Body Image Perceptions of Persons With a Stoma and Their Partners: A Descriptive, Cross-sectional Study
The body image perceptions of persons with a stoma and their partners are rarely examined and have yet to be evaluated in a Turkish sample. Using convenience sampling methods, a descriptive, cross-sectional study was conducted among individuals receiving treatment at the authors’ stomatherapy unit between March 1, 2012 and May 31, 2012 to assess the effect of the stoma on self-image and partner perception.
Eligible participants had to be >18 years of age, married, and with an abdominal stoma (colostomy, urostomy, or ileostomy) for at least 2 months. Data were obtained through separate (patient or partner), face-to-face, 30-minute to 45-minute interviews using the appropriate questionnaire. Questionnaire items assessed demographic variables and patient/partner feelings toward the ostomate’s body using the Body Cathexis Scale (BCS) and author-developed questionnaires comprising statements eliciting individual responses (agree, disagree, undecided) regarding their feelings toward the stoma. Data were tabulated and analyzed using percentile distributions, and Mann Whitney U and Kruskal Wallis H tests were performed (Bonferroni correction was applied). Sixty (60) patients (25 women, 35 men, mean age 56.01 ± 10.1 years; 25 with an ileostomy, 30 with a colostomy, 5 with an ileostomy) participated, along with their 60 heterosexual partners (mean age 54.56 ± 10.25 years) married a mean of 33.06 ± 11.03 years. Mean patient BCS score was 133.15 ± 20.58 (range 40 – low perception — to 200 – high perception). Mean BCS score of patients whose partner helped in stoma care was significantly higher (136.04) than those whose partners did not (120.27) (P = 0.033). Patients who consulted their partners’ opinions on stoma creation and participation in care had significantly higher BCS scores (P <0.05), and BCS scores of patients whose partners thought the stoma had a negative effect on their relationship were significantly lower (P = 0.040); patients’ perceptions toward their bodies were parallel to their partners’. Mean BCS score of patients experiencing physical and psychosocial problems was significantly lower than those of patients who did not experience such problems. The results of this study show a number of factors, including involving patient partners before surgery, affect body perception of persons following stoma surgery.
POTENTIAL CONFLICTS OF INTEREST: none disclosed
Student Author Award Submission— Self-Esteem Disturbance in Patients with Urinary Diversions: Assessing the Void
Quality of Life in Patients with Stomas: The Montreux Study
Although the construction of a stoma is a relatively simple surgical procedure, patients may later experience a range of physical, psychological, and sociocultural issues or difficulties.1 For example, after stoma surgery, patients may encounter psychosocial problems due to factors such as output, gas, loss of odor control, experiencing a sudden change in physical appearance, taking care of the stoma, and having external appliances.2-6 Patient issues include change in body perception, decrease in self-esteem, sexual dysfunction, being unfamiliar with/becoming a stranger to one’s own body, avoiding social settings, quitting previously enjoyed activities, quitting one’s job, and deterioration in quality of life.7–11
Descriptive studies and literature reviews12-16 have shown 1 of the primary psychosocial issues stoma patients struggle with is an abrupt change in how they perceive their bodies. Body perception has been defined as the perception of an individual toward the dimensions, appearance, and function of his/her body.17 Available literature18–23 underscores a positive body perception has a positive impact on confidence, self-esteem, and orientation toward health-promoting behaviors. In contrast, a negative perception has been linked to a variety of psychosocial problems in individuals. Thus, body perception can be described as the depiction in one’s mind of how he or she (and how others) sees his/her own body.24 According to the literature,25-28 this perception encompasses the events and diseases experienced by individuals in addition to their psychological condition and characteristics (eg, age and gender), the attitudes of his/her family and society, and the element of time.
The sudden change in body functions and physical appearance patients experience following stoma formation can negatively affect their body perceptions. Loss of bladder and intestinal functions, concerns regarding gas and odor discharge, problems with clothing, and being diagnosed with cancer are several of the main difficulties they face.15,16 The literature includes numerous references to associated changes in body perception known to render patients unable to view, touch, or conceal the stoma; feel ugly; experience social anxiety; avoid social relations and sexual contact; and be fearful of being rejected by family and friends or of being considered unattractive.3,29-31 Sharpe et al’s32 prospective research of 78 patients found stomas negatively impact the body image of patients with colorectal cancer; persons whose body image is most disturbed are at risk for experiencing more anxiety and depression.
