In the long term following spinal cord injury, bowel dysfunction causes major physical and psychological problems. A retrospective review of intestinal stomas performed in patients with spinal cord injury over a 10 year period was performed to investigate their role in alleviating these problems. Twelve patients underwent left iliac fossa end colostomy and two patients right iliac fossa end ileostomy. The mean age of patients at operation was 54.8 years (20 ± 65), and the mean time from injury to stoma formation was 15 years (2 ± 37). The mean period of unsatisfactory bowel management before stoma formation was 5.4 years (1.5 ± 25). Following colostomy the mean time spent on bowel care per week fell from 8.8 h (0.6 ± 12.2) to 1.4 h (0.3 ± 3.5) and independence in bowel care rose from 50 to 92%. All patients stated that their bowel care was easier and 83% said their independence had increased. Ninety-two per cent wished colostomy had been o ered earlier and no patient undergoing colostomy wanted it reversed. The most common complication following colostomy was exclusion colitis. The mean time of follow-up post colostomy formation was 38 months (7 ± 130). Formation of an intestinal stoma is a safe, e ective and well accepted treatment for selected patients with intractable problems of bowel management following spinal cord injury.

Stoma surgery may be required for many reasons. The circumstances in which intervention is required, with possible permanent changes to the patient's conventional body image and lifestyle, will influence psychological recovery (Borwell, 1997; Black, 2000). Within a diverse multicultural society, addressing the individual psychological problems of the effects of mutilating surgery due to acute/chronic illness can be particularly challenging for health professionals. This can be further compounded if the patient has a physical or mental disability. Stoma care nurses play a vital role in supporting the family of the patient as a whole. Communication is key, encouraging open and genuine dialogue. Listening to patient and family anxieties will facilitate family cohesion and support. Families and/or the significant other of the patient face levels of distress equal to that of the patient, and need to be included in our care package. Psychological adaptation and successful rehabilitation of the patient are potentially achievable by a structured and complete assessment, assisting further understanding of patient, family and social needs. However, existing or additional anxieties will only be revealed if nurses can overcome personal communication difficulties.

The transition from hospital to home is an important milestone for any patient: having progressed through surgery and early postoperative care, they have now achieved discharge status. Stoma surgery can adversely affect patients' body image, and community nurses need to help such patients adjust to these changes. While most patients welcome returning home they often have mixed feelings concerning how they will cope with their stoma, both physically and psychologically, as do their families. Within a multicultural society, addressing the individual psychological effects of surgery due to acute/chronic illness can be particularly challenging. Continuity of care for these patients is therefore crucial. Effective communication and collaboration between health professionals is key to psychological adaptation and successful rehabilitation. This article seeks to outline the various psychological factors that need to be considered when caring for an ostomate.

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