Journal of Cancer Therapy, 2013, 4, 1060-1067 Published Online August 2013 (
Emotions of Gynecologic Cancer Patients Dealing with
Permanent Colostomy: A Qualitative Interview Study*
Gül Pınar1#, Ali Ayhan2, Tevfik Pınar3
1Department of Nursing, Faculty of Health Science, Yildirim Beyazit University, Ankara, Turkey; 2Department of Gyne-Oncology,
Faculty of Medicine, Baskent University, Ankara, Turkey; 3Department of Public Health, Fa culty of Medicine, Kirikkale University,
Ankara, Turkey.
Received May 21st, 2013; revised June 22nd, 2013; accepted June 30th, 2013
Copyright © 2013 Gül Pınar et al. This is an open access article distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Purpose: This study was conducted to describe emotional state of colostomized patients with gynecologic cancer. Pa-
tients and Methods: The study employed a qualitativ e design from May to October of 2010, in a private university hos-
pitals outpatient gnecologic oncology clinic in Ankara, Turkey. Content analysis with an inductive approach had been
used to analyze 32 interviews that served as the data base for this study. Interview form that focused on what gyneco-
logic cancer women felt to living with a colostomy. Results: Findings also reveal that gynecologic cancer patients with
colostomy experience many uneasy feelings that affect their emotional state. The content analysis resulted in the devel-
opment of two thematic units. The first we described as “To experience the consequences of stoma as a gynecologic
cancer patients”. The second was “suffering experienced-being challenged the consequences of the stoma”, and the third
was “promote self management-normalization o f the new condition ”. For the psychological support, family and friends’
support has been mentioned as the most important part that can release their anxiety. Conclusions: We concluded that a
having stoma was difficult for the women. The emotional state of the women when they get colostomy was typically
characterized by fear, and worry about their current process. Body image, self-esteem, social activity, sexuality were the
aspects that most affected the patients. Nurses have very importan t role within holistic ap proach and empathetic in ter ac-
tion, for deter m i ni ng m a jor problem areas.
Keywords: Emotional State; Ostomy; Qualitative Study
1. Introduction
Gynecologic cancer is the second most common type of
cancer for women with malignancies of the ovaries, fal-
lopian tubes, uterus, cervix, vagina and vulva. In 2010,
an estimated 83,750 new cases of gynecologic malign-
ancies will be diagnosed, and almost 27,710 women will
die [1]. Gynecological cancer may be prone to an in-
creased risk of psychological distress [2-4]. The effec-
tiveness of modern methods of treatment and detection in
oncology have contributed to the popular interest in emo-
tional issues among survivors [5,6].
Gynecologic cancers can directly invade nearby tis-
sues and organs or spread through the lymphatic vessels
and lymph nodes or bloodstream to distant parts of the
body. Intestinal stoma is a common surgery among wo-
men with gynecologic cancer, which is the most sig-
nificant predictor of survival in many series [7]. This is a
therapeutic procedure, which is created for the patients to
live longer, to help them to return into a healthier and to
increase the quality of life. But creating a stoma may
cause many changes in emotion and life style [8-12].
People with stoma experience intensified distress such
as a woman feel unattractive and create negative self-
esteem and body image concerns as well as mood disor-
ders [13-15]. In several studies gynecologic cancer pa-
tients reported low mood state, depression and anxiety
among women who had undergone ostomy. Concerns
also include incontinence, fear from unknown, gas, de-
creased sexual activity, dissatisfaction with appearance,
constipation, difficulties in returning to work, travel and
leisure challenges. During this coping period, it is crucial
for the patients with stoma to tell their negative feelings
[12-14]. For these reasons, training and counseling ser-
vices given to these patients must be in a holistic ap-
*Competing interests: The authors report no conflicts of inter est in this
work. The study was n o t supported by grants from any funds.
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Emotions of Gynecologic Cancer Patients Dealing with Permanent Colostomy: A Qualitative Interview Study 1061
proach including physical, social and psychological con-
cerns. Nurses are important members of the health care
team and have a significant role in caring for cancer pa-
tients with stoma. Nurses have care giving, training,
counseling, supportive, coaching and facilitating roles in
patient care [16,17]. In the Turkish context, no study was
found to examine the emotional state of ostomy patients
with gynecolo gi c canc er.
Therefore, this study sought to describe the emotions that
patients face when adapting to colostomy.