Feeling he/she has lost some of his/her beauty and attractiveness, a stoma patient also might respond to his/her new body by trying to conceal it from his/her partner. This could result in problems between the 2 and compromise the harmony between them. On the other hand, fear of damaging the stoma may cause partners to distance themselves from the patient. This reaction may adversely affect the patient’s already uncertain view of his/her own body.7,33-35 In a cross-sectional study conducted among 40 stoma patients in Turkey, Kılıç et al14 reported persons who had positive perceptions of their bodies also had more harmonious relationships with their partners. Conversely, patients who had a negative perception avoided touching or having sexual contact with their partners. A quantitative and qualitative study conducted by Altschuler et al36 among 117 female stoma patients demonstrated the important role partners played in helping patients adjust to their physical changes; partners’ positive attitudes have been noted repeatedly in this and other studies14,34 to have a positive influence on patients’ perceptions and attitudes toward the stoma.
Literature confirming the effects of stomas on the body perceptions of patients is vast.12,14,16,34,37–40 Kılıç et al’s descriptive study14 compared the body perception of patients with and without a stoma using the Body Cathexis Scale (BCS), an instrument employed to assess levels of satisfaction with one’s body (see description to follow). For Kılıç et al’s study, the BCS score of stoma patients was 86.10 ± 16.57, and the mean BCS score of the healthy control group was 105.70 ± 11.99 (P = 0.00). In a study evaluating the life quality of 599 cancer and noncancer patients with colostomies from various ethnic origins, the satisfaction of cancer patients with colostomies concerning their appearance was low. In their descriptive study on the body image and self-esteem of stoma patients in Turkey, Üstindağ et al38 determined mean BCS scores to be 147.5 ± 22. In a descriptive, prospective study conducted on cancer patients with a colostomy, Ramer40 determined the body image of patients was adversely affected after a colostomy operation but their body image became more positive with time.
However, investigations evaluating the perceptions of partners toward the bodies of patients with stomas are relatively limited. No such research has been performed among Turkish patients or their partners. Recognizing the responses and perceptions of healthy partners are known to influence those of patients toward their own bodies and their adjustment to stomas, a descriptive, cross-sectional study was conducted to determine the perceptions of stoma patients with a colostomy, urostomy, or ileostomy and partners toward their bodies.
Methods and Procedures
Population and sample. The study population encompassed patients with stomas (N = 1,120, including patients with a colostomy, urostomy, or ileostomy) monitored at a stomatherapy unit of a 1,037-bed university hospital located in a metropolis in Turkey. Using convenience sampling methods, the study included patients seen for routine monitoring between March 1 and May 31, 2012.
Inclusion criteria stipulated participants must be at least 18 years old, married, and with an abdominal stoma for at least 2 months for evacuation purposes. Partners of patients also were included in the study.
Data collection. Relevant data were collected from stoma patients and their partners using custom-designed forms comprised of items based on the experience of the investigators and a thorough review of the literature.4,5,16,29,41-47 The literature review was conducted with no language or date of publication restrictions using the search terms stoma, stoma and encountered problems, and body image to ascertain the issues involved with regard to personal/partner adjustment to a stoma. The resultant questionnaires consisted of items with 3 answer options (agree, undecided, disagree) addressing: 1) body perception of the patient with a stoma on having a stoma (20 statements), 2) perception of spouses on the body of the patient with a stoma (20 statements), and 3) perception of spouses on the body of the patient with a stoma according to the patient with a stoma (20 statements) (see Table 1 and Table 2). The questions investigated the feelings of stoma patients regarding the stoma, body image of stoma patients, and factors affecting their life quality, body image relevant to the stoma, and the Patient with a Stoma Information Form developed by the Wound Ostomy Incontinence Nursing Society in Turkey.4,5,16,29,4-47 Two different data collection forms were developed — 1 for patients with a stoma and 1 for their partners.
Data collection instruments for patients with a stoma. The data collection form pertaining to patients with stomas consisted of 4 sections.
Demographic characteristics. The first section contained demographic-related characteristic questions and included age, gender, length of marriage, number of children, educational status, occupation, employment status, health insurance, diagnosis, stoma type and duration (colostomy, urostomy, or ileostomy), physical or psychosocial problems in having the stoma, and whether the person was informed preoperatively of the stoma creation. The second section contained the BCS. The BCS was developed by Secord and Jourard and adapted to the Turkish population by Hovardaoğlu,44 who examined the scale’s validity and reliability and reported a Cronbach’s alpha value of 0.91 (P <0.01). As a whole, the BCS consists of 40 items that assess a person’s feelings toward the function and level of activity of each of his/her body parts; individuals respond using a Likert scale-type response using 1 (“I do not like at all”), 2 (“I do not like”), 3 (“I am undecided/unsure”), 4 (“I like”), or 5 (“I like a lot”). Totaled scores can range from 40 to 200 on the scale, with higher total scores representing more positive evaluations of one’s body.
The third section included questions regarding the personal perceptions of patients with a stoma in terms of their body. This section comprised 20 statements in which patients were asked to indicate the response that most reflected their assessment of their body as “I agree,” “I disagree,” or “I am undecided” (see Table 1).
