Adams E, Boulton M, Watson E The information needs of partners and family members of cancer patients: a systematic literature review. Patient Educ Couns. 2009; 77:(2)179-186

Annells M The experience of flatus incontinence from a bowel ostomy: a hermeneutic phenomenology. J Wound Ostomy Continence Nurs. 2006; 33:(5)518-24

Bekkers MJ, van Knippenberg FC, van den Borne HW, Poen H, Bergsma J, vanBerge-Henegouwen GP Psychosocial adaptation to stoma surgery: a review. J Behav Med. 1995; 18:(1)1-31

Bekkers MJ, van Knippenberg FC, van den Borne HW, van Berge-Henegouwen GP Prospective evaluation of psychosocial adaptation to stoma surgery: the role of self-efficacy. Psychosom Med. 1996; 58:(2)183-91

Black PLondon: Bailliere Tindall; 2000

Black PK Psychological, sexual and cultural issues for patients with a stoma. Br J Nurs. 2004; 13:(12)692-7

Black P How should we support patients with colorectal cancer and a stoma?. Gastrointestinal Nursing. 2012; 10:(8)

Black P Supporting patient care with appropriate accessories. Br J Nurs. 2017; 26:(17)S20-S22

Borwell B Psychological considerations of stoma care nursing. Nurs Stand. 1997; 11:(48)49-55

Borwell B Rehabilitation and stoma care: addressing the psychological needs. Br J Nurs. 2009; 18:(4)S20-S25

Burch J, Black PHarrow: St Mark's Academic Institute; 2017

Chelvanayagam S: Gastrointestinal Nursing; 2014

Corner J, Wagland R National cancer survivorship initiative: text analysis of patients’ free text comments: final report. Southampton: University of Southampton/Department of Health. 2012;

Creswell JWThousand Oaks (CA): Sage; 2014

Cancer reform strategy. 2007;

Di Gesaro A The psychological aspects of having a stoma: a literature review. Gastrointestinal Nursing. 2016; 14:38-44

Finlay LChichester: Wiley-Blackwell; 2011

Giorgi APittsburgh (PA): Duquesne University Press; 2009

Goodhart F, Atkins L: Piatkus/Hachette; 2011

Goffman ELondon: Allen Lane; 1968

Helman CLondon: Hodder Arnold; 2007

Johnston B, Patterson A, Bird L Impact of the Macmillan specialist Care at Home service: a mixed methods evaluation across six sites. BMC Palliat Care. 2018; 17

Kelly MP Loss and grief reactions as responses to surgery. J Adv Nurs. 1985; 10:(6)517-25

Kilic E, Taycan O, Belli A, Ozmen M The effect of permanent ostomy on body image, self esteem, marital adjustment, and sexual functioning. Turkish Journal of Psychiatry. 2007; 18:(4)1-8

Mols F, Lemmens V, Bosscha K, van den Broek W, Thong MS Living with the physical and mental consequences of an ostomy: a study among 1-10-year rectal cancer survivors from the population-based PROFILES registry. Psychooncology. 2014; 23:(9)998-1004

Nichols T, Riemer M Body image, perception, the stoma, and peristomal skin condition. Gastrointestinal Nursing. 2011; 9:(1)22-27

Notter J, Chalmers F Living with a colostomy: a pilot study. Gastrointestinal Nursing. 2012; 10:(6)16-24

Notter J, Burnard P Preparing for loop ileostomy surgery: women's accounts from a qualitative study. Int J Nurs Stud. 2006; 43:(2)147-159

Persson E, Hellström AL Experiences of Swedish men and women 6 to 12 weeks after ostomy surgery. J Wound Ostomy Continence Nurs. 2002; 29:(2)103-108

Polidano K, Chew-Graham CA, Bartlam B, Farmer AD, Saunders B Embracing a ‘new normal’: the construction of biographical renewal in young adults' narratives of living with a stoma. Sociol Health Illn. 2020; 42:(2)342-358

Suls J Social comparison processes: implications for physical health.(ed). Oxford: OUP; 2012

Svenaeus F The phenomenology of health and illness.(ed). Dordecht (Netherlands): Kluwer Academic; 2001

Van Mannen MWalnut Creek (CA): Left Coast Press; 2014

Vonk-Klaassen SM, de Vocht HM, den Ouden ME, Eddes EH, Schuurmans MJ Ostomy-related problems and their impact on quality of life of colorectal cancer ostomates: a systematic review. Qual Life Res. 2016; 25:(1)125-33

Wade BLondon: Scutari Press; 1989

White CLondon: Sheldon Press; 1997

Psychological issues affecting patients living with a stoma

25 March 2021
Volume 30 · Issue 6


Stoma surgery is an intrusive operation, with outcomes that can impact seriously on daily life, not just in the immediate postoperative and recovery period, but for the rest of the patient's life. There are changes in bodily function, altered body image, physicality and personal care needs. These changes require acceptance and adaptation and can necessitate a re-ordering of daily life, socially, emotionally and in terms of work. Assessing the patient's needs through the trajectory of diagnosis, surgery and a stoma, is not just important during the treatment phase but needs to continue throughout the lifespan. Traditionally, patient outcome measures after bowel surgery have included overall self-efficacy, checking for stoma complications, clinical health status, function and psychological status. However, over the past three decades there has been increasing recognition that quality of life (QoL), which is now regarded as a key measurement, needs further consideration. Patients report difficulties when explaining to health professionals the challenges they face, and their reactions as they try to make the adjustments to their new normal of life with a stoma. This article examines stoma patients' perceptions of their outcomes from recent research. It discusses how more can be done by health professionals to support stoma patients through their initial transition to life with a stoma and for the rest of their life.

For all patients, regardless of diagnosis, treatment and outcomes, the impact of the changes and experiences that accompany the onset of illness can be frightening and challenging. Although treatment may address the original medical problems, the outcomes can include short-, medium- and long-term health issues. In addition, where major surgery such as stoma formation is needed, the physical changes can also be accompanied by psychological problems that are hard to resolve. Indeed, evidence suggests that more than 20% of stoma patients experience long-term significant psychological challenges and concerns that, unrecognised, can affect and impact not only the patient, but also their family, friends and work situation (Notter and Chalmers, 2012; Black 2018).

It is impossible to separate the psychological and physical self from who we are and what we do. Our daily activities of work, play, family and friends are perceived through our actions and interactions, with our bodies being integral elements in everything we do, including our relationships with others. Fundamentally implicated in all lived experiences, any action that impinges on or affects the mind and body affects individuals' lives. When medical help is sought and the diagnosis results in surgery, and individuals change their roles to become patients, they have to face the reality of the outcome of what may be radical and/or major surgery.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content