SCI & stoma – the medical perspective
We were pleased to welcome Professor Anton Emmanuel to speak in our first of two webinars about stoma and spinal cord injury, hosted by Rhiannon Daniel and Victoria Oliver, partners in Bolt Burdon Kemp’s Spinal Injury Team.
Professor Emmanuel is a professor in neuro-gastroenterology at University College London and consultant gastroenterologist at UCLH and the National Hospital for Neurology and Neurosurgery (Queen Square), and with over 30 years of experience working with spinal patients he was the perfect expert to explain to our webinar attendees the basics of a stoma, in what circumstances a SCI patient may consider a stoma and why a stoma may not be offered to someone with a SCI.
Firstly, Professor Emmanuel outlined some statistics – in 1995, around 10-14 per cent of SCI patients underwent stoma surgery. Nowadays, that number has decreased to around 3-5 per cent. He explained that this fall is partly down to the fact that patients are now offered a range of other treatments to help manage their bowels – a stoma is just one option.
However, Professor Emmanuel did outline that the statistics point to the fact that an overwhelming number of SCI patients who undergo stoma surgery are pleased with the decision. Indeed, 85 per cent say their quality of life has improved post-surgery, and that they’d do it again in a heartbeat. Many state their biggest regret is that they didn’t undergo the surgery sooner.
But stoma surgery isn’t for everyone – and neither is it a fix for issues like pain or bloating, Professor Emmanuel explained. Although this is a commonly performed surgery, things can go wrong and for around 5 per cent of patients, stoma surgery doesn’t work. Sometimes the surgery isn’t possible at all due to a scarred abdomen, for example. Equally, Professor Emmanuel highlighted that once the surgery has been performed it can not be reversed. Therefore, the decision should be carefully considered.
During our webinar, we fielded questions from attendees:
Q. What is the timeline for stoma surgery post spinal injury?
A. Professor Emmanuel explained that in the 1990s, it was recommended not to do anything within the first six months of a SCI. This thinking has evolved and now the period is sometimes around three months post-injury. However, Professor Emmanuel highlighted the most important consideration is the disruption the injury causes to the individual’s life and how best to mitigate this – for example, it’s important to be able to avoid accidents such as faecal incontinence. It’s also important the individual isn’t spending too long in the toilet, and they have a good quality of life. It’s not necessarily about symptoms, but about the individual’s lived experience in weighing up if stoma surgery is the right option.
Q. Does gender or age have an impact on if someone decides to undergo stoma surgery?
A. In Professor Emmanuel’s earlier career he explained he’d usually be treating younger men but thanks to the improvement of safety in both sport and driving, his patients now tend to be older and less predicated by gender.
Q. What psychological considerations play a part in deciding if someone should have a stoma?
A. Usually if someone has concerns, speaking to someone with a stoma, in addition to their medical team may help, Professor Emmanuel explained. In some instances, patients will have a practice bag for a day or two to see if they could get used to a stoma. However, Professor Emmanuel explained some patients simply can’t bear the thought of having a stoma and for these patients, other options will be explored.
Q. I have a stoma and sometimes some of the food seems to be undigested – am I not absorbing the nutrients I need?
A. In 95 percent of cases, SCI will slow down the digestive process, however in that five per cent, it will be speeded up. However, studies show that minerals and vitamins are still absorbed into the body.
Q. Some individuals may put off having a stoma until they’re older – are there any risks in doing this?
A. Generally, age doesn’t impact the success of stoma surgery – although other health concerns can impact whether stoma surgery can be performed. Professor Emmanuel explained he performed the surgery on a 92-year-old lady, who is now 105. So, age alone certainly isn’t a significant risk factor.
Q. Do you anticipate stoma surgery rates will increase?
A. Yes, Professor Emmanuel said he thinks the rate of stoma surgery will slightly increase – and certainly the time frame between injury and having a stoma may be shortened. And that’s a good thing but ultimately, it’s about a tailored solution for the individual and for patients to have the best quality of care.
Q. Where should people go if they need more advice on this issue?
A. Professor Emmanuel recommends if you’re not under the care of a specialist spinal unit to make an appointment to see your GP, who will be able to refer you.
Please note this does not consist medical advice – if you have concerns, please contact your GP.
Thanks again to Professor Emmanuel for his time and valuable insights.