The fourth section included 20 statements (10 positive, 10 negative) on how the patient perceived their partner’s perceptions toward the stoma (see Table 2). Patients were asked to indicate the response that most reflected their assessment of their partners’ perceptions from the following: “I agree,” “I disagree,” or “I am undecided.”
Data collection instruments for partners.
Demographic characteristics. The data collection form pertaining to partners similarly gathered information on demographic characteristics and included age, gender, length of marriage, number of children, educational status, profession, employment status, and health insurance, as well as whether he/she was informed of the stoma creation preoperatively and how he/she felt about touching the stoma.
Partner perception of the ostomate’s body. The second section contained 20 statements (10 positive, 10 negative) regarding the perceptions partners had toward the stoma patient’s body (see Table 2). Partners of stoma patients responded to statements with “I agree,” “I disagree,” or “I am undecided.”
Data instrument assessment. After the 2 forms were developed by the investigators, they were reviewed by 2 experts whose recommendations and opinions informed the revision of the forms.
A preliminary survey in connection with the study was conducted among 10 patients who were married and >18 years old, registered at the stomatherapy unit between December 6 and 25, 2011 who had an abdominal stoma for a period of at least 2 months. The questionnaires were revised according to the results of the preliminary testing.
The purpose and method of the study were explained to couples who agreed to participate in the study. The couples were told the information would be kept confidential and not shared with partners. Participants arranged suitable times for the interviews that were conducted separately with each partner in a room suitable for interviews in the hospital. The data collection forms were completed through 30-minute to 45-minute, face-to-face interviews with patients and their partners. Data collection forms were completed by the researcher, a clinic nurse who worked in general surgery and thus had an understanding of the treatment of the patients with a stoma.
Data analysis. The data were digitized by the investigators using the Statistical Package for the Social Sciences (SPSS) 15.0 (Chicago, IL). The frequencies and percentage distributions of the related data were assessed. Mann Whitney U test and Bonferroni-corrected Kruskal Wallis H test were used to examine the difference among the groups in consequence of the normality test. The latter test was used to examine the difference between the stoma type and the scoring of the body image scale, and the Mann Whitney U test was used to examine the difference between the characteristics of the other stoma and the scoring of the body image scale (see Table 3). The Bonferroni-corrected Kruskal Wallis H test also was used to examine the difference between statements for Patients with a stoma personal perceptions of their body with a stoma, Partner perception of the ostomate’s body, Patients with stomas perception of how their partner perceives their about body with a stoma, and the scoring of the body image scale (see Table 1 and Table 2).
Ethical considerations. The study was approved by the Clinical Research Ethics Committee of Gazi University (February 22, 2012, resolution no: 084). Written permission also was obtained from the head physician’s office at the hospital where the research was conducted (March 13, 2012, s:B.30 2. GUN. 0.20-1852). All research participants were informed about the study and their written consent was obtained. All the patients fulfilling the research criteria who were monitored in the stomatherapy unit during the study period were informed about the study, and the related informed consent form was approved by all the patients who accepted to participate in the research.
Demographic findings and relationships to BCS scores. The study was conducted with a total of 60 patients (25 women, 35 men; mean age 56.01 ± 10.1 years) and their partners (mean age 54.56 ± 10.25 years), mean length marriage 33.06 ± 11.03 years. All couples participating in the study were heterosexual. Of the patients surveyed, 26 (43.3%) were graduates of primary school; 58 (96.7%) had children; 33 (55.0%) did not work before stoma surgery; 52 (86.7%) did not currently work at any job; and all patients had health coverage. Among their partners, 25 (41.7%) were primary school graduates and 49 (81%) did not currently work at any job (see Table 3).
The most common reason for stoma creation was cancer (54, 90.0%); 33 (55.0%) had a temporary stoma and 23 (38.3%) had a stoma for 2–3 months. Among participants, 48 persons (80%) were informed of stoma surgery; 40 (66.7%) of patients had their stoma site marked by stoma care nurses; and 30 (50%) of the patients with a stoma had a colostomy, 25 (41.7%) had an ileostomy, and 5 (8.3%) had a urostomy. Out of 30 colostomy patients, only 5 (16.7%) performed colostomy irrigation. Among the patients’ partners, 8 (30%) stated the stoma had a negative impact on their relationship (see Table 4).
Mean patient BCS score was 133.15 ± 20.58; specifically, mean BCS score of patients with a stoma due to cancer was 135.6 and to other diagnoses was 111.0, a statistically significant difference (P = 0.026). The mean BCS score of patients with an ileostomy (125.8) was lower than patients with a colostomy (135.6) and patients with a urostomy (154.8) (P = 0.005). No significant difference was determined in BCS scores in terms of the stoma being temporary or permanent (P = 0.214). The mean BCS score of patients who consulted spouses regarding the stoma operation was 137.0 and 127.11 among ostomates who did not consult spouses before surgery (P = 0.021) (see Table 5).