2. Materials and Methods
Because qualitative enquiry depends on samples selected
purposefully to investigate the phenomenon of interest,
the twenty-two gynecologic cancer patients with stoma
who volunteered to participate in this research were se-
lected by purposeful sampling. Sample consisted of wo-
men returning for routine follow-up in outpatient gne-
cologic oncology clinics in a Private Univ ersity Hospital,
Ankara-Turkey. To be eligible for participation in this
study, participants required to have following criteria: 1)
underwent surgery at least 6 months ago; 2) were no in
stage IV disease; 3) had completed active treatment; 4)
Without distant recurrence; 5) at least first grade educa-
tion; 6) 18 years of age or older and 70 years of age un-
der; 7) having had an ostomy in place for at least 6
months; 8) freedom from other disease; and 9) signed
informed consent.
The exclusion criteria were being 1) had difficulty in
understanding the questionnaire, having any cognitive
and hearing loss, 2) patients have received any psychiat-
ric diagnosis or assistance from a mental health profes-
sional before. All participants have trained physicians
and nurses in understanding the colostomy issues. Data
were gathered from patients’ files, surgical and patholo-
gical recordings. The patients who had bowel surgery
besides standard surgery for gynecologic cancer were
included in the study. In addition to in-depth semistruc-
tured interviews using open-ended questions were carried
out understanding of how people feel and what the ex-
periences are like for them, tape-recorded in the office of
the author at a hospital. Questionnaire that contained an
open-ended request for respondents 1) What you think
about your stoma? 2) After you have a stoma, are you
worry about anything? 3) What is the most important
concern that makes you unhappy or anxiety? 4) Regards
to your own opinion , what do y ou prefer more stom a care
education, the individual or group counseling? 5) When
you feel anxiety or sad, how do you get psychological
support to release negative feelings?
The interviewer then asked the women about their
emotional state during current illness after colostomy.
Data were analyzed analysis using the technique of con-
tent analysis. The time and place of the interview were
arranged according to participants’ preferences. Each
interview lasted about 30 - 40 minutes. The authors of
the study individually listened to the taped interviews
and read the transcripts several times in order to obtain
further understanding of the respondents’ statements.
Meaning bearing units were identified in each of the in-
terviews, the authors co mbined their findings together by
comparing and discussing each step of the process of
their individual analyses until an agreement was reached
about the meaning bearing units, the condensation, the
coding and the categorizing. The research was approved
by the Ethics in Research Committee of the Private Uni-
versity Hospital. Written consent was obtained from all
participants and the anonymity and privacy of the par-
ticipants were guaranteed.
3. Results
All subjects had compleyted active teratment; their ages
varied from 33 to 70 years of age, with the average of
age being 59. Eleven women were elementary school
graduates, sixteen were housewives, eighteen of the pa-
tients were married, nine had no children. Eleven had
endometrial ca, ten had ovarian ca, nine had serviks ca,
two had tuba ca, twelve had undergone hysterectomy.
The evaluation of the disease stage of the patients
showed that; all of women were stage III. Sixteen were
being treated for cancer for less than a year. The time
since colostomy surgery varied between 4 months and 32
months. The average time since a colostomy surgery was
8.2 months.
The physiological and psychological changes that oc-
cured in women during experience of their colostomy
can lead to emotional sensitivity, an increase in anxiety-
fear in all women. Categorization of the data bring out
identification of two thematic units. The first we de-
scribed as “suffering experienced-being challenged the
consequences of the stoma”. This theme demonstrates
how women felt when they initially received their
ostomy surgery. The second was “promote self manage-
ment-normalization of the new condition”. This thema
shows how patients tried to get into a state of readiness
and prepare themselves for the new condition. In second
thematic unit patients begins to take responsibility for
their lives and were able to regain a sense of control.
Thus, they manage to improve self-efficacy for their ad-
justment process, and to integrate the cancer experience
into their life.
Patients with stoma faced with many problems mostly
physiological, psychological and social in general. First
thematic unit demonstrated that the most common feeling
is worry and fear related to alters patients’ body image
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Emotions of Gynecologic Cancer Patients Dealing with Permanent Colostomy: A Qualitative Interview Study
and self esteem, impaired sexual functioning, decreased
social activities, loss of an important function of body,
withdrawal, and economic pressure. Over half of re-
spondents felt severely affected by their stoma appear-
ance. To see and care their stoma is quite challenging for
stoma patients. Some of the respondents expressed the
worries for the disease recurrence. They also faced a dif-
ferent series of worries such as diet, spirituality, physical
activity, travel, social-family relationship, energy, feel-
ings of stigma-social isolation, and sexual functions.
