CPCP: Psychosocial Adjustment to Ostomy

Jim Amos MD 7Well, every once in a great while, I have to pitch in and make a Clinical Problems in Consultation Psychiatry (CPCP) presentation and this one is on an issue which I generally don’t get called about. Really, the last time I acted as a psychiatric consultant regarding a patient’s difficult adjustment to a colostomy was well over 15 years ago. It did not end well. The patient committed suicide shortly after discharge home, as a direct result of severe anxiety and depression over the stress of having to cope with the ostomy.

That was the first patient who committed suicide who was under my care, albeit as a consulting psychiatrist. I will never forget it.

However, that is a rare outcome. The video above, produced by the United Ostomy Associations of America, Inc. (UOAA, Inc.) shows what the reality of living with an ostomy can be and most often is. And you can google “ostomy” on YouTube and find what you won’t see in the official UOAA video–instructions on bag changing and irrigation by everyday heroes. They are expressions of altruism.

As I looked through the medical literature, I was surprised at how old most of it is and how very few of the papers are written by either surgeons or psychiatrists. The majority are published in nursing journals, with notable exceptions by consulting psychiatrists such as Barney Dlin, MD. There is an Academy of Pyschosomatic Medicine (APM) award with his name on it, Dlin-Fischer Award for clinical research, along with that of  H. Keith Fischer, MD.

I was not aware of the Phantom Rectum Syndrome (PRS), which can occur after abdominoperineal resection for rectal cancer. It’s a lot like phantom pain syndromes following limb amputations, with painful and nonpainful forms, the latter an uncomfortable sensation of having to defecate, in the absence of a rectum.

And I was fascinated to find an article on the proposal to use mindfulness meditation to help patients adjust to ostomy. It was about 20 years ahead of its time and I didn’t see any other articles published more recently than that one. The paper is hard to obtain and I’m just lucky to have university library access which enabled me to get a copy by interlibrary loan. Otherwise I would have had trouble even getting the abstract:

Trunnell, E. P. (1996). “Mindfulness and people with stomas.” J Wound Ostomy Continence Nurs 23(1): 38-45.

Persons with a stoma must contend not only with the immediate physical changes produced by the operation but also with psychologic adjustments, changes in body image, changes in self-concept, and the chronic stress of stoma care and physical functioning. Mindfulness training can enable these persons to make the necessary adjustments in a more realized and conscious manner. The practice of mindfulness training has been demonstrated to be effective in dealing with clinical and psychologic problems. Mindfulness is defined as being fully awake and is characterized as being nonjudging, having a beginner’s mind, being trusting, nonstriving, accepting, and letting go. Mindfulness training is described, and roadblocks to the practice of mindfulness are discussed and exemplified. Resources on the practice of mindfulness and applications to persons with ostomies are provided. Mindfulness training is proposed as an adjunct to patient education or support groups.

I had to query Dr. Google a few times, though. I found a powerpoint presentation on adjustment to ostomy which I think illustrated the challenge some people have in overcoming stigma. My favorite quote from the author, Michael Gerald, is, “Remember that an Ostomate is a person interacting with their natural environment, not a pouch with legs.” The UOAA, Inc. has a novel way to fight stigma, which is the WannaWearOne Campaign.

I also think the name “Ostomate” adopted by those who have undergone this procedure is great. When you hear it spoken, it sort of rhymes with “optimist.”

In order to see the picture galleries of photos or powerpoint slides, click on one of the slides, which will open up the presentation to fill the screen. Use the arrow buttons to scroll left and right through the slides or up and down to view any annotations.