Live and be independent
“It is not because things are difficult that we have no
courage. It is because we have no courage that things
are difficult.”
Séneca – Roman writer
1. What is an Ostomy? .............................................................2
2. Choosing the Device (Pouch) ................................................2
3. What you need to know..........................................................2
4. How to change the appliance..................................................3
5. How to prevent skin problems.................................................5
6. Advice for daily life..................................................................5
7. Welfare compensations and fiscal benefits.............................7
To live and be independent is a manual to inform, clarify and
teach you how to live with your new reality. You are not going
to be sick all your life! It is only a phase, which you are going to
overcome. Remember that people who are in close contact
with you, are your main emotional support and both need time
to adjust to the new reality. Sharing your feelings with
someone will help you to be more tranquil.
Be aware that there is a team of healthcare professionals, to
which Nurses from the Stoma Care Counselling belong, who
are available to help you and your family at this moment of
your life.
1. What is an Ostomy?
An ostomy is an opening in the abdominal wall (made by an operation) which is called
STOMA, through which the faeces or urine pass out. This new situation does not
depend on your will, requiring the use of a pouch, which adheres to the skin around the
stoma.
2. Choosing the Device (Pouch)
There are various types and brands of pouches, which will be shown to you at the
hospital. They can be made of one or two pieces, transparent or opaque, closed or
open.
If you choose the one-piece pouch, this has to be changed whenever necessary. If you
choose the two-piece pouch (pouch and plate), the plate adheres to the skin for 4 to 5
days at the most, while the pouch is changed whenever necessary.
When you leave the hospital you will have the required quantity and variety of pouches to
take with you to use during the first few days and you can choose whichever device is the
most comfortable for you.
After having made your choice a prescription will be made out for you and the references
of the pouch so that you can buy them.
3. What you need to know
• The stoma is pink or a bright red colour, is moist and mucous (white particles) might
appear around it;
•To touch the stoma is not painful;
•The stoma can bleed a little when you clean it or when you change the device. Don’t be
worried, it is normal;
•The device must be changed (if it is closed) or emptied (if it is open) whenever half of its
capacity is full;
•The devices (pouches and plates) must be kept inside the boxes, in a dry place, at room
temperature so that their properties are not altered.
4. How to change the device
Every time you change the pouch or plate, you should clean the stoma and
surrounding skin with water and pH neutral liquid soap. Good hygiene is the best
guarantee for well being, safety and quality of life, as it will avoid any complications.
We recommend that, initially, the device should be changed in front of a mirror to
ensure that it is correctly placed.
.
We will now explain the steps you must take to change your device
Cutting
The pouches or plates have a very tiny opening, which has to be cut to the same diameter
as your stoma. It is important that you follow this rule so that the skin does not make any
contact with the faeces or urine, thus avoiding any possible irritation.
•Use the moulds supplied by the hospital and draw it on the self-adhesive paper
and/or skin protector of the pouch (if it is a one-piece device) or plate (if it is a twopiece device).
•Cut around the design you have made, using scissors with curved points;
•Pass with your index finger around the cutting, to smooth it and remove any ridges.
Material Required
Before changing the device, wash your hands and prepare all the material that you are going to
use:
•Device already cut according to your stoma size;
•pH neutral liquid soap;
•Natural sponge;
•Tissues, paper napkins or soft toilet paper (double or three ply);
•Disposal bag.
Changing the device
After preparing all the material that you are going to use, start changing the pouch:
•Withdraw the soiled device with both hands gently from top to bottom. As you remove the
pouch with one hand, hold the skin surrounding it firmly with the other;
•Put the used pouch in the disposal bag.
Hygiene of the Stoma and Skin
This will be the correct time to clean the stoma and surrounding skin, as follows:
Clean the stoma and skin with toilet paper to remove the excess faeces and urine;
•Without scraping, wash the stoma and skin with a natural sponge moistened with warm
water and pH neutral liquid soap. Repeat this operation with a sponge just moistened
with water;
•Dry the stoma and surrounding skin well with tissues or toilet paper with very soft patting
movements and without scraping.