The mean BCS score of patients whose partner helped in stoma care (136.04) was also higher than those whose partners did not help (120.27) (P = 0.033) (see Table 5).
Additionally, 44 patients (73.4%) with stomas experienced physical problems (skin problems, odor, leakage, gas, diarrhea, prolapse, parastomal herniation, bleeding, retraction, infection, fistula, mucocutaneous separation) and 36 (60.0%) encountered psychosocial problems (anxiety, anger, refraining from sexual intercourse, depression, decrease in self-confidence, impairment in family relationships, avoidance of social activities, staying away from friends, disagreed to stoma.) The mean BCS score of patients experiencing a stoma-related physical problem was 129.64 versus 142.81 among persons who did not experience such problems (P = 0.022). The mean BCS scores of patients experiencing psychosocial problems was 127.5 versus 141.5 among those who did not experience such problems (P = 0.012) (see Table 5).
The mean BCS scores of patients whose partners stated the stoma adversely affected their relation was 125.6 compared to 138.1 among patients whose partners did not think the stoma adversely affected their relationship (P = 0.040) (see Table 5).
No other demographic variables were significantly different.
Patient BCS scores regarding body perception. As detailed in Table 1, the mean BCS score of patients agreeing with the statement I believe that people like my physical appearance, was 140.95, higher than those who disagreed with that statement (126.38) (P = 0.047). Further, the mean BCS score of patients agreeing with the statement I feel comfortable in my clothes (140.50) was higher than those who disagreed (118.79) (P = 0.011). BCS scores of patients who disagreed with the statements I do not enjoy seeing or touching my stoma and I think that my body is not under my control due to my stoma were higher (P = 0.018 and P = 0.029, respectively) than those of patients who agreed with the statement.
Patient BCS scores regarding agreement with partner perceptions of their bodies. The mean BCS score of patients agreeing with the statement When I am naked, my partner feels that I am sexually attractive (143.83) was higher compared to those stating they were undecided (125.40) (P = 0.005). BCS scores were also higher among patients who disagreed with the statement My partner does not enjoy seeing and touching my stoma (140.84) than those agreed (124.00) and were undecided (117.83) (P = 0.000) and in patients who disagreed (137.11) with the statement My partner thinks that the stoma causes me to have an unpleasant appearance than in who were undecided (122.92) (P = 0.036). The mean BCS scores of patients who disagreed with the statements My partner thinks that the stoma limits my choice of clothing and There has been a decrease in the interest and admiration of my partner toward me due to my stoma were higher than those who agreed (P = 0.025 and P = 0.026, respectively) (see Table 2).
Patient BCS scores regarding how partners perceived their bodies. The mean BCS score of patients whose partners agree with the statement Looking at the stoma is not different than looking at the other organs for my partner (140.03) were higher than those whose partners were undecided (119.67) (P = 0.023). BCS scores also were higher among patients with partners who agreed with the statement I feel sexually attracted to my partner when s/he is naked (139.41) than those whose partners disagree (126.25) (P = 0.017) and higher among patients whose partners agree with the statement My partner feels comfortable in clothing (140.28) than among those whose partners were undecided (123.60) (P = 0.015). The mean BCS score of patients with partners who disagreed with the statement I think that my partner’s body is not under his/her control due to his/her stoma (142.08) was higher than among those who agreed (125.56) (P = 0.009). Patients whose partners disagreed with the statement I am embarrassed by the appearance of my partner’s body due to the stoma (137.69) scored higher on the BCS than those whose partners were undecided (115.63) (P = 0.003) (see Table 2).
In this study conducted among 60 patients with stomas and their partners to ascertain the perceptions of stoma patients and their partners toward their bodies, the most frequent reason for creation of the stoma was cancer (see Table 4). According to statistics published by the Ministry of Health of the Republic of Turkey,48 colorectal cancers are the second most prevalent cancer type among females and the third most prevalent type among males in Turkey. Üstündağ et al38 determined 79.9% of patients had a stoma created due to cancer; in their cross-sectional study (N = 53) with a stoma in Turkey, Yaşan et al49 found the rate to be 68.17%; and in their study conducted in Iran (N = 155), Mahjoubi et al50 determined this rate to be 70.2%.
These findings were consistent with the current study. The prevalence of colorectal cancer both globally and nationwide continues to increase. Resection and stoma creation is an effective method of treatment.
The study found the mean BCS score of patients with a cancer-related stoma (135.61) was lower than those with a stoma due to other reasons (111.00) (P = 0.026) (see Table 3). According to Ramer’s40 prospective descriptive studies on how cancer changes self-image, patients had a low body image score before stoma creation and no significant change postoperatively; the cancer diagnosis had a negative impact on body image, findings similar to the current study.