Second thematic unit demonstrates through the state-
ments of the participants how they have been able to re-
store and adopt theirs lives, despite their condition of
vulnerability and shaken feelings and uncertain perspec-
tives after undergoing the ostomy surgery. The partici-
pants of the study express clearly that the beginning was
difficult for them to accept their new condition. However,
as time passed by, they became conformed and accepted
the new condition, especially with the support of their
family. They faithfully speak about a new meaning of
life after stoma surgery.
3.1. Fear for Stoma Appearance
First thema (suffering experienced-being challenged).
One participant stated, “I still feel unco mfortable when
I see my stoma. At first, I felt fear for its appearance even
though the procedure of my disease. I feel scared to
touch my stom a. It looks di sgusting.
Another participant stated, “I was shocked to find out
that the hole looks bloody and strange. I was pretty wor-
ried immediately after my ostomy. I was so stunned how
it works”.
Second thematic unit (promote self management-nor-
One participant stated, “I was nervous that running,
swimming or other sport activity will loosen my ostomy
bag and cause a leak. The ostomy bag attached to me is
very obvious. When I look in the mirror, I notice the bag
under my clothes. I tried to keep my ostomy. But I can
heared noise coming from my stoma. I am worried about
the odor when emptying my ostomy bag, therefore, I use
air sprays to minimize odor. Now, I dont let a fear and
Another participant stated, “I think it is quite good that
my doctor told me what would happen on my body. At
least, I have time to think and accept it psychologically”.
Actually, the pouch wasn’t very visible if I was wearing
a loose-fitting shirt. I believe that ostomy is no longer a
handicap .“
3.2. Fear for the Disease Recurrence-Future Life
First thema (suffering experienced-being challenged).
One participant stated, “At first, I felt numb.” “For the
cure of the cancer, there still has a long way to go. I
worry about the tumors relapse.”
Another participant stated, “I feel sick is actually. I
dont really think about the fact that I have a colostomy.
I am worry about the cancer spreading. It is so difficult
to absorb this feeling. I wonder will I live or die? How
long I live?”
Another participant stated, “After the operation, I ex-
perienced mixed emotions, sometimes relief, sometimes
fear, at times feel tearful an d angry. I thought I have lost
my life. I worried about whether I can live as before,
which may cause sadness”.
Second thematic unit (promote self management-nor-
One participant stated, “I could passed a car accident
that left me a qu adriplegic, or I could lost an eye, arm or
a leg. There are many operations that are worse. I have a
colostomy and a p ouch bu t life goes on. So in my op inion
it’s not matter of living or die its matter of igno ring life.
Today I value life much more”.
Another participant stated, In the beginning it was
very difficult. It took me a long time to adapt to that. Af-
terwards I got used to it. I felt really good (normal). I
look forward to having the cancer reversed”.I person-
ally believe that it does”.
Another participant stated, “I have fully accepted the
fact that I have a colostomy and that my life may be
changed after it is all over. I can even accept the colos-
tomy because it is my best chance for long term sur-
3.3. Worry for Social Life-Physical
Activity-Energy Level
First thema (suffering experienced-being challenged).
One participant stated , “After the op eration, my friends
rarely come to visit me. They knew my situation and not
encourage me to fight with illness. I feel Im not as same
as others bec a u se of the stoma.”
Another participant stated, “Im fear for the stool
leakage, whether it can be smelt or heard, other peoples
awareness of stoma and societys isolation. I sometimes
close off to the other people in my lives. I was unable to
express my fears and concerns. I pushed my friends and
family away. They can not be able to fully understand
what I am feeling”.
Another participant stated, “I spend most of the time
alone in my room. I didnt want to go out in public be-
cause I have a bag on my stom ach. I am so tired from my
problems. I dont have the energy anyway. It makes me
sad. I faced pressure from friends or family to be more
sociable. I feel uncomfartable with their support”.
Another participant stated, “I feel frustrated that I am
not able to perform at my previous level of functioning. I
would strain my abdomen. I love water spo rts and travel-
ling. I used to do plan every weekend. But, I have to give
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Emotions of Gynecologic Cancer Patients Dealing with Permanent Colostomy: A Qualitative Interview Study 1063
up this hobby now. I dont go to a ll the places. My stoma
not only affected my life but also bother my family and
friends, which may cause sadness”.