If it is not necessary to change the plate (this can remain for 4 to 5 days), remove the pouch
and proceed cleaning the stoma with the plate fixed in place.
How to apply a new device
One-piece device
•Remove the auto-adhesive strip or skin protector avoiding touching it;
•Place the edge of the opening against the lower border of the stoma and gently stick the
adhesive or skin protector, from the bottom to the top, along the skin surrounding the
stoma;
•With your hand stretched over the device, press it lightly for a few seconds so that it
adheres better to your skin;
•Make sure that it is secure by pulling it lightly.
Two-piece device
•Remove the auto-adhesive strip and/or skin protector of the plate already cut;
•Place the edge of the plate against the lower border of the stoma, sticking it to the skin.
Press lightly with your fingers around the stoma and on the whole plate;
•Adapt the edge of the pouch to the plate by pressing it lightly;
•Make sure it is secure by pulling it.
After these proceedings place the disposal pouch in the rubbish bin. Wash your hands and
tidy the material.
We recommend that, every time you change the pouch and take care of your stoma, you
look at it and surrounding skin carefully, checking to see if there are any alterations.
You must be careful to detect:
•Any change of colour and size of the stoma;
•Possible alterations of the skin and surrounding it, which might be red or wounded.
In these cases you should contact your nurse and / or assistant doctor.
5. How to prevent skin problems
• It is very important that the opening, which you cut in the device, is
exactly the same size of the stoma, so that the skin is completely covered.
The skin which is not protected will be in contact with faeces and urine,
which might cause irritation;
•Whenever the pouch or plate is not well adherent and faeces or urine can
be seen passing through the adhesive and / or skin protector, it should be
replaced immediately;
•Do not use disinfectants to clean the stoma. Wash it just with water and
pH neutral liquid soap, instead of other types of soap and perfumed
soaps, as they can dry the skin and / or cause allergies;
•Cut the hair around the stoma with scissors with round points. Do not use
a shaving machine or razor, as there is a danger that you might cut
yourself and make a wound, or depilatory cream as it might cause an
allergy;
•To clean the stoma do not use products which irritate (alcohol, acetone, ether, perfumes,
tincture of benjoim, etc.) or perfumed tissues (disposables);
•You shouldn’t apply greasy products on the skin such as ointments or creams, which
prevent the device adhering as it should;
•Change the pouch or plate only when it is necessary. Frequent changes may cause skin
irritation.
6. Advice for daily life
The fact of having a stoma and using a device should not affect your daily life, as
nowadays there are devices, which are comfortable and safe to use.
After your operation and as you are improving, it is important to learn how to take care of
your ostomy by yourself. Thus, you will not need the help of other people and will more
rapidly return to an independent life once again.
Personal Hygiene
You can have a bath with or without a pouch, you have to try both and choose what is best
for you. The pouches are made of material, which is waterproof and dries easily with the
help of a towel. If you have a bath with the pouch, stick the adhesive on the filter preventing
it from getting wet and losing its properties.
You should be careful of the temperature of the water, which should not be too hot in order
not to “burn” the stoma and affect the adhesive and / or skin protector device.
Clothes
Whenever possible you should use the same clothes you used before. However,
belts or elastic must not be used on top of the stoma. If you use them, they should be
raised or lowered or you should use suspenders.
If you need to, for more confidence in yourself, you can use a girdle or an adequate
strap with an opening for the stoma, as long as this is not tight. Your stoma care
nurse will give you the necessary advice.
Food
The fact that you have a stoma is not a reason for you to diet. You should have a
varied and balanced diet, eating a bit of everything. When you are discharged from
hospital you should return slowly to your usual diet.
•It is not necessary to eat a lot at every meal, but instead you should have regular
meals throughout the day (five to six);
•Eat small quantities of new food until you are certain what the reaction of your body
will be. In a short while you will know what food agrees with you;
•Drink about 2 litres of liquids per day (water, tea or natural juices). This quantity
should be increased on very hot days or every time you perspire a lot.
Professional activity
During the first weeks after being operated on, it is natural that you will feel a little weak,
but you will be recovering slowly. If you were working before the operation it is likely that
you can go back to work after 6 or 8 weeks.
