Improving quality of life for Muslim patients requiring a stoma: A critical review of theological and psychosocial issues

Abstract

Aim The impact of a stoma on the health related quality of life (HRQoL) in patients is irrespective of faith. Muslim patients report lower quality of life and spiritual well‐being following stoma surgery as compared to others. This critical review aims to improve awareness of Islamic practices and HRQoL outcomes in this cohort of patients amongst healthcare professionals. Method An extensive non‐systematic search of EMBASE, MEDLINE and Google Scholar was performed for original research articles pertaining to health related quality of life (HRQoL), stoma care and impact on religious practice in Muslim patients. A narrative synthesis of extracted data was performed and presented using basic thematic analysis. Results The findings from the 10 original articles, including 954 participants, were identified. Perceptions of cleanliness emerged as a concern to Muslim patients with stomas as it is core to the performance of prayer. Muslim patients with stomas are known to avoid or reduce participation in prayers due to perceived inferior hygiene and fear of leakage. The consensus opinion from Islamic scholars is that they can pray normally, attend mosque and perform the Hajj pilgrimage. Stoma patients may fast in the holy month of Ramadan provided it is medically safe. Evidence suggests religion‐specific counselling can reduce the detrimental effect on HRQoL of Muslim patients following stoma‐forming surgery and increases engagement in social aspects of life. Conclusions It is important for patients, family members and healthcare professionals to understand the practical and religious implications of stomas on these patients for appropriate guidance and counselling.

Experiences of Ethnic Minority Patients Who Are Living with a Primary Bowel Condition or Bowel-Related Symptoms of Other Chronic Diseases: A Systematic Review

“…Guidance in using medication during Ramadan could be addressed in future interventions (37). Religious actions were noted to have positive impact on experiences of IBD in our review (31,36,37), however other studies revealed that surgical interventions may also reduce QOL (60,61,63). A literature review (61) of stoma patients found that perceptions of symptoms (e.g.…”

“…Anxieties around IBD symptoms (e.g., fear of incontinence and bowel movements) on managing daily religious duties based on physical puri cation for Muslim South Asians (31,36,37), has been previously reported with other bowel-related conditions such as IBS ( 59), colostomy procedures (60,61) and in urinary incontinence (20,58). Since certain bowel symptoms may nullify the state of puri cation, during symptom are-ups there may be additional selfmanagement challenges due to the repeated need for puri cation and needing to be near washing facilities (62); these challenges may be heightened during religious months such as Ramadan, and the Hajj pilgrimage (60,61). Guidance in using medication during Ramadan could be addressed in future interventions (37).…”

“…uncleanliness) had a negative impact on psychological, religious and spiritual well-being since patients were restricted in fully immersing themselves in religious activities after surgery e.g., participation in congregational prayer in mosques and limited frequency or complete cessation of prayer. Fear of damaging the stoma was mentioned as a contributing factor to ceasing fasting in Ramadan, though medically safe (60,61).…”

Experiences of ethnic minority patients who are living with a primary chronic bowel condition: a systematic scoping review with narrative synthesis

“…Discretion in discussing bowel symptoms were also relevant to Pakistani women with urine incontinence [ 48 , 68 ]. Anxieties around IBD symptoms (e.g., fear of incontinence and bowel movements) on managing daily religious duties based on physical purification for Muslim South Asians [ 43 , 48 , 49 ] has been previously reported with IBS [ 69 ], colostomy procedures [ 70 , 71 ], and in urinary incontinence [ 22 , 68 ]. Since certain bowel symptoms may nullify the state of purification, therefore during symptom flare-ups there may be additional self-management challenges due to the repeated need for ablution and needing to be near washing facilities [ 72 ]; these challenges may be heightened during religious months such as Ramadan and the Hajj pilgrimage [ 70 , 71 ].…”

“…One literature review [ 71 ] of stoma patients found that perceptions of symptoms (e.g., uncleanliness) had a negative impact on psychological, religious, and spiritual well-being, since patients were restricted in fully immersing themselves in religious activities after surgery, for instance participation in congregational mosque prayers and limiting the frequency or complete cessation of prayer. Fear of damaging the stoma was mentioned as a contributing factor to ceasing fasting in Ramadan, though it is medically safe [ 70 , 71 ].…”