Defunctioning stoma

A stoma is the connection of an internal organ to the skin.

Sometimes, when the digestive or urinary system is damaged, blocked, or diseased, it may need to be diverted. The surgeon will divert the digestive or urinary system using a portion of intestine brought out onto the abdomen. A pouch (a bag) that will collect stool or urine is placed over the stoma.

The stoma is created by a surgeon and can be:

• Temporary: it is put in place to allow an organ to heal, and is later closed.
• Permanent: it is permanent when natural continuity cannot be restored.

The main types are:

• Colostomy (colon)
• Ileostomy (small intestine)
• Urostomy (urinary tract)

A stoma may be indicated in several medical situations.

Digestive indications

• Cancer of the colon, rectum or anus
• Crohn’s disease or ulcerative colitis
• Intestinal obstruction
• Perforation or severe intestinal complication

Urinary indications

• Bladder cancer
• Severe urinary function disorders
• Congenital malformations
• Neurological conditions affecting the bladder

The decision to create a stoma is made on a case-by-case basis, after medical discussion and patient information.

Returning home is an important step. With proper support, care becomes part of daily routine.

Stoma care

• Clean the skin around the stoma with water
• Dry thoroughly before applying a new device
• Change the pouch according to recommendations (generally every 1 to 3 days)
• Check that the appliance adheres properly to prevent leaks

Monitoring the skin and the stoma

• The skin around the stoma must remain healthy
• Any redness, pain or oozing must be reported
• Observe the size and height of the stoma

Diet and hydration

• Adapted diet and hydration (depending on the type of stoma you have)
• In the case of a digestive stoma, certain foods may alter bowel movements: for example increase gas or odors (cabbage, onions, carbonated drinks)
• Remember to follow the advice given by the dietitian and your stoma care nurse during your surgery

Psychological support

Living with a stoma can be emotionally difficult. Support from relatives and healthcare professionals is essential, and sometimes that of a psychologist.

Certain situations require special attention:

Contact your stoma care nurse if:

• Itching under the pouch
• Repeated leaks
• Persistent skin irritation or wound around the stoma

If you have any doubt or question: one phone call is better than isolating yourself out of fear or concern.

Seek medical attention quickly if:

• The stoma becomes black, purple or very painful
• Significant bleeding appears
• Abdominal pain, fever, nausea

If in doubt, do not stay alone: contact your home care team, the stoma care nurse or, if necessary, go to the emergency department.

At the Brussels University Hospital (H.U.B), several professionals support patients with a stoma:

• Stoma care nurse: main contact for care, education and adaptation of equipment
  • Follow-up at Erasmus Hospital: 02 555 56 30
  • Follow-up at Jules Bordet Institute: 02 541 03 02
• Specialist doctor (surgeon, gastroenterologist, urologist)
• Medical secretariat

At night or on weekends, if possible wait until the next day or Monday, contact your home nurse or your general practitioner, or go to the emergency department if needed.