Second thematic unit (promote self management-nor-
One participant stated, I am with the bag. Is it a com-
fortable thing? No, no it isnt. But its something to
which we have to adapt. Actually, reasonable activity do
not restrict me from my life. Even seat belts cause a
problem over the colostomy, I can still drive my car, still
go swimming, still go camping, I even was able to hang
around with my friends. Getting angry only makes it
worse. Thank God my family is very good, my children
are very good to me, this feeling made easier accept my
Another participant stated, “I faced more challenges. I
have got to learn to live with stoma. It took a lon g time to
become comfortable with my ostomy. But, I received
much support from my husband, friends and relatives
after the surgery. They didnt give up on me. Hopefully,
when all those pieces of the puzzle have been satisfied I
feel truly relax enough to return to work, hobbies, and a
social life”.
Another participant stated, “I had no desire to do any
kind of physical activity after operation. Slowly I found
myself doing many activities. I feel very gratitude when I
see my husband and daughter helped me to manage the
stoma. It is a dirty work, but they didnt reluctant me. It
is important that nothing is changed in my family. I
really appreciate their care and support.”
3.4. Worry for Lack of Confidence, Self Care,
and Self-Control
First thema (suffering experienced-being challenged).
One participant stated, “Initially, I dont know how to
change stoma bag with adequate pro fessional stoma care
knowledge and facilities p roperly. I felt stuck in this way
I was without choice. I had no control over gas and
bowel movements. Changing the bag wasnt pleasant.
The smell was terrible. I couldnt deal with it. This feel-
ing makes me low mood.”
Another participant stated, “I am always with gas, I
cant be able to control when stoo l and gas move in to the
pouch. I am not normal. I feel dirty, I could not change
dirty pouch myself. I used to can take care of myself. My
husband had to take care of me. My disease already
caused trouble for my husband. I dont want them to bear
more for me.”
Another participant stated, “At first, I felt difficulty to
manage my stoma. I did not freely on my own. I was
completely unprepared to deal with. So, I was extremely
traumatized because I could not return previous roles. I
became very depressed. I was finally moving into the
adopt phase”.
Second thematic unit (promote self management-nor-
One participant stated, “I feel amazingly relax when I
clean my ostomy pouch. Gas and smell discharge highly
decreased. I regularly check the seal to make sure its
tight. I spend less time worrying about the its effects. “I
cant control all events, but I can also control my reac-
tions to events”. I leaned to take better care of myself.
When I get tired, I take a rest. I can take my medicine,
see my doctors. When I go out, I can find a sit down toi-
let, and sanitary bins to be clean and confident”.
Another participant stated, “I particularly had diffi-
culty waking up with a full puffy pouch every morning. I
felt like such a mess. The whole procedure of apply
ostomy appliances was too complicated. Even when I see
nurses do it, I felt it is also not a easy job for me. But
somehow, I overcame these feelings once I mastered the
application of my ostomy system. I have to get accus-
tomed to our ostomy systems presence as a constant part
of my lives. I can discuss more sensitive issues with my
doctor and nurse. I trust them.”
3.5. Worry for Body Image-Self Esteem
First thema (suffering experienced-being challenged).
One participant stated, “I was clearly in anxious emo-
tional state due to the ostomy. It was uncomfortable
around my abdomen. I am sometimes afraid to go out. I
am embarrassed by my ostomy. I try to hide my stoma in
order to avoid comments that could lead to feelings of
being different from others. My self-esteem droped se-
Another participant stated, “At first, when I saw get a
pouch. Id start crying as soon as my doctor out fro m my
room. I was scared of losing my body integrity and I am
embarrassed by the changes in my appearance since my
stoma. I worried that my stoma might be a problem. I
focused on me. I can say that my body changes did trou-
ble me”.
Second thematic unit (promote self management-nor-
One participant stated, “As time passed, my colostomy
became a smaller and less important part of my life. With
each day, I felt more comfortable about my new self-
image. Then I never had trouble with my ostomy bags
leaking-liquids or smell. I got used to it, however, and it
became just a normal part of everyday life.”
Another participant stated, “Thankfully, my husband
did stoma care for the first few days. After a couple of
weeks, I felt well enough to do my own stoma ca re. I also
had to examine the stoma on a regular basis, to look for
problems. I accepted my body image”.
