Body image is defined as an individual’s perception of the appearance or attractiveness of his or her own body. It has been the subject of media, medical and mental health reporting since the term was first used in the 1930’s. Poor body image comes from negative thoughts and feelings about your appearance. The concept of body image affects men, women and children. The interpretation of body image varies around the world based on cultural expectations that help craft the concept of what is desirable.
Many who experience debilitating illnesses or injuries, resulting in a change in health or appearance, may find themselves with a changed sense of self. This can impact their perception of how they look to others. This can be especially true for people with bladder or urinary tract cancers that have had surgical urinary diversion. Urinary diversion is a method of redirecting urine produced by the kidneys when the bladder or other parts of the urinary tracts are not fully functional or have been removed. Urinary diversions can be temporary or permanent. Some diversions require a stoma. A stoma is a surgically created opening from an area inside the body to the outside. Urine can drain into a small pouch that fits over the stoma and attaches to the skin with adhesive. This pouch needs to be emptied and cleaned.
Changing body image after urinary diversion
As if body confidence is not difficult enough to maintain, suddenly finding that your body doesn’t work the way it used to can be upsetting. Learning how to go to the bathroom is a behavior learned at a very young age. Since you went off to school you were diaper-free and had control of your bathroom habits. A change in this kind of independent control of your bladder or bowels can have an impact on self-image and self-esteem. If you have been diagnosed with bladder or other pelvic cancers, or urological complications, you may have to undergo a urinary diversion. Suddenly urinating is not as simple as just running to the bathroom. Timing and self-care play a big role in staying comfortable and free of infection.
Feelings play a big role in body image. While others may perceive you as exactly the same person as you were before your urinary diversion, your own internal feelings about the surgery can impact your self-esteem. It’s completely normal to feel upset about visible changes in your body, and these feelings can affect your different parts of your life. Some people may grieve over their lost body function while they are getting used to the change.1
Having your bladder removed is a loss, and grieving loss is a natural process, even for a physical part of your body or body function. Some people report feeling frustrated, saddened and angry about a change in appearance and irritated by having to make lifestyle changes. Some struggle with how they feel they look in public, of having to make changes in the way they dress, or worrying about having the ability to void (eliminate urine) when needed. This can result in reduced self-esteem.
Creating a care plan
What can be done about it? There are professionals who can assist patients in creating a care plan to make the process of getting used to a urinary diversion as smooth as possible. Some people are able to do this on their own. Others benefit from self-help groups, therapists and guidance from nurses who are specially trained in wound and ostomy care.2 There are 4 fundamental steps:1
Assessment: Evaluating how you feel about yourself and the way you think others feel about you
Intervention: Communicating with people who have had a urinary diversion and hearing their thoughts and opinions
Autonomy: Promoting independence, learning how to care for their new method of elimination (often with help from a nurse or other expert)
Reinforce: Reinforcing self-esteem, accepting the change, and building confidence
The goals of each care plan be specific to the areas of concern for each person. For some, goals may include feeling less isolated. For others, it could be finding ways to feel good about sexual activity and resuming normal activities.
The new normal
It can take some time to get used to the “new normal” after a radical cystectomy and reconstructive surgery. Recovering from a major surgery, re-learning bathroom habits, and adjusting to the physical changes is no small task. Every person is different, and for some, finding undetectable ways to hide a stoma and bag helps in improving body image. For others, embracing a changed body and focusing on the positive helps to boost body image. There is no right way to cope with the many changes that come with surviving bladder cancer, but reaching out for support can help!
Salloum, M. Self-esteem disturbance in patients with urinary diversions: assessing the void. Ostomy/wound management. Published December 2005. https://www.researchgate.net/publication/7333472_Self-esteem_disturbance_in_patients_with_urinary_diversions_assessing_the_void. Accessed October 23, 2017.
Ewing, G. The nursing preparation of stoma patients for self-care. J Adv Nurs. 1989;14(5):411- Published May 1989. https://www.ncbi.nlm.nih.gov/pubmed/2738237. Accessed October 24, 2017