Knowledge, Attitudes and Practices Regarding Muslim-Specific Fatāwās (Protocols) Regarding Purification (Ablution) Amongst Muslim Ostomates

Hafiz Yahya  Iftikhar; Farhan  Zaheer; Syeda  Mahjabeen; Amber  Ali; Tayram  Khalid

doi:10.54112/bcsrj.v6i4.2013

Authors

Hafiz Yahya Iftikhar Surgical Unit 5, Dr Ruth K M Pfau CHK, Karachi, Pakistan
Farhan Zaheer Department of Surgery 5, Institute Dow University of Health Sciences, Karachi, Pakistan
Syeda Mahjabeen Surgical Unit 5, Dr Ruth K M Pfau CHK, Karachi, Pakistan
Amber Ali Surgical Unit 5, Dr Ruth K M Pfau CHK, Karachi, Pakistan
Tayram Khalid Surgical Unit 5, Dr Ruth K M Pfau CHK, Karachi, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i4.2013

Keywords:

Ostomy, Muslim patients, Purification, Fatāwā, Ablution, Quality of life, Knowledge-attitude-practice

Abstract

Living with a stoma imposes significant psychosocial and spiritual challenges for Muslim patients, particularly regarding purification and ritual worship. Limited understanding of fatāwā (Islamic legal rulings) related to ostomy care may hinder religious observance and affect quality of life. Objective: To assess the knowledge, attitudes, and practices (KAP) of Muslim ostomates regarding purification and fatāwā, and to explore their impact on religious observance. Methods: A descriptive cross-sectional survey was conducted over six months in a tertiary care hospital (May 2024-November 2024). Consecutive sampling recruited 103 Muslim ostomates with colostomies or ileostomies. A pretested questionnaire assessed socio-demographics, knowledge of purification fatāwā, attitudes toward faith-based guidance, and changes in worship practices. Data were analyzed using SPSS, with associations tested by chi-square and ANOVA at p < 0.05. Results: Participants had a mean age of 42.6 years; 54.4% were female, and 60.2% had colostomies. Before stoma surgery, 94.2% offered all daily prayers and 72.8% fasted regularly; this declined to 61.1% and 28.2%, respectively, post-surgery. Knowledge was poor: only 10.7% achieved adequate scores, while 81.6% had never received structured teaching on fatāwā. Demographic and clinical factors showed no significant association with knowledge levels (p > 0.05). Despite this, attitudes were positive—84.5% believed access to fatāwā would boost confidence, and 79.6% supported healthcare staff training in Islamic rulings. Coping behaviors included repeated ablution (92.2%) and avoidance of mosque prayer (37.9%). Conclusion: Muslim ostomates face marked declines in worship practices post-stoma, primarily due to uncertainty over purification rulings. The pervasive knowledge deficit underscores the urgent need for integrating faith-sensitive counselling into stoma care. Collaboration between clinicians and Islamic scholars to deliver structured education may restore confidence in worship and improve the holistic quality of life.

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References

Slater R. Intestinal stomas: UK prevalence. Colorectal Dis. 2013;15(5):e246–52.

Heikens JT, et al. Quality of life after colorectal surgery with or without stoma. Dis Colon Rectum. 2012;55(4):400–6.

Norwood MG, et al. Ethnic variation in presentation and outcome of colorectal cancer. Colorectal Dis. 2009;11(7):745–52. https://doi.org/10.1111/j.1463-1318.2008.01675.x

Alves A, Panis Y, Pocard M, Regimbeau JM, Valleur P. Management of complications after stoma surgery. Dis Colon Rectum. 2005;48(10):1780–6.

Brown H, Randle J. Living with a stoma: a review of the literature. J Clin Nurs. 2005;14(1):74–81. https://doi.org/10.1111/j.1365-2702.2004.00945.x

Holzer B, et al. Quality of life after stoma surgery in Muslim vs non-Muslim patients. Int J Colorectal Dis. 2005;20(1):19–25.

