IBD Research Unit

16. Sexuality and Intimacy

The patient is able to express sexuality/intimacy concerns.

It is not unusual for persons with an ostomy to have concerns about resuming relations or whether their sex life will change or if they will be less attractive to their partner. Fears of rejection, odour, leakage, and performance are natural. Patients need to be encouraged to share their feelings and concerns. Understanding each other’s feelings is a very important part of coping with an ostomy. An ostomy should not limit or curtail sexual activity. In fact, many people report that the experience of the surgery and the knowledge that the disease is treated has brought their families and loved ones closer together.

During sexual activity, one may want to experiment with different positions to find the one most comfortable. Prior to sexual intimacy they will want to empty their appliance to minimize concerns about leakage or spillage. A closed end pouch, mini pouch, a frilly half-slip, crotchless panties, or a tube top stretched over the abdomen can often help to keep one from thinking about their ostomy. It is advisable to have patients/families seek additional professional help if difficulties are not resolved.

With some surgeries such as an abdominal perineal resection or cystectomy, physical alteration in sexual function may occur. Nerve damage can occur resulting in an inability to obtain an erection. Patients need to be advised pre-operatively of this risk and reassured post-operatively that interventions exist which can improve sexual function.

PLISST Model

The PLISST model is a model used in sexual counselling and can be helpful when addressing sexual issues and concerns with your patient.

P – Permission
Let your patient know it is okay to have concerns about body image and sexuality. Use open-ended statements such as: “Many people have concerns about their partner’s reactions following surgery. Is this an area of concern for you?” With this statement you are normalizing concerns and giving permission for the patient to share concerns/fears.

LI – Limited Information

• Talk openly and honestly about sexuality and body image.
• Create a therapeutic relationship that is trusting, and open.
• Explore their thoughts and feelings about surgery and the ostomy.
• Questions you may ask include: How do you feel about your body now, and how do you think your feelings will change with surgery? How do you normally cope with changes and losses? Who is your partner? Do you feel your partner is supportive? Do you feel you have a strong relationship? Do you have open communication or are topics around intimacy taboo? What are your specific concerns about living with an ostomy?
• Clarify misconceptions

SS – Specific Suggestion

• Discuss “helpful hints” with your patient/partner
• Share information.

T – Therapy
There will be times when a patient and his/her partner require intensive therapy which can only be offered by a trained professional. The important thing to remember is to recognize when problems and issues extend beyond your knowledge base and to consult others with added expertise in the area.

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14. Medication Considerations

The patient is able to discuss special medication considerations.

Individuals with an ileostomy should be aware of enteric coated or sustained released preparations. Enteric coated or sustained release drugs may not be effective because such drugs can pass unabsorbed through the intestinal tract. Products which can be either crushed, chewed, swallowed or injected are best.

Specific Drugs and their Effect

Antibiotics

Some broad-spectrum antibiotics that are effective against a wide range of bacteria can alter the normal bacteria in the bowel and may cause diarrhea or yeast infections on the skin around the stoma. Antibiotics may also cause the stool to be more odorous.

Vitamins

Generally, supplemental vitamins are unnecessary unless the patient is debilitated with significant weight loss. Vitamins can cause a strong odour in the stool and must be injected (Vitamin B12) to be effective.

Diuretics

Diuretics should be used with great care because salt imbalance and dehydration can result from additional fluid loss.

Laxatives

A person cannot become constipated with an ileostomy. Laxatives, enemas, rectal tubes or rectal thermometers should not be used. If a person were not passing stool or flatus, the concern would be a blockage.

Miscellaneous

There have been no reported problems with the absorption of the birth control pill in individuals with ileostomies. Magnesium-containing antacids may produce diarrhea and aluminium hydroxide may slow the bowel and produce constipation in individuals with colostomies. Analgesics that contain codeine will slow the action of the bowel.

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15. Travelling Tips

The patient is able to discuss travel tips.

The following "tips" can be shared with your patient:

• Always carry identification which would include your type of stoma, appliance used and names of physician/Enterostomal Therapy Nurse. Your ostomy chapter, ostomy retailer or company will often supply ostomy identification cards.

• Before departing on a trip, check for the name and address of the local ostomy vendor as well as the Enterostomal Therapy Nurse (ET). Your ET nurse can provide you with that information.

• Always take at least twice as many ostomy supplies than your normal requirement and always carry supplies in your hand luggage. Do not check them with luggage as they could get lost.

• With the new airline regulations, you will want to avoid carrying scissors in your luggage. Pre-cut your flanges or pouches in advance.

• To avoid unnecessary questioning by immigration in the event of luggage checks, a letter outlining the medical reasons for the ostomy supplies may be helpful. Your Enterostomal Therapy Nurse can provide you with the letter.

• Always carry a supply of prescription drugs that you are using. Also, have a written prescription, with the name address and telephone number of your doctor. Obtain the generic names or chemical compositions of drugs from your doctor or pharmacist. Brand names vary in different countries. Keep prescriptions in their original bottles instead of other plastic containers. This way, you will not have to explain your medication to a customs officer.

• Make sure you have travel insurance.

• Place your closure clamp underneath your watchband when emptying your pouch to keep it from falling or being misplaced.

• Take advantage of available bathroom facilities to empty your pouch more frequently than you normally would to avoid unexpected bathroom delays.

• Carry extra toilet tissues or pre-moistened wipes in the event a restroom is lacking.

• Always be prepared for potential problems by carrying an “emergency kit”. A make-up bag, tobacco pouch, glass case or man’s handbag (fanny pack) can be used. The kit should contain a zip lock baggie, extra closure clip, pre-cut flange, pouch, paste (optional), individually packaged pre-moistened towelettes or J-cloths to serve as a washcloth/towel and mirror. It is important to periodically check your kit. Heat can interfere with the adhesives of the appliance.

• In an emergency, your pouching can be emptied into a zip lock bag or baggie with twist tie until it can be disposed of later.

• Apple sauce, oatmeal, bananas, cheese, creamy peanut butter, boiled rice, tapioca, boiled milk will help to thicken loose stool.

• Drink at least 6-8 glasses of non-caffeine liquids each day.

• Caffeine may cause diarrhea. Beverages such as coffee, tea, chocolate and cola drinks contain caffeine.

• Eat lightly and sensible, especially on airplanes. Gases expand as the plane ascends.

• Yogurt helps to control gas formation and buttermilk helps to soothe an irritated bowel.

• If carbonated drinks result in gas problems, a shake of salt or sugar will cause fizzing which helps to dissipate the carbonation.

• Plan your visits to the washroom on airplanes to avoid peak times, such as after meals, after the movie, and before landing.

• Travel with understanding, patient people

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13. Dietary Modifications

The patient is able to identify dietary modifications.

Having an ileostomy is not usually associated with a highly restricted diet. After surgery, the diet will require some modification, but eventually the person will be able to enjoy most if not all of their favourite foods.

During the first six weeks following surgery, it is often recommended that “potential problem foods” such as skins, seeds, nuts, fibre be excluded from the diet. These foods tend to be more difficult to digest for a person with an ileostomy and could lead to a food blockage. Following the six week period, all foods should be gradually reintroduced. A person with an ileostomy should always be aware of the importance of fluid intake – at least eight glasses of fluid per day, as well as extra salt and potassium. The colon has either been removed or bypassed and thus some of the ability to absorb water, salt and potassium has been reduced.

There are generally no dietary modifications related to colostomy surgery. Unless otherwise indicated, the importance of healthy eating, including foods high in fibre need to be stressed.

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