The mean BCS score of patients participating in the current study was 133.15 ± 20.58 (see Table 3). In Kılıç et al’s descriptive study,14 the mean BCS score was 86.10 ± 16.57, and in Üstündağ et al38 it was 147.5 ± 22. The mean BCS score of patients with stomas in the current study supported previous data, but was it was low. The body perception of stoma patients has been known to change negatively with organ and function loss, defecation, loss of gas and odor control, changes in body appearance, and being diagnosed with cancer15,16; hence, the low mean BCS score of patients in this study was an expected finding.
Furthermore, 41.7% patients in the current study had an ileostomy created and their mean BCS score (125.88) was significantly lower than patients with a colostomy (135.60) or urostomy (154.80) (P = 0.005) (see Table 3). Further analyses revealed patients with an ileostomy experienced more physical and psychosocial problems, which may explain the difference observed in mean scores. In the current study, the mean BCS score of patients experiencing physical (129.64) and psychosocial problems (127.56) was significantly lower than those of patients who did not experience such problems (142.81 and 141.54, respectively; P = 0.022 and P = 0.012, respectively) (see Table 3). In a previous body perception study (N = 60) conducted by Piwonka,39 patients with stomas were found to face multiple physical and psychosocial changes and challenges.1,8,10 In fact, patients with ileostomy may encounter more stomal and peristomal problems due to the liquid and enzymatic content of the stoma output.2,51,52 These problems can negatively affect patient perception of their bodies.2,52
In the current study, a large majority of patient partners assisted with stoma care, and the mean BCS score of patients whose partners (136.04) assisted with care was higher than those of patients whose partners (120.27) did not help (P = 0.033) (see Table 3). According to Altschuler et al,36 undertaking stoma care together with partners was found to have a positive effect on the psychosocial adjustment of patients. In fact, many previous investigations, including by Rehse and Pukrop,53 Raingruber,54 and Altschuler et al,36 confirmed family support was essential to reducing the psychosocial problems patients faced or in coping with such issues post ostomy surgery. Patients with stomas fear rejection by their families and especially their partners.3,31 However, the involvement of partners in care enables patients to accept the stoma and adapt more easily to his/her new body. Partner participation also contributes to the development of positive body perceptions among stoma patients, which is in essence a psychosocial concept.
More than half of the stoma patients surveyed consulted their partners’ opinions in the decision to create a stoma; their mean BCS score was higher (137.00) than that of patients whose partners were not consulted (127.11) (P = 0.021) (see Table 5). No similar result was found in the literature. The emotional support of the patient’s family has been shown to be considerably important in deciding to undergo the procedure.55 Thus, patients with stomas who had consulted the opinions of their partners went through all the stages pertaining to treatment and care along with their partners and were able to share their feelings and thoughts. The high BCS scores of patients deciding on an operation with their partners is a relatively important finding in terms of the rehabilitation of patients with stomas whose body perceptions have been negatively impacted.
The BCS scores of patients whose partners thought the stoma had a negative effect on their relationship were observed to be significantly lower (125.6) (P = 0.040) (see Table 5). In a descriptive study of patients with a permanent colostomy (N = 121), Szczepkowski7 reported 19.4% of men and 20.4% of women believed having a stoma increasingly deteriorated their relationships with their partners. In Kılıç et al’s14 research, patients with an ostomy acknowledged having considerable difficulty maintaining harmonious relationships with their partners, and the body perceptions of those who did manage to do so were more likely to develop in a positive direction. Altschuler et al’s36 research found partners who responded more positively had a positive effect on patients’ adjustment to stomas. As these studies and the current study reveal, the newly forming body perceptions of recent stoma patients are directly affected by their close partners.
In the current study, patients held positive perceptions of their own bodies (eg, who thought they were beautiful and attractive, whose partners had such positive thoughts, or who believed their partners had positive perceptions of their bodies), scored higher on the BCS than persons with negative views or assessments (see Tables 1 and Table 2). Salisbury’s34 descriptive research of 18 patients with an ostomy found 10% of men and 50% of women believed they were attractive until the time of stoma surgery. Kılıç et al14 found patients who had harmonious relationships with their partners had good sexual communication and positive body perceptions, while Yaşan et al49 observed 40.92% of patients with a permanent stoma and 74.19% of patients with a temporary stoma in their study (N = 53) felt embarrassed by their physical appearance. Beauty and attractiveness are social concepts, symbolized by the entire body. Changes in physical appearance may lead to changes in interest and admiration between partners; having a stoma could lead patients to think they had lost their beauty and attractiveness and thus the interest and admiration of their partners. This perception influences that of their partners, which in turn influences the view/opinion held by patients. Thus, patients and their partners reinforce the negative and positive perceptions they have of each other.