Soulsby R, et al. Quality of life after stoma formation in Asian vs non-Asian patients. Colorectal Dis. 2011;13(12):1323–8. https://doi.org/10.1111/j.1463-1318.2010.02209.x

Office for National Statistics (ONS). Muslim population of the UK: 2013 census report. London: ONS; 2013.

Harris R, et al. Deprivation and colorectal cancer outcomes in the UK. Br J Cancer. 2009;101(3):459–64.

Habib A, Connor MJ, Boxall NE, Lamb BW, Miah S. Improving quality of life for Muslim patients requiring a stoma: a critical review of theological and psychosocial issues. Surg Pract. 2020;24(1):29–36. https://doi.org/10.1111/1744-1633.12409

Ahmad N, et al. Quality of life in Muslim stoma patients: a Pakistan perspective. APIMS. 2011;7(4):123–9.

Alenezi A, et al. Ostomy-related quality of life challenges in Saudi Arabia. J Clin Nurs. 2023;32(5–6):1124–34.

Iqbal J, et al. Prevalence of intestinal stoma formation in abdominal emergencies: experience at Sialkot. Pak J Surg. 2016;32(3):201–5.

Kaur P. Ostomates in India: survey data by Asia South Pacific Ostomy Association. Med Res Publ. 2024.

Akgül B, Karadağ A. The effect of colostomy and ileostomy on acts of worship in the Islamic Faith. J Wound Ostomy Continence Nurs. 2016;43(4):392–7. https://doi.org/10.1097/WON.0000000000000237

Cavdar I. Religious worship in patients with abdominal stoma. Int J Caring Sci. 2013;6(3):295–302.

Altuntaş YE, et al. Ramadan fasting in patients with a stoma. J Wound Ostomy Continence Nurs. 2013;40(4):e1–e7.

Miah S, et al. Islam and the urinary stoma: a contemporary theological and urological dilemma. Eur Urol Focus. 2019;5(2):331–5. https://doi.org/10.1016/j.euf.2017.06.015

Iqbal F, Zaman S, Karandikar S, Hendrickse C, Bowley DM. Engaging with Faith councils to develop stoma-specific fatāwā. J Relig Health. 2016;55(3):803–11. https://doi.org/10.1007/s10943-013-9772-4

Habib A, et al. Improving quality of life for Muslim patients requiring a stoma: a critical review. Surg Pract. 2020;24(1):29–36. https://doi.org/10.1111/1744-1633.12409

Albar AA. Permanent diversion stomas: guidelines for Muslim patients. Saudi Med J. 1995;16(6):613–6.

IslamQA. Ablution and prayer for a person who had colostomy surgery [Internet]. IslamQA; 2019 [cited 2025]. Available from: https://islamqa.org/en/answers/90768

IslamQA. Ruling on wiping over artificial limbs in ablution (Fatwa 396849) [Internet]. IslamQA; 2019 [cited 2025]. Available from: https://islamqa.info/en/answers/396849

Cavdar I, Yildirim A, Bilen K, Uğur Ö. Changes in religious practices after stoma surgery: a Turkish experience. J Wound Ostomy Continence Nurs. 2016;43(4):398–404.

Alenezi A, Osman N, Al-Mutairi E. Impact of stoma on worship life and social participation in Saudi ostomates. J Clin Nurs. 2023;32(5–6):1138–47.

Ahmad N, Hussain M, Farooq U. Spiritual challenges and coping among Muslim ostomates: a mixed-methods study in Pakistan. APIMS. 2020;9(2):56–64.

Rahman T, Azizullah S, Faheem M. The role of imams in post-operative counselling for Muslim surgical patients in Bangladesh. Bangladesh Med J. 2021;45(1):12–8.

Miah S, Neal DE, McDonald F. Faith, stigma and the stoma: qualitative study among British Muslim stoma patients. BMJ Open. 2020;10(8):e038810. https://doi.org/10.1136/bmjopen-2020-038810

Altuntaş YE, Vural D, Aslan S. Fasting and stoma: patients' perspectives during Ramadan. J Wound Ostomy Continence Nurs. 2013;40(6):e34–e42.