The Effect of Pelvic Floor Muscle Exercises on Bowel Evacuation and Quality of Life in Following Intestinal Ostomy Closure: Randomized Controlled Trial.

PURPOSE: This purpose of this study was to evaluate the effect of pelvic floor muscle exercises (PFMEs) on bowel evacuation problems and health-related quality of life (HRQOL) following ostomy closure. DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: Forty individuals following ostomy closure consented to participate in the study; 6 participants (15%) did not complete the trial (2 died and 2 required a second ostomy) yielding a study sample of 34. Participants were randomly allocated to an Exercise Group (EG, n = 17) and Control Group (CG, n = 17). The mean age of the EG was 55.7 (SD 12.6) years, whereas the mean age of the CG was 62.0 (SD 12.1) years. The study setting was the surgery clinic of 4 hospitals in Ankara, Turkey. Data were collected between December 2018 and May 2020. METHODS: The study intervention, PFME training by a clinician, was administered to participants in the EG; CG participants received no information regarding PFME. Data were collected during face-to-face interviews on the day before discharge and by phone at the first, second, third, and sixth months after surgery. A questionnaire was used for data collection that queried a demographic and pertinent clinical questions, along with the Assessment Form for Bowel Evacuation Habits and Psychosocial Problems, Wexner Scale, and the Short Form (SF-36) Health-related Quality of Life Scale. Descriptive statistics and Mann-Whitney U test, t-test, Pearson-χ2 test, Fisher's Exact test, Friedman test, and Cochran-Q test statistical analysis according to normal distribution were used in data evaluation. RESULTS: The number of defecations in the EG was statistically significantly lower than the CG at the second, third, and sixth months (P = .002, P = .002, P = .001, respectively). In addition, the number of individuals experiencing night defecation was statistically significantly less in the EG compared to the CG at the second-, third-, and sixth-month follow-ups (P = .001, P = .001, P = .028, respectively). HRQOL scores were also significantly higher in the EG. CONCLUSION: Pelvic floor exercises applied after ostomy closure are effective in reducing bowel evacuation and increasing quality of life. Given these findings, PFMEs are recommended for patients after ostomy closure.

The Effect of Stoma Site Marking on Stomal Complications: A Long-term Retrospective Study.

OBJECTIVE: To identify the effect of stoma site marking on stoma-related complications. METHODS: The study sample included 639 individuals with stomas who were followed up in a stomatherapy unit in Turkey between January 1, 2017, and June 20, 2021. Researchers collected patient data from nursing records. Data were evaluated using number, percentage, χ2, and logistic regression tests. RESULTS: Of the individuals with stomas, 60.6% (n = 387) were men, and 72.6% (n = 464) had a cancer diagnosis. Their mean age was 60.16 (SD, 14.81) years. The stoma site was marked preoperatively in of 67.1% of patients (n = 429), and 17.1% (n = 109) developed stoma-related complications. The complication rate was higher in individuals with unmarked stoma sites (25.7%; P = .000), emergency surgeries (25.0%; P = .006), colostomies (23.9%; P = .042), and permanent stomas (28.3%; P = .002). The three most common complications were peristomal skin problems (56.9%), mucocutaneous separation (13.8%), and edema (9.2%). CONCLUSIONS: The incidence of stoma-related complications in the postoperative period was higher in individuals with unmarked stoma sites. The authors recommend that stoma and wound care nurses mark the stoma site in individuals for whom stoma creation is planned.

Changes in the Lives of Individuals with a Stoma and Their Spouses: A Qualitative Study.

OBJECTIVE: Individuals with a stoma and their spouses experience various changes with regard to their new life situation. The authors aimed to determine the changes caused by stoma creation in the lives of individuals with a stoma and their spouses. METHODS: This study was carried out with individuals with a stoma (n = 15) and their spouses (n = 15) in a stoma therapy unit. Semistructured interviews were digitally audio recorded and transcribed. Inductive reasoning was used in the analysis of the qualitative data. RESULTS: As a result of the data obtained from in-depth interviews, the authors identified three contexts, nine themes, and many subthemes (49 subthemes for individuals with a stoma and 30 subthemes for spouses). Most subthemes were expressed by both the individual with a stoma and his/her partner, showing that the feelings, thoughts, and difficulties experienced were often shared between spouses. CONCLUSIONS: Ostomies change the lives of individuals and their spouses. These changes have mostly negative biopsychosocial effects. However, after stoma surgery, spouses strengthen their commitment to each other and better understand the value of being healthy.

Determination of Quality of Life and Self-Care Agency in Patients Who Underwent Colorectal Cancer Surgery: A Prospective Descriptive Study.

