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Current guidelines from the British Society of Gastroenterology concerning the management of IBD in adults1 highlight that surgery remains necessary in up to 30% of patients with UC. First described by Parks and Nicholls,2 restorative proctocolectomy with ileal pouch–anal anastomosis (RPC) has become the established operation for patients with therapy-resistant UC, indeterminate colitis, familial adenomatous polyposis and for some patients with UC-related neoplasia.3 ,4
Ethnic variations in the incidence and prevalence of IBD in the UK are diminishing.5 IBD has increased dramatically in British South Asians,6 the majority of whom are Muslim. Intestinal surgery impacts on the lives of all patients, but we wish to highlight some issues specific to the Muslim population.
Daily prayer constitutes one of the five pillars of Islam and is deemed the most important after the shahadah (declaration of faith). Muslims pray up to five times a day and hold strict hygiene requirements for their prayer. This includes washing the perianal skin (called istinjāh) after every bowel movement. Faecal seepage invalidates istinjāh, and this must be repeated in order to resume prayers. Some Muslims with a stoma avoid …