• Home
• About
• Courses
  & Events
• Fatawa
• Marriage
  Arbitration
  • FAQs
  • Application Forms
• Resources
  • Our Scholars
  • Letters of Support
  • Testimonials
  • AGM Video
• Contact

[FULL QUESTION]

A stoma is an artificial opening from a part of the bowel onto the surface of the skin allowing a patient to excrete their waste products into a bag. This type of surgery becomes necessary because of diseases causing inflammation of the bowel or because of a blockage often from a cancer.

When we make these stomas it is usually permanent but can be a temporary measure. My questions are geared to those people in which this becomes a permanent feature. There are two types of stoma.

An ileostomy- which comes from the small intestine making the contents like a smelly liquid...when patients have this they continuously and unpredictably pour this water into their stoma bag. The water is also very corrosive to the skin so if they wash it too many times it causes irritation. Also if they pour too much out, which is common, they can lose vital electrolytes and minerals making them prone to dehydration.

A colostomy is from the large bowel, so the contents are like faeces. It empties out 1-2 a day and people who have this can often 'predict' when this will happen. No electrolyte problems occur but if they don't eat well or fast they can become constipated blocking the stoma and making them come into hospital for treatment. Please see pictures attached for further clarification. Questions for the sheikh are;

1) For patients with a stoma (any kind)- what special conditions can they adopt in terms or prayer. Can they combine/ shorten- making them less prone to handling a stoma avoiding the problems above

2) Are these people classed as 'ill' so is fasting not compulsory for them given the risks of dehydration and/or constipation?

3) What washing conditions apply for them- for example in a stoma some patients cannot control passing wind- does that mean they have to do wudhu every time this happens?

4) What if they have an odour (of faeces) because some bags are made that way- are they allowed to pray in jamaat?

5) What precautions do they have to do when performing haj?

6) Where should we place this stoma as surgeons- choice between left side of body and right- is there any religious ruling with regards to this?

7) What do we say to those Muslims who refuse this surgery because of the taboos to this type of surgery- are they committing a sin- because in some cases they are almost certainly going to die without it?

8) Similar to the problem above- what if during salaat an ileostomy pours out liquid into the bag- this is almost always unavoidable- do they continue praying?

9) Changing and washing a bag and stoma can be very arduous and it is recommended that there is limited handling of the stoma, can Muslims combine their prayer because of this reason?

10) I would also be interested to know whether the Sheikh has ever encountered being approached by a Muslim to discuss matters prior to surgery. Are these issues ever discussed during Kutbahs or is there an advice service with regards to health issue at the mosque they are based in?

And what general advice would he give with regards to this issue?

الجواب حامداً و مصلياً

Answer

Before answering each of your questions individually, it seems pertinent to make some introductory points related to the questions asked.

It is important to note that the person who is required to wear the stoma bag and who has impurities which constantly exit from the body such as stool, urine, wind etc. is regarded in Shariah as being in the ruling of someone wearing a Jabirah or Isabah (cast, bandage or dressing for an injury).

Thus, Wudhu (ablution) will remain intact and valid for these stoma patients as long as the said impurities do not exit the stoma bag, just as Wudhu remains valid for a person wearing a bandage, even if the bandage contains blood from a wound. However, in the case the impurities do exit the bag, for example there is a leakage, Wudhu would be invalidated.

On the other hand, if as in some cases the type of stoma bag utilised allows wind to exit the stoma bag via perforations, then a different ruling to the above is applicable. Here, the Wudhu would be invalidated, as the wind in this situation would constantly exit both the body and the bag via the perforations. In this scenario the person will be regarded in the Shariah as Ma’zur (excused).

The ruling of the Ma’zur person is that they will only need to make a Wudhu at the start time of the Salah (prayer) and it will suffice for the entire Salah time, subject to the fact that the Wudhu is not invalidated by any other factor which nullifies Wudhu, such as bleeding from another part of the body etc.

After performing Wudhu, a Ma’zur person may pray and perform other forms of worship which require Wudhu, such as reading Qur’an etc.

Similarly, it is not prohibited for a person with a stoma bag to enter a mosque or to perform Tawaf (circumambulation of the Kaba), on the condition that they are sure that they will not soil the masjid area and there is no unpleasant odour which could inconvenience other worshippers.

It should be clear that, the stoma bag which is attached to the body of the stoma patient is permitted to be worn during Salah and can be taken into the mosque, as it is a medical necessity.

However, a used bag containing impurity which is not being used by the patient cannot be taken into the mosque, as doing so contravenes the sanctity of the masjid. Indeed nor is it permitted that such used bags be carried on one’s person for example in a ruck sack etc. whilst praying outside the mosque, as carrying such impurities during prayer would contravene the prerequisite of one’s cleanliness for the Salah.

It should be noted that, in the abovementioned situation if the person’s clothing becomes frequently and repeatedly soiled by the said impurities in such a way that washing the clothing is of no benefit. For example if the clothing keeps on getting soiled as soon as it has been washed, in this situation the patient will also be considered excused from having to wash or change the soiled clothing for Salah.