In the present study, patients who did not enjoy seeing and touching their stomas and who thought their partners had similar feelings had low BCS scores (P = 0.018, P = 0.000 for patients and partners, respectively) (see Table 1 and Table 2). In Krouse et al,37 13.0% of patients who had a stoma created due to cancer and 16.0% of those who had one constructed for other reasons experienced difficulties in looking at the stomal region. Being unable to look at his/her body and avoiding touching his/her body may signify a patient who is unable to accept the stoma and become accustomed to its appearance, perceiving it to be foreign. In such situations where an individual has to live with a body part he/she rejects, his/her body perception may be adversely affected.
The present results showed patients whose partners perceived they had difficulties with being comfortable wearing/choosing clothing and who themselves thought similarly had relatively lower BCS scores (P = 0.015) (see Table 2). A vast majority of the literature has verified stomas affect individual styles of dressing.6,37,49 Patients who feel more comfortable with their clothing tend to be more at peace with their bodies and vice versa; these 2 factors mutually influence each other.
In the current study, the BCS scores of patients who believed their bodies were not under their control were significantly lower than persons who did not express that belief (P = 0.029) (see Table 2). Furthermore, the scores of those whose partners disagreed with the statement I think that my partner’s body is not under his/her control due to the stoma were higher than those who agreed (P = 0.009) (see Table 2). In a cross-sectional study of patients with a colostomy (N = 86), Mckenzie et al55 noted 50% of the individuals thought they had lost control over their body due to the stoma. Feelings of loss of control were due largely to patients’ loss of control over elimination, gas, and odor through the stoma, which can negatively influence patients’ perceptions of their bodies.
Because body perception is created from an individual’s thoughts regarding the appearance of his/her body and how other people see it,27 it involves an intellectual process that is affected by time, experiences, diseases, and the attitudes/values of family and society. The opposite sex is known to play an important role in determining the ideal body, their messages having substantial influence.56 The supportive comments and thoughts of partners can positively affect the perceptions of individuals toward their own bodies.33
The study was conducted only with individuals with an abdominal stoma created for elimination purposes for a period longer than 2 months and monitored in 1 stomatherapy unit (there are 12 stomatherapy units in Turkey). The preoperative body perceptions of individuals and their partners were not evaluated. The study involved only heterosexual married couples and only included individuals 18 years of age and older, and convenience sampling methods may have biased the sample in some way.
A descriptive, cross-sectional study was conducted to assess the perceptions of 60 persons with a stoma and their partners toward the body of the stoma patient. Patients’ perceptions of their bodies parallelled those of their partners. Among pertinent findings were 1) the mean BCS score of patients whose partner helped in stoma care was significantly higher than among persons whose partners did not help and 2) consulting a partner’s opinions on stoma creation increased his/her participation in care. The BCS scores were lower in patients whose partners thought the stoma had a negative effect on their relationship. In line with these results, informing stoma patients and their partners of the stoma before its creation and consulting the opinions of partners regarding the surgery, building protective resources/services against potential physical and psychosocial problems associated with stomas and their care, increasing partner participation in stoma care, periodically evaluating patient perceptions, and organizing activities for patients involving their partners are all recommended for the development of positive body perceptions of patients following the creation of a stoma.
The results obtained from this study will contribute to the development of current literature on stomas and their associated issues and help facilitate practical solutions/suggestions for enhancing training and consultancy services to positively affect the body perceptions of patients with stomas.
1. Karadağ A, Menteş B. Regarding the Care of Patients with Colostomy, and İleostomy Guide Book. Available at: www.stoma-seite.de/kolostomili.htm. Accessed December 12, 2013.
2. Porrett T, Mcgrath A. Stoma Care. Oxford, UK: Wiley-Blackwell Publishing Ltd;2005.
3. Burch J. Psychological problems and stomas: a rough guide for community nurses. Br J Community Nurs. 2005;10(5):224–227.
4. Baykara Z, Leventoğlu S, Menteş B. Individual feelings and opinions regarding the first ıntestinal excretion following stoma closure: a pilot study. Kolon Rektum Hast Dergisi. 2007;17(2):76–81.
5. Nugent KP, Daniels P, Stewart B, Patankar R, Johnson CD. Quality of life in stoma patients. Dis Colon Rectum. 1999;42(12):1569–1574.
6. Taylan S, Akıl Y, Polat M, Akçam T. The Training Effect on the Development of Stoma Complication. [Koloproktoloji Stoma-terapi Sempozyumu Kitapçığı}. Adana, Poland: Çukurova Unuversity;2005:188.
