J. F., Stern L. O. Psychologic response to colectomy. Arch Gen Psychiatry. 1968 Jan;18(1):53–59. doi: 10.1001/archpsyc.1968.01740010055008. [DOI] [PubMed] [Google Scholar]
  9. Druss R. G., O'Connor J. F., Stern L. O. Psychologic response to colectomy. II. Adjustment to a permanent colostomy. Arch Gen Psychiatry. 1969 Apr;20(4):419–427. doi: 10.1001/archpsyc.1969.01740160035006. [DOI] [PubMed] [Google Scholar]
  10. Eardley A., George W. D., Davis F., Schofield P. F., Wilson M. C., Wakefield J., Sellwood R. A. Colostomy: the consequences of surgery. Clin Oncol. 1976 Sep;2(3):277–283. [PubMed] [Google Scholar]
  11. Feldman E., Mayou R., Hawton K., Ardern M., Smith E. B. Psychiatric disorder in medical in-patients. Q J Med. 1987 May;63(241):405–412. [PubMed] [Google Scholar]
  12. Ford S., Fallowfield L., Lewis S. Can oncologists detect distress in their out-patients and how satisfied are they with their performance during bad news consultations? Br J Cancer. 1994 Oct;70(4):767–770. doi: 10.1038/bjc.1994.393. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Ford S., Lewis S., Fallowfield L. Psychological morbidity in newly referred patients with cancer. J Psychosom Res. 1995 Feb;39(2):193–202. doi: 10.1016/0022-3999(94)00103-c. [DOI] [PubMed] [Google Scholar]
  14. Foulis W., Mayberry J. F. Elderly ileostomists and their social problems. J Clin Gastroenterol. 1990 Jun;12(3):276–278. doi: 10.1097/00004836-199006000-00008. [DOI] [PubMed] [Google Scholar]
  15. Gloeckner M. R. Partner reaction following ostomy surgery. J Sex Marital Ther. 1983 Fall;9(3):182–190. doi: 10.1080/00926238308405846. [DOI] [PubMed] [Google Scholar]
  16. Hopwood P., Howell A., Maguire P. Screening for psychiatric morbidity in patients with advanced breast cancer: validation of two self-report questionnaires. Br J Cancer. 1991 Aug;64(2):353–356. doi: 10.1038/bjc.1991.305. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Jones M. A., Breckman B., Hendry W. F. Life with an ileal conduit: results of questionnaire surveys of patients and urological surgeons. Br J Urol. 1980 Feb;52(1):21–25. doi: 10.1111/j.1464-410x.1980.tb02913.x. [DOI] [PubMed] [Google Scholar]
  18. Keltikangas-Järvinen L., Järvinen H. J. Psychosocial adaptation to ileostomy: a study after construction of conventional and continent stomies. Scand J Gastroenterol. 1987 Mar;22(2):202–206. doi: 10.3109/00365528708991880. [DOI] [PubMed] [Google Scholar]
  19. Keltikangas-Järvinen L., Loven E., Möller C. Psychic factors determining the long-term adaptation of colostomy and ileostomy patients. Psychother Psychosom. 1984;41(3):153–159. doi: 10.1159/000287803. [DOI] [PubMed] [Google Scholar]
  20. Klopp A. L. Body image and self-concept among individuals with stomas. J Enterostomal Ther. 1990 May-Jun;17(3):98–105. doi: 10.1097/00152192-199005000-00017. [DOI] [PubMed] [Google Scholar]
  21. Köhler L. W., Pemberton J. H., Zinsmeister A. R., Kelly K. A. Quality of life after proctocolectomy. A comparison of Brooke ileostomy, Kock pouch, and ileal pouch-anal anastomosis. Gastroenterology. 1991 Sep;101(3):679–684. [PubMed] [Google Scholar]
  22. Küchenhoff J., Wirsching M., Drüner H. U., Herrmann G., Köhler C. Coping with a stoma - a comparative study of patients with rectal carcinoma of inflammatory bowel diseases. Psychother Psychosom. 1981;36(2):98–104. doi: 10.1159/000287532. [DOI] [PubMed] [Google Scholar]
  23. Lefebvre M. F. Cognitive distortion and cognitive errors in depressed psychiatric and low back pain patients. J Consult Clin Psychol. 1981 Aug;49(4):517–525. doi: 10.1037//0022-006x.49.4.517. [DOI] [PubMed] [Google Scholar]
  24. MEYER B. C., LYONS A. S. Rectal resection; psychiatric and medical management of its sequelae; report of a case. Psychosom Med. 1957 Mar-Apr;19(2):152–157. doi: 10.1097/00006842-195703000-00009. [DOI] [PubMed] [Google Scholar]
  25. Maguire G. P., Julier D. L., Hawton K. E., Bancroft J. H. Psychiatric morbidity and referral on two general medical wards. Br Med J. 1974 Feb 16;1(5902):268–270. doi: 10.1136/bmj.1.5902.268. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Maguire G. P., Lee E. G., Bevington D. J., Küchemann C. S., Crabtree R. J., Cornell C. E. Psychiatric problems in the first year after mastectomy. Br Med J. 1978 Apr 15;1(6118):963–965. doi: 10.1136/bmj.1.6118.963. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Maguire P. Barriers to psychological care of the dying. Br Med J (Clin Res Ed) 1985 Dec 14;291(6510):1711–1713. doi: 10.1136/bmj.291.6510.1711. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Maguire P., Tait A., Brooke M., Thomas C., Sellwood R. Effect of counselling on the psychiatric morbidity associated with mastectomy. Br Med J. 1980 Nov 29;281(6253):1454–1456. doi: 10.1136/bmj.281.6253.1454. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Mayou R., Hawton K. Psychiatric disorder in the general hospital. Br J Psychiatry. 1986 Aug;149:172–190. doi: 10.1192/bjp.149.2.172. [DOI] [PubMed] [Google Scholar]
