Co‐existence of true colonic diverticula with angiodysplasia

The first pillar is Shahdah or belief in Allah, the creator and Muhammad, the messenger. The second pillar is Salah or prayer. Prayers are obligatory and must be offered five times a day. These involve postural changes including kneeling and bending. Ritual cleanliness and ablution are required before offering prayers. Friday prayers or Jum’ah are special and must be offered in congregation at a mosque. There are rules for prayers in a mosque that require devotees to wear clean clothes and not leak urine or other body fluids. If a leak occurs, the mosque must be cleaned before prayers can resume. The third pillar is Zakah or tax on wealth and alms for the poor. The fourth pillar is Sawm or fasting during the month of Ramadan. The fifth pillar is Hajj or pilgrimage to the holy city of Mecca in Saudi Arabia. This is obligatory and must be undertaken at least once in a lifetime [1–3]. Clearly; a stoma may bear negative effects on three out of the five pillars of Islamic belief. Islam has made provisions for the sick. Prayers are excused if a person is bed bound. Those unfit to leave home must pray at home and resume mosque prayers as soon as fit, especially on Friday. People unable to kneel or bend during prayers may use appropriate furniture. Religious leaders confirmed that the presence of a stoma and bag is not deemed unclean as long as there is no leak. Sick people are exempt from fasting but must make up equal number of days when better or feed a needy person for each missed day. The General Medical Council guidance on consent requires patients to be given adequate information in order to make an informed decision. This should include information that has serious implications on their employment, social and personal life. It is the doctor’s duty to do their best to find out about the patient’s belief, culture, occupation and other factors that may have a bearing on their decisionmaking [4,5]. Independent stoma management involves a learning curve. This could be weeks, months or years and indeed some may depend on others for rest of their lives. It is interesting to consider what effect a stoma has on three ‘pillars’ of Islam namely, prayers, fasting and Hajj. The postural effects on the stoma bag and adhesive integrity need to be assessed for leaks. A leakage during congregational prayers is likely to interrupt proceedings, cause embarrassment and inconvenience others. It may be preferable to defer mosque prayers until patients achieve independence with stoma management. Religious leaders would be happy to discuss the patient’s needs and advice accordingly. Fasting from first light of dawn until sundown and abstaining from food and drink may have adverse effects on patients with ileostomy. This may affect their fluid and electrolyte balance. Patients may not be able to undertake Hajj until they are fully independent and fit to travel. It is important to discuss these issues in the preoperative period so that all Muslim patients are appraised with the possible effects of a stoma on their religious practices. They also need to consult the religious leaders for lifestyle advice. Patients who have been able to make properly informed decisions are more likely to cooperate fully with stoma care thereby improving their chances of early return to day to day activities and religious practices. A practising Muslim may have doubts when agreeing to consent for a stoma if it is likely to interrupt or interfere with ritual practices. The advantage of providing adequate information and discussion with religious leaders early on will help with informed decision making. It is not always possible to avoid a stoma. There is a need for wider awareness amongst healthcare personnel of the sensitive religious needs of Muslim patients. Providing adequate information and discussion with religious heads early on will help with informed decision-making. This we believe amounts to good practice in keeping with the General Medical Council guidance.