Another participant stated, “I was the only one who
knew about my stoma. People were not going to know I
was using it. I was uncomfortable discussing my ostomy
with people. Thats how I conformed myself and today I
accept it. Thus, I wasnt the only person in the world with
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Emotions of Gynecologic Cancer Patients Dealing with Permanent Colostomy: A Qualitative Interview Study
an ostomy”.
3.6. Worry for Nutrition
First thema (suffering experienced-being challenged).
One participant stated, “I can only take some soft fo od.
I dont know if the intake nutrition can satisfy my needs.
Im afraid that the soft foods didnt contain enough nu-
trition to suppor t my recovery.”
Another participant stated, “I used to ha ve good appe-
tite. There are a lots of food restrictions after having a
colostomy. Some food have an adverse side effect on me.
My life was boring if I could not eat whatever I want to
eat. When I diarrhoea I felt fear that my bag come off.
Diet was problem for me”.
Second thematic unit (promote self management-nor-
One participant stated, “I know how each food affects
my digestion. I am able to ask my doctor or nurse about
special products I can use. I thought that having a stoma
is not a hindrance in any way whatsoever. I am not seen
as an obstacle in my life”.
3.7. Worry for Stigma-Isolated
First thema (suffering experienced-being challenged).
One participant stated, “I was afraid my appearance
will change as a result of my treatment. I did not want
others to see me sick. I had made an effort to alter my
appearance. Others saw me differently since I have b een
operated with canc er. I felt stigmatized”.
Another participant stated, “Im afraid that stoma can
be seen or smell by other people. People around me will
discriminate against me. They probably will far away
from me because Im dirty and disable. I am feeling like
a social outcast because of colostomy”.
Another participant stated, “I worry odour or leaking,
that may draw the attention of others creating unpleasant
feelings for those others, exposing the person with a
stomasincompleteness’. No one will ever accept me be-
cause I have a stoma. I feel unhappy. My friends dont
accept me as a normal person. My situation has made me
a weak person. When I look in the mirror I see asick
Another participant stated, “Even with a supportive
family, friends and co-workers, I often still feel isolated.
This is especially so after a surgery t hat I dont feel at ease
to talk about openly. I have lost our guarantee of good
health. I feel scared, confused, frustrated or helpless”.
3.8. Worry for Economic Pressure-Occupational
First thema (suffering experienced-being challenged).
One participant stated “Im worry about the cost of
stoma appliance and the fu ture treatment expenses. I felt
disappoint about the interruption of my career. Im
afraid that my familys life quality will be affected by this
stoma if it needs lots of money”.
Another participant stated, “Im upset because I cant
work as before again. Im afraid that they couldnt afford
the long-term expenses due to my stoma, which would
affect my future career and income whereas I need it for
my healing. My illness leads to feelings of inadequacy,
worthlessness and dependence, changes in my social
roles, functions.”
Second thematic unit (promote self management-nor-
One participant stated, “If I can not work anymore, I
dont know how much it will cost and whether my sav-
ings can support my future treatment because it is a
long-term fee. I dont want to bother my children at the
money problem. My family immediately affords the ex-
penses. Now, I feel relax”.
Another participant stated, “I bought some medical
supplies for my ostomy, I often use a special belt when I
go back to work, so I feel more confident with my ostomy.
I am feeling well. I think to retire now. Thu s, I will get
enough money for the treatment”.
3.9. Worry for Sexual Functions
First thema (suffering experienced-being challenged).
One participant stated, “After surgery I was worried
about my relationship with my husband. I felt ashamed.
my sex life was changed with an ostomy. I was not ready to
have sex right away. I did not find that some sexual posi-
tions put pressure on my ostomy and are uncom- fortable”.
Another participant stated, “Dealing with cancer out-
comes sexual desire may not be so important. If I feel
accepting of mynewbody, my partner is likely to do the
same. Sure, I dont expect to be better immediately.
When I am safe and healthy, we then turn to love, normal
sexual intimacy”.
Second thematic unit (promote self management-nor-
One participant stated, “Before I felt less attractive
with my ostomy, I discussed this with my partner, he
helped make me feel more comfortable and reassure, and
then take my return to intimacy slowly. Sexual intimacy
even continue after my ostomy. Participating in counsel-
ing sessions with my spouse, my worry was decreased”.
Another participant stated, “I believed that the odor
from my stoma can be a turn-off for my partner. Physical
change after ap plication of stoma affected my sexual life
as well. I try to keep my sense of feminity, communicate
openly with my partner. Ill never have a sexual contact
3.10. Worry for Religious Considerations
First thema (suffering experienced-being challenged).
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Emotions of Gynecologic Cancer Patients Dealing with Permanent Colostomy: A Qualitative Interview Study 1065
One of them said, “I could not fulfill his religious
worship and that was making him very upset. When I am
going to pray in the Mosque, I feel I am not worthy
enough to join the praying group, because I worry about
my cleanliness for worship, prayer, and other religious
Second thematic unit (promote self management-nor-
One participant stated, “My belief changed in my God
after colostomy. I begin to find meaning in my lives and
the healing begins. The ostomy is in the background of
my lives. It’s there, but I don’t focus on it anymore. I
truly became a more compassionate and caring person. I
pray God to protect me for the rest of my life, so I felt
more peaceful.”
4. Discussion
Having cancer naturally causes a great deal of stress.
Cancer survivorship provekes diverse alterations in a per-
son’s life, and results in complex emotional, social, phy-
sical, including sexual concerns [9,11]. The treatments,
which are invasive, stressful and associated with numer-
ous side-effects, may be greatly detrimental to the quality
of life and social contacts which often elicits fear and
emotional distress. The use of the colostomy bag presents
a challenge as to the adjustment to the new condition of
life. The establishment of a stoma affects sexuality di-
rectly by disruption of nerve and blood supply to the
genitals and indirectly by the effect on sexual activity [9].
For these reasons, it is important to understand how af-
fected women experience their altered life situation and
thus to know their real problems and needs [16].
Using a qualitative design leads to better understand-
ing and insight into coping and acceptance of life with
ostomy from the patient’s perspective. In this study was
explored many dimensions with permanent colostomy
and each participant experienced the process of adapta-
tion to a colostomy in a differently way. However, there
were some similarities between the study participants,
such as interpersonal relationships, family income, and
work activities. The women reacted differently to the
new condition. The women with an ostomy experienced
the disease as an existential threat. Some of them ac-
cepted their fate, or turn ed feelings off, others were calm
and suppressed intrusive thoughts and some women as-
sociated the disease immediately with death. They also
had sexual problems, social isolation, fear of odor, leak-
age, and alterations in body appearance. Many problems
reported by the participants in our study were related to
the early period after surgery and colostomy. Passage of
time was the most important factor in adapting success-
fully to life with an ostomy.
We found that colostomy initially was a source of
an x i et y for patients. In general patients were deep l y s h oc k-
ed after surgery, they were afraid of desperation and
death, they complained of a total lack of energy, power-
lessness, fatigue, step by step they felt more in control
and more in a relaxed state. They have also reported that
positive thought might use to reduce stress, including
fears about other stoma care. But, sometimes when they
confronted lack of support they felt unable to cope with
the stress as well as their other fears. They experienced
fear loss of social status. This is consistent with the find-
ings of earlier studies conducted among cancer patients
who had unde rgone colostomy [11-13] .
In the study of Brown and Randle (2005) suffered
from cancer, common problems included sexual prob-
lems, gas, irritated peristomal skin, odor, travel difficul-
ties, and dissatisfaction with appearance among ostomiz-
ed patients. In a diff erent study confirmed that most of all
people with a stoma have either one or more of these
concerns; anxiety about such complications could result
in lifestyle and quality-of-life changes [1 2].
In our study women who had to overcome barriers in
obtaining health support and emotional needs were more
likely in an optimistic mood and tented to be strong.
Family support and professional medical support become
fundamentally necessary, essential for the acceptance of
the ostomy, a faster and more efficient rehabilitation and
a good reconstruct their lives based on new condition In
this way, women and their families should be offered
support that really helps them [11,15]. Health care pro-
fessionals, e.g. nurses, play an important role in guaran-
teeing a consistent and patient-centred approach in deal-
ing with difficulties, feelings, and patients’ perceptions
on how the illness affects their life [16]. At the same time,
specialized stoma/oncology nurses play an important role
in education and counselling before and after ostomy
surgery within holistic approach for determining major
problem areas as members of the health care team [15].
In recent years, efforts to enhance mood state in cancer
patients as one of the important aims of treatment in on-
cology. In addition to the effectiveness of modern meth-
ods of treatment and detection in oncology has contrib-
uted to the popular interest in emotional issues among
survivors [17].