You should avoid activities that demand force, such as lifting weights (above 20 kg) thus
preventing any complications as for instance a hernia.
Sport and Entertainment
It is important that you go out and enjoy yourself with your family and friends. You can
go to the beach, wear a swimming costume and swim. Though you should avoid
violent sports such as judo, karate, boxing and rugby.
Travelling
Whenever you travel do not forget to take the necessary material you will need for
that period. However, to feel more secure and in order to avoid “shortage” of material,
you should take with you more than you require generally. Keep the references on
the boxes with you. If you travel by plane, take the ostomy material in your hand
luggage, as you might lose your luggage.
Have a light meal before leaving.
Sex
The changes in sexuality can be connected with the operation you had, but in most
cases, they are related to other factors, such as: anxiety and fear of not being
accepted by the other. In order to improve this situation, share your feelings with your
partner and do not be ashamed to speak openly with the stoma care nurse or doctor.
They are available to help you.
Safety bag
Whenever you go out, take a bag with you with:
•Some cut devices (two or three);
•Tissues or soft toilet paper;
•Disposal bag for soiled bags;
•Small bottle of water.
Thus, if the device comes unstuck the situation can easily be overcome with or
without a toilet.
7. Welfare compensations and fiscal benefits
As an ostomized person you have the right to certain benefits, such as:
•Reimbursement of a percentage on the cost of devices (pouches and plates) and
accessories as shown in the following table.
S.N.S.
National HealthCare System
Normative law 25/95 dated 14th
September 1995
Colostomy
and Ileostomy
pouches
Urostomy
pouches
Accessories
for Ostomy
devices
Irrigator for
Colostomies
90%
ADSE
Portuguese HealthCare System for
Civil Servants
Normative Law (2nd Series) nº 244
dated
26-09-2001
100%
up to 2 Euros
without limit to quantity and
amount
90%
90%
up to 2.5 Euros
up to 1,500 per year and 3.19
Euros per pouch
100%
90%
without limit to quantity and
amount
100%
90%
Coloplast Irrigator - without
limit to quantity and amount
•If you belong to the National HealthCare System, when buying devices (pouches and /
or plates) and respective accessories you should ask for an invoice or receipt, so you
can submit it together with the prescription to the Welfare Centre where you are
enrolled. If your welfare system is the ADSE (Portuguese HealthCare System for Civil
Servants), you should send the receipt, writing on the reverse your name, present
address and beneficiary number (according to your card) for reimbursement as per the
amounts referred to in the table on page 23;
•Exemption from payment of minimum rates, when you go to the public welfare system
services;
•Attribution of a certain degree of handicap depends on the type of illness and ostomy
you have. For the degree of incapacity to be conferred, you should submit a petition to
the Assistant to the Health Regional Delegate together with the report issued by your
doctor and medical examinations, sending all this documentation to the Health
Delegate.
Within an approximate period of 60 days, a Medical Group who will decide on the degree
to which you are incapacitated will call you for examination.
•Non-utilisation of safety belts in cars. For that purpose, a medical certificate issued by the
Health Delegate is required.
Depending on the degree of incapacity given and in case of need, you can ask for other
benefits such as: support at home, tax exemptions, special conditions in the transmission
of house rent, amongst others.
Please ask your Stoma Care Nurse for more information.