7. Szczepkowski M. Do we still need a permanent colostomy in XXIst century? Acta Chir Iugosl. 2002;49(2):45–55.
8. Persson E, Hellstrom AL. Experiences of Swedish men and women 6 to 12 weeks after ostomy surgery. J Wound Ostomy Continence Nurs. 2002;29(2):103–108.
9. Engel J, Kerr J, Schlesinger-Raab A, Sauer H, Holzel D. Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg. 2003;238(2):203–213.
10. Dabirian A, Yaghmaei F, Rassouli M, Tafreshi MZ. Quality of life in ostomy patients: a qualitative study. Patient Preference and Adherence. 2011; doi: 10.2147/PPA.S14508.
11. Manderson L. Boundary breaches: the body, sex and sexuality after stoma surgery. Soc Sci Med. 2005;61(2):405–415.
12. Brown H, Randle J. Living with stoma: a review of the literature. J Clin Nurs. 2005;14(1):74–81.
13. Cotrim H, Pereira G. Impact of colorectal cancer on patient and family: implications for care. Eur J Oncol Nurs. 2008;12(3):217–226.
14. Kılıç E, Taycan O, Belli AK, Özmen M. The effect of permanent ostomy on body ımage, self-esteem, marital adjustment, and sexual functioning. Türk Psikiyatri Derg. 2007;18(4):302–310.
15. Ünal S. Problems of patient’s with stoma and ways to deal with them: İndividuals diagnosed with cancer, body image distortion, loss of function of social isolation VIII. Basic Stoma Care Nursing Course Notes. Ankara, Turkey: Ekim;2010.
16. Cohen A. Body image in the person with a stoma. J Enterostomal Ther. 1991;18(2):233–240.
17. Kozier B, Erb G, Berman AJ, Burke K. Fundamentals of Nursing Concepts, Process and Practice, 6th ed. Upper Saddle River, NJ: Pearson Prentice Hall;2000;906–922.
18. Atik D, Örten T. Social and ınstitutional factors shaping the ıdeal body ımage and effects of this ıdeal on ındividuals. Edebiyat Fakültesi Dergisi. 2008;25(1):17–35.
19. Why is body image important? Available at: www.youth.gov.au/sites/Youth/bodyImage/informationsheets/Documents/BodyI.... Accessed February 10, 2014.
20. Rumsey N, Harcourt D. Body image and disfigurement: issues and interventions. Body Image. 2004;1(1):83–97.
21. Melissa DS, Cash FT. Self-help for a negative body image: a comparison of components of a cognitive-behavioral program. Behavıor Ther. 2002; doi:10.1016/S0005-7894(02)80027-2.
22. David BS, Thomas A, Wadden, Michael J, Pertschuk Linton AW. The psychology of cosmetıc surgery: a revıew and reconceptualızatıon. Clin Psychol Rev. 1998;18(1):1–22.
23. Canatan K. Beden Sosyolojisi, 1st ed. İstanbul, Turkey: Şenyıldız Matbaacılık; 2011.
24. Sanford LT, Donovan ME. Women and Self-Esteem. Kunt S (Translation), 1st ed. Ankara, Turkey: HYB Yayıncılık:1999.
25. Breckinridge P. Self concept. In: Perry A, Potter P. Fundamentals of Nursing, 5th ed. Canada: Elsevier Mosby Inc;2001:540–565.
26. Grogan S. Body Image: Understanding Body Dissatisfaction in Men, Women and Children, 2nd ed. New York, NY: Routledge;2008.
27. Tiggeman M. Body image across the adult life span: stability and change. Body Image. 2004;1(1):29–41.
28. Heatherton TF. Body Image and gender. In: Smelser NJ, Balte PB. International Encyclopedia of the Social and Behavioral Sciences, 1st ed. Oxford, UK: Elsevier;2001:1282–1285.
29. Karadağ A, Göçmen Baykara Z. Care of the patient with an ostomy. İn: Atabek Aşti T, Karadağ A. Hemşirelik Esasları: Hemşirelik Bilim ve Sanatı, 2nd ed. İstanbul, Turkey: Akademi Basın ve Yayıncılık;2013:1015–1056.
30. Carpetino-Moyet LJ. Handbook of Nursing Diagnosis, 13th ed. Erdemir F (Trans), Ankara, Turkey: Nobel Tıp Kitapevleri;2012.
31. Black PK. Psychological, sexual and cultural issues for patients with a stoma. Br J Nurs. 2004;13(12):692–697.
32. Sharpe L, Patel D, Clarke S. The relationship between body image disturbance and distress in colorectal cancer patients with and without stomas. J Psychosomatic Res. 2011;70(5):395–402.
33. Mclaren L, Kuh D, Hardy R, Gauvin L. Posıtıve and negatıve body-related comments and theır relatıonshıp wıth body dıssatısfactıon in mıddle-aged women. Psychol Health. 2004;19(2):261–272.