If however the clothing is soiled infrequently in such a manner that one could offer the prayer without the clothing getting soiled, the normal ruling is applicable, i.e. the area to the extent of an average sized coin of impurity is excused. In the case that the impurity covers a greater area than that, then the effected article of clothing must be washed or changed.

After these introductory remarks, we will now answer each question below in light of the above detail:

1...In the above mentioned scenario, prayers may be prayed together to reduce hardship, for example the end time of one prayer and the beginning time of the next prayer are utilised. However prayers cannot be shortened (Qasr) as that dispensation is specific to travellers.

2...With regards to fasting in the holy month of Ramadhan, stoma patients may fast on the condition that there is no medical reason preventing them from doing so. If they cannot fast due to medical advice, which also indicates that they are unlikely to be able to fast in the future, then they can pay Fidya (a charitable donation given to the poor) as for the missed fasts.

However, if according to medical advice the patients’ health is likely to improve in the future enabling them to fast, then in this situation the missed fasts are to be made up (Qadha) as and when it becomes possible for them to do so.

To assess if one is able to fast or not, one should initially make an attempt to fast, however, at the first instance of finding any difficulty due to the medical condition, one should end the fast immediately and follow the abovementioned rulings regarding missed fasts.

3/4...Please refer to the above introduction

5...The Haj (the pilgrimage to Makka) may be performed by a person with a stoma subject to medical advice. If one is medically advised to avoid the journey, then such a person will be excused from performing Haj. However, if Haj had already become obligatory on the person prior to having had the stoma, then in this situation, the obligation of Haj remains after the stoma surgery.

Although in this situation it is permissible, to have someone else perform Haj on the behalf of the patient, if one cannot perform it due to the hardship arising from the medical condition.

6...In principle the positioning of the stoma should be decided according to the best position available from a medical perspective. However, in the situation where there is a choice, then it is preferable that the stoma be positioned in such a way that it facilitates the using of the left hand to empty the stoma bag and enables sleeping on the right hand side.

It should be clear that these two points are not a requirement; rather they are a part of Islamic etiquette for personal hygiene which encourages one to use the left hand for cleaning and relieving oneself (and the right hand for eating). Similarly sleeping on the right-side is considered an Islamic etiquette for adopting a restful sleep posture.

However, these etiquettes are to be avoided, if they compromise in any way, the health and wellbeing of the stoma patient.

7...With regards to the ruling of whether one must undergo surgery and other forms of medical treatment or whether it is optional, the Shariah instructs Muslims that they should accept medical treatment if according to medical opinion, it is on the balance of probabilities likely to be successful. However, if they do not wish to undergo medical treatment then it is not regarded as sinful.

On the other hand, if the type of surgery was on the balance of probabilities merely speculative in nature in terms of a successful outcome, in this situation it is conversely not recommended to undergo such surgery, however, if one still chose to do so, it is not held as impermissible.

8... Please refer to the introduction.

9... Please refer to answer number 1.

10...Our general advice regarding these type of contemporary issues is that, it is important to appreciate that these are essentially new issues which have recently arisen, as these new forms of modern surgery and medical treatment were not historically available in the past, thus they require new research from a Shariah perspective, to clarify the appropriate rulings regarding them.

It is also worth noting that due to the very nature of these often complex and detailed issues, they are often best dealt with in an appropriate and suitable forum, ideally where both Shariah experts and medical practioners contribute to the discussion.

As for why stoma related issues are not usually discussed in mosques etc. it may well be that the technical nature of the subject area generally precludes it from being addressed in Friday sermons and similar religious gatherings. Also another contributory factor for a lack of discussion in the mosques regarding stomas is perhaps due to the fact that it is often difficult to find suitably qualified scholars to explain such matters. As a scholar would not only need to have the appropriate expertise regarding the applicable Shariah rulings, but importantly he must also have the requisite understanding of the relevant medical back ground related to the issues under discussion.

Finally, it is commendable that you have sought to find answers from a faith perspective with regards to these important questions to help meet the needs of your Muslim patients. Hopefully, the above answers are of some help and go towards fulfilling that need.

References

36/1 و في الفتاوى الهندية

و لو كانت جراحة فربطها فابتل ذلك الرباط ان نفذ البلل الى الخارج نقض الوضوء والا فلا.

و في حاشية الطحطاوي على المراقي 295

ولا خلاف في صحة الاقتداء بالمتيمم في صلاة الجنازة ( و ) صح اقتداء ( غاسل بماسح ) على خف أو جبيرة أو خرقة قرحة لا يسيل منه شيء

قوله:( لا يسيل منه شيء) فان سال فهو معذور ان استوفى شروطه...