Qualitative studies in gynecological cancer and its
treatment have highlighted women’s concerns in relation
to femininity, losing positive image in their own body
[9,10]. Previous studies have suggested that body image
is an important concern for gynecologic cancer survivor
[11,13]. This negative image of body include dissatisfac-
tion with appearance, and feelings of diminished sexual
attractiveness. Especially ostomy surgery can make alter
sensation and sexual enjoyment [18]. Sexuality is an im-
portant aspect of physical, psychological and social life,
increasing life quality. Sexual dysfunction, a loss of
pleasure and diminution in sexu al ability and activity, are
Copyright © 2013 SciRes. JCT
Emotions of Gynecologic Cancer Patients Dealing with Permanent Colostomy: A Qualitative Interview Study
common long-term consequence of pelvic cancer treat-
ment. Chemotherapy and hysterectomy have been asso-
ciated with vaginal dryness, pain during intercourse, loss
of pleasure and diminution in sexual function [4]. There-
fore, the disease can be impaired sexual intimacy easily,
in particular in people with ostomy [19]. We found that
ostomy surgery and its associated problems affected the
patients’ relationship with their intimate partners, espe-
cially in the early period after surgery. They also stated
fear that they may hurt their partner or the stoma as a
result of sexual activity. Some of these women had stop-
ped sexual intercourse. A few others continue their sex-
ual life exhibit a low level. They often had to fight that
their body image. Minimizing and preventing the sexual
problems can be managed by nursing interventions be-
fore and after ostomy surgery [16]. In this study women
described feeling overwhelmed experiencing loss of phy-
sical and emotional control, feeling impaired self esteem,
ashamed, some wear clothing that conceals the abdomen.
Similar results have been reported by some studies and it
was stated that negative body image affects sexual satis-
faction negatively [13,14].
Another different finding in this study relates to reli-
gious issues, most participants stated that they did not
have a major problem with this dimension, generally
women realized the full meaning of their gynecologic
cancer after the first shock of the ostomy surgery. Day to
day, they became aware that this disease was more than a
tonsillectomy, or a broken leg and that the surgical pro-
cedure was only the beginning of a usually long-lasting
treatment. They focused on creating meaningful life.
Cancer outcomes were not always the worst thing which
women had experienced. Another issue that is, some of
women stated that, they need to irrigation inside of their
pouch regularly to be clean and free of any fecal material,
especially when praying, reading Quran, visiting mosque.
This situaton is very crucial in Islam. Therefore, it is very
important for nurses to pay attention to the religious ritu-
als of their clients and nurses need to optimize patient
hygiene as far as possible [16].
5. Conclusions and Recommendations
In conclusion, the findings of this study revealed that the
stoma patients have extremely vulnerably after colos-
tomy. Gynecologic cancer and colostomy are important
health issue, affecting many a women physical, emo-
tional, social and family life. The findings of the study
identified that the stoma changed patients’ body image
and self-esteem negatively. In some cases, reported eco-
nomic burden as well as lack of the knowledge about
ostomy management, especially for the diet and self-care
management. Health care knowledge maximally should
be provided according to patients’ individual needs, and
to make sure that the stoma patients improved the know-
ledge about the self-care concerning ostomy manage-
ment before the discharge from the hospi t al . Nurses shoul d
help in gaining skills to the patient by preparing the pa-
tient for the future, by using teaching-learning method
and preparing an individualized training program.
The results can be used by health care providers to
create a supportive environment that promotes better
emotional health for their ostomy patients into routine
clinical care. More research is needed to determine pre-
cisely which psychosocial variables greater women with
gynecologic cancer.
6. Authors’ Contributions
All authors have contributed to, seen and approved the
final manuscript. The work presented here was carried
out in collaboration between two authors; defined the
research theme, designed methods, analyzed the data,
interpreted the results and wrote the paper.
7. Acknowledgements
The authors wish to thank all the nurses and doctors in
this study for their kind assistance to the present study.
The authors are grateful to all of the women who partici-
pated in the study and shared their emotional experience.
[1] A. Jemal, R. Siegel, J. Xu and E. Ward, “Cancer Statistics,
2010,” CA : A Cancer Journal for Clinicians, Vol. 60, No.
5, 2010, pp. 277-300. doi:10.3322/caac.20073
[2] G. Pinar, A. Kurt and T. Gungor, “The Efficacy of Preo-
poerative Instruction in Reducing Anxiety Following Gy-
neoncological Surgery: A Case Control Study,” World
Journal of Surgical Oncology, Vol. 9, No. 1, 2011, pp.
38- 45.
[3] G. Pinar, S. Okdem, L. Buyukgonenc and A. Ayhan,
“The Relationship between Social Support and the Level
of Anxiety, Depression, and Quality of Life of Turkish
Women with Gynecologic Cancer,” Cancer Nursing, Vol.
35, 2012, pp. 229-235.
[4] G. Pinar, L. Algier, M. Colak and A. Ayhan, “Quality of
Life in Patients with Gynecologic Cancer,” Uluslararasi
Hematoloji-Onkoloji Dergisi, Vol. 18, No. 3, 2008, pp.
[5] B. D. Bultz and J. C. Holland, “Emotional Distress in Pa-
tients with Cancer: The Sixth Vital Sign,” Community
Oncology, Vol. 3, 2006, pp. 311-314.
[6] M. M. Lobchuk and S. A. Bokhari, “Linkages among
Empathic Behaviors, Physical Symptoms, and Psycho-
logical Distress in Patients with Ovarian Cancer: A Pilot
Study,” Oncology Nursing Forum, Vol. 35, No. 5, 2008,
pp. 808-814. doi:10.1188/08.ONF.808-814
[7] G. Pinar, S. Okdem, N. Dogan, L. Buyukgonenc and A.
Copyright © 2013 SciRes. JCT
Emotions of Gynecologic Cancer Patients Dealing with Permanent Colostomy: A Qualitative Interview Study
Copyright © 2013 SciRes. JCT
Ayhan, “The Effects of Hysterectomy on Body Image,
Self-Esteem, and Marital Adjustment in Turkish Women
with Gynecologic Cancer,” Clinical Journal of Oncology
Nursing, Vol. 16, No. 3, 2012, pp. 99-104.
[8] E. Ozalp, E. S. Cankurtaran, H. Soygur, G. P. Ozdemir
and P. B. Jacobsen, “Screening for Psychological Distress
in Turkish Cancer Patients,” Psycho-Oncology, Vol. 16,
No. 1, 2007, pp. 304-311.
[9] H. Brown and J. Randle, “Living with a Stoma: A Review
of the Literature,” Journal of Clinical Nursing, Vol. 14,
No. 1, 2005, pp. 74-81.
[10] D. M. Smith, G. Loewenstein, P. Rozin, R. L. Sherriff
and P. A. Ubel, “Sensitivity to Disgust, Stigma, and Ad-
justment to Life with a Colostomy,” Journal of Research
in Personality, Vol. 41, No. 4, 2007, pp. 787-803.
[11] M. A. Mehraban, E. Ashoori, A. Moladoost and S. Agha-
yi, “Psychological Experiences of Patients with Surgical
Stoma (Colostomy): A Phenomenological Study,” Re-
search and Behavioral Science, Vol. 2, No. 5, 2008, pp.
[12] T. Nichols and M. Riemer, “The Impact of Stabilizing
Forces on Postsurgical Recovery in Ostomy Patients,”
Journal of Wound, Ostomy and Continence Nursing, Vol.
35, No. 3, 2008, pp. 316-320.
[13] P. K. Black, “Psychological, Sexual, and Cultural Issues
for Patients with the Stoma,” British Journal of Nursing,
Vol. 13, No. 12, 2004, pp. 692-695.
[14] J. Junkin and J. M. Beitz, “Sexuality and the Person with
a Stoma,” Journal of Wound, Ostomy and Continence
Nursing, Vol. 32, 2005, pp. 121-128.
[15] J. Junkin and J. M. Beitz, “Sexuality and the Person with
a Stoma: Implications for Comprehensive WOC Nursing
Practice,” Journal of Wound, Ostomy and Continence
Nursing, Vol. 32, No. 2, 2005, pp. 121-128.
[16] J. Burch, “The Pre- and Post-Operative Nursing Care for
Patients with a Stoma,” British Journal of Nursing, Vol.
14, No. 6, 2005, pp. 310-318.
[17] J. Burch, “Psychological Problems and Stomas: A Rough
Guide for Community Nurses,” British Journal of Com-
munity Nursing, Vol. 10, No. 5, 2005, pp. 224-227.
[18] J. M. Jenks, K. H. Morin and N. Tomaselli, “The Influ-
ence of Ostomy Surgery on Body Image in Patients with
Cancer,” Applied Nursing Research, Vol. 10, No. 4, 1997,
pp. 174-180. doi:10.1016/S0897-1897(97)80548-4