BACKGROUND: Knowledge about the relationship between quality of life and self-care among patients with colorectal cancer in Turkey is limited. PURPOSE: This prospective, descriptive study evaluated the quality of life and self-care agency of patients who underwent surgery for colorectal cancer. METHODS: Patients were recruited to participate preoperatively from the general surgery clinics in 2 hospitals in Turkey. Sociodemographic variables were collected preoperatively, and the Quality of Life Scale for Cancer Patients (EORTC QLQ-C30) Turkish Version 3.0, the Quality of Life Scale for Colorectal Cancer Patients (EORTC QLQ-CR29), and the Self-Care Agency Scale were completed preoperatively and at 1, 3, and 6 months postoperatively. RESULTS: Thirty-seven (37) patients (average age 59.49 years [±10.84]) who met the inclusion criteria participated in the study. The majority were male (22 patients; 60%), and 25 (67%) did not have a stoma postoperatively. Compared with preoperative scores, QLQ-C30 general well-being, functional status, physical functions, and role performance scores decreased in the first month after surgery and increased in the third and sixth months (58.3 [preoperative] vs 75.0 [month 3] vs 83.3 [month 6]; P = .000). The preoperative QLQ-CR29 excretory system pleasure scores were higher than the postoperative third- and sixth-month scores (1.7 [preoperative] vs 1.0 [month 3] vs 1.0 [month 6]; P = .001). The Self-Care Agency scores at 6 months were higher than the postoperative first month (109.62 ± 11.62 vs 115.19 ± 14.22; P = .006). A positive correlation was found between Self-Care Agency scores and functional status scores of the QLQ-C30 scale at 3 and 6 months postoperatively (P = .000). CONCLUSION: Quality of life and Self-Care Agency scores decreased immediately after surgery but increased in the following 6 months. A positive correlation was found between quality of life and self-care agency.

Family Functioning, Perceived Social Support, and Adaptation to a Stoma: A Descriptive, Cross-sectional Survey.

The creation of a stoma is a life-saving surgical procedure that requires major adjustments. PURPOSE: The aim of this study was to examine the relationships among family functioning, perceived social support, and adaptation to living with a stoma. METHOD: A descriptive, cross-sectional survey was conducted between October 2013 and June 2015 among consecutive patients who visited the stomatherapy unit of a university hospital in Ankara, Turkey, for regular follow-up visits. Eligibility criteria stipulated participants must be at least 18 years of age, literate, live with family, have their stoma for at least 2 months, and be willing to participate. Instruments included a demographic and stoma-related information form, the Multidimensional Scale of Perceived Social Support (MSPSS; subscale range 4-28, total score range 12-84; higher scores indicate better perceived support), the McMaster Family Assessment Scale (FAS; range 1.32-3.15; higher scores indicate deteriorating family function), and the Ostomy Adjustment Inventory Scale-23 (OAI-23; range 19-85; higher scores indicate increasing adaptation). Data were entered into statistical software for analysis that included descriptive statistics and Mann-Whitney U and Spearman correlation tests. RESULTS: Among the 75 participants (mean age 55.4 ± 12.96 years; average stoma duration 3.77 ± 4.97 years), 41 (54.7%) were male, 59 (78.7%) were married, and mean duration of living with a stoma was 3.77 ± 4.97 years. The average MSPSS score was 61.0 5 ± 15.00, the average FAS score was 1.98 ± 0.38, and the average OAI-23 score was 49.39 ± 14.62, all within the "moderate" range for their measures. Stoma complications, time since surgery, stoma self-care, marital status, whether the surgery was planned or an emergency, and employment status significantly affected MSPSS, FAS, and OAI-23 scores. As the FAS scores increased, the MSPSS (r = -.399; P = .001), and OAI-23 (r = -.300; P = .009) scores decreased. CONCLUSION: The results suggest wound, ostomy, continence nurses should assess and encourage familial and social support. Prospective studies examining the effect of familial and social support on stoma adjustment are warranted.

A multicenter, retrospective study to evaluate the effect of preoperative stoma site marking on stomal and peristomal complications.

Even though preoperative marking of the stoma area is considered important for the prevention of postoperative complications, not all healthcare institutions have universally adopted this practice. A multicenter, retrospective, descriptive study was conducted to determine the effect of stoma site marking on stomal and peristomal complications. The 1-year study included 748 patients (408 [54.5%] male, mean age 56.60 ± 16.73 years) from eight stomatherapy units in Turkey. Patient data, including age, gender, diagnosis, type of surgery, history of preoperative stoma site marking, person performing the marking, and postoperative complications, were obtained from patient records, abstracted, and analyzed. Cancer was the reason for the operation in 545 (72.9%) of the cases. In 287 patients (38.4%), the stoma and wound care nurse and/or surgeon marked the stoma area; this occurred 1 day before or on the day of surgery according to Wound Ostomy Continence Nurses Society and American Society of Colon and Rectal Surgeons recommendations. Stomal/ peristomal complications developed in 248 (33.2%) persons; the most frequently observed complications in patients were parastomal skin problems (136, 48.7%), mucocutaneous separation (52, 18.6%), and retraction (31, 11.1%). The rate of complications was higher among patients whose stoma site was not marked than among those whose stoma site was marked (22.9% and 46%, respectively; P <0.001). The results of this study confirm the stoma area should be marked preoperatively in all planned surgical interventions in order to reduce the risk of postoperative complications. Additional prospective and experimental studies on effectiveness of preoperative stoma site marking should be conducted with larger sample groups.

Colostomy irrigation: an important issue for Muslim individuals.

Colostomy irrigation (CI) is a bowel management method in individuals with permanent colostomy, as an alternative to pouch use, which may provide continence. CI helps the individuals with an artificial stoma to adjust to the stoma and may increase their quality of life (QOL). An uncontrolled intestinal gas discharge invalidates ablution, and noisy gas discharge and smell prevents congregational prayers, which cause problems to Muslims with stomas. Therefore, CI may be an appropriate solution for this patient group. Using the example of one affected individual we discuss how the praying problem can be resolved with teaching to self-perform CI and emphasize the beneficial effects on QOL.