List of consultations for Stoma Care Nursing
Aveiro
Nurses
Hospital Distrital de Aveiro (5th floor – Oncology) ........Graciete Marques (from 8 to 15H)
Centro de Saúde de Aveiro ...........................................Cristina Cera (Wednesdays from 9 to 12H)
Centro de Saúde de Castelo de Paiva ..........................Glória Gomes and Maria de Fátima (Tuesdays from 14 to 17H)
Centro de Saúde de Ilhavo ............................................Sandra Irene (Wednesdays from 14 to 17H)
Beja
Hospital Distrital de Beja
External consultation – Urology ..…..............................Isabel Gonçalves
Braga
Hospital Distrital de Braga ..........................................Madalena and Maria José (Mondays and Wednesdays in the
afternoon)
Castelo Branco
Centro de Saúde de Castelo Branco .............................Maria Isabel Barata (by appointment)
Centro de Saúde de Belmonte ......................................Beatriz Martinho (by appointment)
Coimbra
Nurses
Hospitais da Universidade de Coimbra (Surgery Service 1) ….Licínio Silvestre (Fridays in the afternoon)
Centro Regional de Oncologia de Coimbra .......................Isabel Morais (Mondays, Tuesdays and
Fridays from 8 to 16H)
Évora
Hospital Distrital de Évora (External consultation) ............…...Cecília Varandas (Thursdays at 14H30)
Faro
Hospital Distrital de Faro ...................…...................................Felicidade Oliveira
Associação Oncológica do Algarve .........................................Felicidade Oliveira (by appointment)
Guarda
Centro de Saúde de Trancoso ................................................Cristovão Marques (by appointment)
Guimarães
Hospital da Senhora da Oliveira Surgery Service .............Alcina Machado (Wednesdays in the
afternoon)
Leiria
Nurses
Centro Hospital das Caldas da Rainha ..............................João Domingos (Tuesdays at 14H)
Centro de Saúde Gorjão Henriques ...................................Maria de Fátima Soares (by appointment)
Lisboa
Associação Portuguesa de Ostomizados ..........................Augusta Pinheiro
(Mondays and Wednesdays by appointment)
Liga Portuguesa contra o Cancro ......................................Augusta Pinheiro
(Tuesdays and Thursdays by appointment)
Hospital de São José ........................................................Esperto and Estela Rodrigues (MET)
(Surgery Service 4)
Hospital São Francisco Xavier ...........................................Lídia Chapuça and Manuela Miranda
Surgeon on duty (Wednesdays from 14 to 17H)
Hospital Montijo .................................................................Helena Silvestre and Sandra Silva
(Tuesdays from 16 to 18H)
Hospital Distrital de V. Franca de Xira ..............................Célia Sanches and Madalena Van Zeller
(Mondays from 9 to 13H) (Day Hospital)
Porto
Nurses
Hospital de São João (External consultation) ......................Maria Manuel Castro
Hospital de Santo António (ex-CICAP) ................................Joana Tavares and Rocha
(Mondays and Wednesdays in the morning)
Hospital de Vila Nova de Gaia ..............................................Marina Mimoso (Mondays in the afternoon)
Hospital Distrital de Penafiel .................................................Goretti de Carvalho (Mondays in the afternoon)
Liga de Ostomizados de Portugal .........................................Emília Paula Alves (by appointment)
Santarém
Hospital Distrital de Santarém ...............................................Maria Helena Fernandes (every morning)
(External consultation)
Setúbal
Hospital de São Bernardo (Surgery II) ..................................Célia Elsa and Patrícia
Antónia Almeida (Fridays in the afternoon)
Hospital Garcia da Orta ........................................................Graça Travanca
Viana do Castelo
Hospital Distrital de Viana do Castelo .................................Manuela Gabriel and Paula Torre
(Tuesdays and Thursdays from 9 to 17H)
(Surgery 2)
Viseu
Centro de Saúde de Tondela ...............................................Ana Cristina Rodrigues (by appointment)
Centro de Saúde de Penalva do Castelo .............................Ana Maria Almeida (by appointment)
Conceived by:
Sponsored by:
Ana Cristina Ferreira
Dora Neves
Coloplast A/S (Portugal)
Idália Silva
Isabel Morais
Rua Gorgel do Amaral, 4 – cv dt
Ana Seiça
João Moreira
Tel. 21 383 86 26
Conceição Mineiro
Manuel Jorge Araújo
Fax. 21 383 86 28
Helena Pereira
Nurses from the Supporting Counselling of Stoma Care of
Centro Regional de Oncologia de Coimbra (Oncology Centre
of Coimbra)
Avenida Bissaya Barreto – 98
3030 – 075 Coimbra
Tel. 239 400 200 Ext. 2504 / 2505
January 2003
Notes: