Factors that influence low back pain in people with a stoma

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: 9.513), EQ-5D health state: mean = 6.9 (±1.75), BPI pain severity: median = 4.5 (IQR: 2.875.4). 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).