prayer and brachot for cancer patient with a stoma

It is permissible to daven (even to serve as the Sheliah Tzibbur) and to make brachos, provided that the bag is affixed tightly to the skin barrier and that a foul odor does not emanate. It is preferable that the bag also be covered. The explanation is as follows:

Regarding the presence of excrement during krias shema or davening, the Gemara (Brachos 25b) and Shulchan Aruch (O.C. 76:1) explain that the issue is covering, not seeing, as it says: "Cover your excrement." (Devarim 23:14) Therefore, even if the excrement is covered with something transparent, one is permitted to daven in its presence. Therefore, one is permitted to daven even if the colostomy bag has excrement in it.

However, there are three additional halachic concerns: 1) Excrement on one's body or "at its place" (classically, the rectum). 2) Foul odor. 3) "Avit" (bedpan).

1. There is a dispute among the Rishonim regarding excrement that is covered, but on the body. Both opinions are cited in Shulchan Aruch (O.C. 76:4), who concludes: "It is proper to follow the stringent opinion." However, the Mishna Berurah (76:17) writes that is cases of need one can rely on the lenient opinion.

"Excrement at its place" is more severe. It is prohibited according to both opinions to recite Shema and daven even when covered, since this is the primary place of the excrement and particularly filthy. The Mishna Berurah (76:17) writes that even if one already recited Shema or davened, he must repeat it when clean.

Nishmat Avraham (O.C. 76:5:9) cites the Minchas Yitzchak (6:11-12) who addresses the question of stoma and permits davening, provided that the area is covered. However, he was concerned that the stoma opening might be considered "excrement at its place," and therefore only allowed when there is an element of doubt, when the person is unaware whether excrement currently exited his body. However, Tzitz Eliezer (9:6) maintains that the stoma opening in not like the rectum and does not have the status of "excrement at its place." Rav Elyashiv zt"l is cited as concurring with this ruling.

2. Rot that has a foul odor is considered as excrement and it is necessary to distance 4 cubits (approx. 2 meters) from where the odor ceases. Even when there is a foul odor that has no tangible source (e.g., passing gas), it is prohibited to recite shema or daven until the odor ceases (O.C. 76:9). Excrement that is covered is treated as odor without tangible source (see M.B. 76:3) and one must distance from the odor. Therefore, if odor emanates from the stoma it is prohibited to daven. With today's technology, the bags are generally affixed tightly and the creams and barrier provide an almost hermetic seal, so that there is no need, in general, to be concerned about odor.

3. The Shulchan Aruch (O.C. 87:1) writes that one must distance from an earthen or wooden bedpan like from excrement, even if it is washed and clean and has no odor (M.B. 87:1), but metal glass or glazed ceramic is permitted if washed well. What is the status of plastic? Nishmat Avraham (ibid:2) cites that Rav S.Z. Auerbach zt"l was of the opinion that a catheter bag, since it is intended for disposable use, is not treated as a bedpan and that plastic seems more similar to metal or glass. This rationale would apply also to a colostomy bag. Nonetheless, it is preferable to cover the bag out of concern for this reason.

B'vracha,

Rabbi Meir Orlian