و في مجمع الأنهر في شرح ملتقى الأبحر :كتاب الطهارة 1/75

( وَيَجُوزُ ) الْمَسْحُ ( عَلَى الْجَبِيرَةِ ) وَهِيَ الْعيَدَانِ الَّتِي تُشَدُّ عَلَى الْعِظَامِ الْمَكْسُورَةِ .
وَفِي مُخْتَارَاتِ النَّوَازِلِ وَإِنَّمَا يَجُوزُ الْمَسْحُ عَلَيْهَا إذَا كَانَ الْمَاءُ يَضُرُّ الْجِرَاحَةَ إذَا غَسَلَهَا فَإِذَا أَضَرَّ يَمْسَحُ عَلَى الْجِرَاحَةِ ، وَإِنْ أَضَرَّ يَمْسَحُ عَلَى الْجَبِيرَةِ ، وَإِنْ أَضَرَّ الْمَسْحُ عَلَى الْجَبِيرَةِ سَقَطَ الْمَسْحُ ، وَكَذَا الْحُكْمُ فِي مَوْضِعِ الْفَصْدِ وَالزِّيَادَةُ عَلَى مَوْضِعِ الْجِرَاحَةِ تَبَعٌ لَهَا ... )وَخِرْقَةُ الْقُرْحَةِ ) وَهِيَ مَا يُوضَعُ عَلَى الْقُرْحَةِ ( وَنَحْوُهَا ) كَالْجُرْحِ وَالْكَيِّ وَالْكَسْرِ...

و في حاشية رد المحتار2/92
أقول: والظاهر أن مسألة الكلب مبنية على أرجح التصحيحين، من أنه ليس بنجس العين، بل هو طاهر الظاهر كغيره من الحيوانات، سوى الخنزير فلا ينجس إلا بالموت، ونجاسة باطنه في معدنها فلا يظهر حكمها كنجاسة باطن المصلي، كما لو صلى حاملا بيضة مذرة صار محها دما جاز، لانه في معدنه، والشئ ما دام في معدنه لا يعطى له حكم النجاسة، بخلاف ما لو حمل قارورة مضمومة فيها بول فلا تجوز صلاته لانه في غير معدنه كما في البحر عن المحيط.

و في حاشية الطحطاوي على المراقي 150

فرع : إذا أصاب ثوب المعذور نجاسة عذره هل يجب غسله قيل : لا لأن الوضوء عرف بالنص والنجاسة ليست في معناها لأن قليلها يعفى فألحق به الكثير للضرورة ولأنه غير ناقض للوضوء فلم يكن نجسا حكما ولأن أمر الثوب ليس بآكد من البدن وهو قول ابن سلمة : كما في القهستاني وغيره وفي البدائع يجب غسل الزائد عن الدرهم إن كان مفيدا بأن لا يصيبه مرة بعد أخرى حتى لو لم يغسل وصلى لا يجزيه وإن لم يكن مفيدا لا يجب ما دام العذر قائما وهو اختيار مشايخنا اهـ

و في رد المحتار1/544

( وَدَمُ اسْتِحَاضَةٍ ) حُكْمُهُ ( كَرُعَافٍ دَائِمٍ ) وَقْتًا كَامِلًا ( لَا يَمْنَعُ صَوْمًا وَصَلَاةً ) وَلَوْ نَفْلًا ( وَجِمَاعًا ) لِحَدِيثِ { تَوَضَّئِي وَصَلِّي وَإِنْ قَطَرَ الدَّمُ عَلَى الْحَصِيرِ } ...

قال الشامي^(رح) تحته:( قَوْلُهُ وَقْتًا كَامِلًا ) ظَرْفٌ لِقَوْلِهِ دَائِمٍ ، الْأَوْلَى عَدَمُ ذِكْرِ هَذَا الْقَيْدِ : أَيْ قَيْدِ الدَّوَامِ ؛ لِأَنَّهُ فِي حُكْمِهِ فِي الدَّوَامِ وَعَدَمِهِ ط ( قَوْلُهُ لَا يَمْنَعُ صَوْمًا إلَخْ ) أَيْ وَلَا قِرَاءَةً وَمَسَّ مُصْحَفٍ وَدُخُولَ مَسْجِدٍ وَكَذَا لَا تُمْنَعُ عَنْ الطَّوَافِ إذَا أَمِنَتْ مِنْ اللَّوْثِ قُهُسْتَانِيٌّ عَنْ الْخِزَانَةِ ط .

و في رد المحتار2/517

( وَ ) كُرِهَ تَحْرِيمًا ( الْوَطْءُ فَوْقَهُ ، وَالْبَوْلُ وَالتَّغَوُّطُ ) لِأَنَّهُ مَسْجِدٌ إلَى عَنَانِ السَّمَاءِ ( وَاِتِّخَاذُهُ طَرِيقًا بِغَيْرِ عُذْرٍ ) وَصَرَّحَ فِي الْقُنْيَةِ بِفِسْقِهِ بِاعْتِيَادِهِ ( وَإِدْخَالُ نَجَاسَةٍ فِيهِ ) وَعَلَيْهِ ( فَلَا يَجُوزُ الِاسْتِصْبَاحُ بِدُهْنٍ نَجِسٍ فِيهِ ) وَلَا تَطْيِينُهُ بِنَجِسٍ ( وَلَا الْبَوْلُ ) وَالْفَصْدُ ( فِيهِ وَلَوْ فِي إنَاءٍ ) وَيَحْرُمُ إدْخَالُ صِبْيَانٍ وَمَجَانِينَ حَيْثُ غَلَبَ تَنْجِيسُهُمْ وَإِلَّا فَيُكْرَهُ ...

And Allah Knows Best