34. Salisbury M. Sexual awareness, body ımage, and self-esteem of ındividuals who have ostomies. Master Thesis in Nursing. Ohio: Medical College; 2004.at: https://etd.ohiolink.edu/ap:10:0::NO:10:P10_ACCESSION_NUM:mco1121701377. Accessed January 26, 2014.
35. Sprunk E, Alteneder RR. The impact of an ostomy on sexuality. Clin J Oncol Nurs. 2000;4(2):85–88.
36. Altschuler A, Ramirez M, Grant M, Wendel C, Hornbrook MC, Herrinton L, et al. The ınfluence of husbands’ or male partners’ support on women’s psychosocial adjustment to having an ostomy resulting from colorectal cancer. J Wound Ostomy Continence Nurs. 2009;36(3):299–305.
37. Krouse R, Grant M, Ferrell B, Dean G, Nelson R, Chu D. Quality of life outcomes in 599 cancer and non-cancer patients with colostomies. J Surg Res. 2007;138(1):79–87.
38. Üstündağ H, Demir N, Zengin N, Gül A. Body image and self-esteem in patients with stoma. Turkiye Klinikleri J Med Sci. 2007;27:522–527.
39. Piwonka MA, Merino JM. A multidimentional modeling of predictors influencing the adjustment to a colostomy. J Wound Ostomy Continence Nurs. 1999;26(6):298–235.
40. Ramer L. Self-image changes with time in the cancer patient with a colostomy after operation. J ET Nurs. 1992;19(6):195–203.
41. Jenks M, Morrin H, Tomaselli C. The influence of ostomy surgery on body image in patient with cancer. Appl Nurs Res. 1997;10(4):174–180.
42. Ayaz S, Kubilay G. Effectiveness of the PLISSIT model for solving the sexual problems of patients with stoma. J Clin Nurs. 2009;18(1):89–98.
43. Wound Ostomy Inkontinance Nursing Society. Wound Ostomy Inkontinance Nursing Society Patient with Stoma’s Information Form. Available at: www.yoihd.org.tr/UserFiles/formlar/. Accessed August 12, 2011.
44. Hovardaoğlu S. The Body Cathexis Scale, 3P. Dergisi. 1993;1(2):26.
45. Kurt E, Özdilli K, Yorulmaz H. Body image and self-esteem in patients with rheumatoid arthritis. Arch Neuropsychiatr. 2013; doi: 10.4274/npa.y6195.
46. Karadağ A, Öztürk D, Çelik B. Adaptation of Quality of Life Scale for Ostomy Patients into Turkish. Kolon Rektum Hast Derg. 2011;2(4):173–181.
47. Baxter NN, Goodwin PJ, MCleod RS, Dion R, Devins G, Bombardier C. Reliability and validity of the body image after breast cancer questionnaire. Breast J. 2006;12(3):221–232.
48. Turkey Statistical Institute. Annual of Turkey Statistical, 2010. Ankara, Turkey: Turkey Statistical Institute Matbaası;2011.
49. Yaşan A, Ünal S, Gedik E, Girgin S. Quality of life, depression and anxiety among patients who have undergone permanent or temporary ostomy. Anadolu Psikiyatri Dergisi. 2008;9(3):162–168.
50. Mahjoubi B, Mohammadsadeghi H, Mohammadipour M, Mirzaei R, Moini R. Evaluation of psychiatric illness in Iranian stoma patients. J Psychosomatic Res. 2009;66(3):249–253.
51. Baykara Z. Ostomy care. İn: Atabek Aştı T, Karadağ A. Klinik Uygulama Becerileri ve Yöntemleri, 1st. Adana : Nobel Kitabevi;2011:1146-1177.
52. Life with ileostomy. Available at: http://www.yoihd.org.tr/userfiles/formlar/Ileostomi_Ile_Yasam.pdf. Accessed: February 10, 2013.
53. Rehse B, Pukrop R. Effects of psychosocial interventions on quality of life in adult cancer patients: meta-analysis of 37 published controlled outcome studies. Patient Educ Couns. 2003;50(2):179–186.
54. Raingruber B. The effectiveness of psychosocial interventions with cancer patients: an integrative review of the literature (2006–2011). ISRN Nurs. 2011 1-27. Published online 2011 November 16. Article ID 638218, doi: 10.5402/2011/638218.
55. McKenzie F, White CA, Kendall S, Finlayson A, Urquhart M, Williams I. Psychological impact of colostomy pouch change and disposal. Br J Nurs. 2006;15(6):308–316.
56. Stanford NJ, McCabe PM. Body ımage ıdeal among males and females: sociocultural influences and focus on different body parts. J Health Psychol. 2002;7(6):675–684.