  30. McLeod R. S., Lavery I. C., Leatherman J. R., Maryland P. A., Fazio V. W., Jagelman D. G., Weakley F. L. Factors affecting quality of life with a conventional ileostomy. World J Surg. 1986 Jun;10(3):474–480. doi: 10.1007/BF01655313. [DOI] [PubMed] [Google Scholar]
  31. Oberst M. T., Scott D. W. Postdischarge distress in surgically treated cancer patients and their spouses. Res Nurs Health. 1988 Aug;11(4):223–233. doi: 10.1002/nur.4770110404. [DOI] [PubMed] [Google Scholar]
  32. Pezim M. E., Nicholls R. J. Quality of life after restorative proctocolectomy with pelvic ileal reservoir. Br J Surg. 1985 Jan;72(1):31–33. doi: 10.1002/bjs.1800720114. [DOI] [PubMed] [Google Scholar]
  33. Pryse-Phillips W. Follow-up study of patients with colostomies. Am J Surg. 1971 Jul;122(1):27–32. doi: 10.1016/0002-9610(71)90342-4. [DOI] [PubMed] [Google Scholar]
  34. Roy P. H., Sauer W. G., Beahrs O. H., Farrow G. M. Experience with ileostomies. Evaluation of long-term rehabilitation in 497 patients. Am J Surg. 1970 Jan;119(1):77–86. doi: 10.1016/0002-9610(70)90016-4. [DOI] [PubMed] [Google Scholar]
  35. Rubin G. P., Devlin H. B. The quality of life with a stoma. Br J Hosp Med. 1987 Oct;38(4):300-3, 306. [PubMed] [Google Scholar]
  36. STAHLGREN L. H., FERGUSON L. K. Influence on sexual function of abdominoperineal resection for ulcerative colitis. N Engl J Med. 1958 Oct 30;259(18):873–875. doi: 10.1056/NEJM195810302591806. [DOI] [PubMed] [Google Scholar]
  37. SUTHERLAND A. M., ORBACH C. E., DYK R. B., BARD M. The psychological impact of cancer and cancer surgery. I. Adaptation to the dry colostomy; preliminary report and summary of findings. Cancer. 1952 Sep;5(5):857–872. doi: 10.1002/1097-0142(195209)5:5<857::aid-cncr2820050503>3.0.co;2-y. [DOI] [PubMed] [Google Scholar]
  38. Sensky T. Patients' reactions to illness. BMJ. 1990 Mar 10;300(6725):622–623. doi: 10.1136/bmj.300.6725.622. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Sprangers M. A., Taal B. G., Aaronson N. K., te Velde A. Quality of life in colorectal cancer. Stoma vs. nonstoma patients. Dis Colon Rectum. 1995 Apr;38(4):361–369. doi: 10.1007/BF02054222. [DOI] [PubMed] [Google Scholar]
  40. Thomas C., Madden F., Jehu D. Psychological effects of stomas--I. Psychosocial morbidity one year after surgery. J Psychosom Res. 1987;31(3):311–316. doi: 10.1016/0022-3999(87)90050-x. [DOI] [PubMed] [Google Scholar]
  41. Thomas C., Madden F., Jehu D. Psychological effects of stomas--II. Factors influencing outcome. J Psychosom Res. 1987;31(3):317–323. doi: 10.1016/0022-3999(87)90051-1. [DOI] [PubMed] [Google Scholar]
  42. Thomas C., Madden F., Jehu D. Psychosocial morbidity in the first three months following stoma surgery. J Psychosom Res. 1984;28(3):251–257. doi: 10.1016/0022-3999(84)90027-8. [DOI] [PubMed] [Google Scholar]
  43. Wade B. E. Colostomy patients: psychological adjustment at 10 weeks and 1 year after surgery in districts which employed stoma-care nurses and districts which did not. J Adv Nurs. 1990 Nov;15(11):1297–1304. doi: 10.1111/j.1365-2648.1990.tb01745.x. [DOI] [PubMed] [Google Scholar]
  44. Whates P. D., Irving M. Return to work following ileostomy. Br J Surg. 1984 Aug;71(8):619–622. doi: 10.1002/bjs.1800710819. [DOI] [PubMed] [Google Scholar]
  45. Williams N. S., Johnston D. The quality of life after rectal excision for low rectal cancer. Br J Surg. 1983 Aug;70(8):460–462. doi: 10.1002/bjs.1800700805. [DOI] [PubMed] [Google Scholar]
  46. Wirsching M., Drüner H. U., Herrmann G. Results of psychosocial adjustment to long-term colostomy. Psychother Psychosom. 1975;26(5):245–256. doi: 10.1159/000286938. [DOI] [PubMed] [Google Scholar]
  47. Young C. H. Sexual implications of stoma surgery. Part 1. Clin Gastroenterol. 1982 May;11(2):383–391. [PubMed] [Google Scholar]
  48. Zigmond A. S., Snaith R. P. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x. [DOI] [PubMed] [Google Scholar]

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England

RESOURCES