Factors that influence low back pain in people with a stoma

Abstract

Purpose: People with a stoma believe that there is a link between their surgery and low back pain (LBP). Aim: To explore factors relating to (i) core stability in people with a stoma and LBP and (ii) biopsychosocial factors related to LBP. Methods: Adults with an ileostomy and LBP (n = 17) completed (i) a range of standardised instruments, (ii) clinical tests and (iii) an ultrasound scan of right and left transversus abdominis (TrA). Results: The findings showed moderate pain and disability: RMDQ: median = 12 (IQR: 9.5–13), EQ-5D health state: mean = 6.9 (±1.75), BPI pain severity: median = 4.5 (IQR: 2.87–5.4). The TrA contraction was less on the operated than the unoperated side and this was linked to less control for BKFO to the operated side, and the presence of a parastomal hernia. Co-morbidities were associated with greater balance problems during the stork test (p < 0.05). Men had more fear avoidance (p < 0.05) on the FABQ regarding physical activity. Discussion: Abdominal function may be altered after stoma surgery leading to reduced ability to perform functional tasks and a possible increased risk of back pain. These results should be viewed with caution due to the small sample size.

Implications for Rehabilitation

• Back pain in people with a stoma is a complex problem including both physical and psychological issues.

• The ability of transversus abdominis (TrA) to contract efficiently is unclear; however, those with a thinner TrA had poorer balance and core stability (as measured by bent knee fall out).

• The psychological factors of fear avoidance must be addressed alongside any physical interventions for motor control, muscle strengthening and rehabilitation of function after surgery.

• This research needs to be repeated with a larger sample due to the small numbers in this exploratory study (n = 17).

Keywords::

• Ileostomy
• low back pain
• stoma

Acknowledgements

The authors would like to thank Dr. Philip Glasgow and Ms. Mary-Jo Thompson RCN, for their valuable input in designing this study. The authors would also like to acknowledge Chris McNicholl MCSP for the ultrasound data collection; Lois Brown, Helen Carlisle and Elizabeth George for their clerical skills; Professor Teo Forcht Dagi for his guidance regarding stoma surgery; and especially, the members of IA who participated in this study.

Declaration of interest: The authors report no conflicts of interest.