△ Surgical Nursing

Colorectal Surgery Nursing Guide

A comprehensive perioperative and stoma care reference for nurses practising in GCC healthcare settings, aligned with DHA and SCFHS competency frameworks.

📋 6 Modules ⚙ ERAS Protocol 🏦 Stoma Care 📌 GCC Context 📅 Updated April 2026

Colorectal Anatomy

📐 Large Intestine Segments

Caecum – receives ileal content via ileocaecal valve
Ascending colon – right side; absorbs water & electrolytes
Transverse colon – crosses abdomen; haustra formed by taeniae coli
Descending colon – left side; retroperitoneal
Sigmoid colon – S-shaped; commonest site of diverticular disease
Rectum – 12–15 cm; ampulla acts as reservoir
Anal canal – 4 cm; internal (involuntary) & external (voluntary) sphincters

🪨 Vascular Supply (Clinical Relevance)

Superior mesenteric artery (SMA) – proximal to splenic flexure
Inferior mesenteric artery (IMA) – distal colon & upper rectum
Middle/inferior rectal arteries – internal iliac; distal rectum
Splenic flexure – watershed zone; ischaemia risk during surgery
Venous drainage – portal system (liver metastases route)

Common Colorectal Conditions

🔵 Colorectal Cancer

Third most common cancer globally; increasing incidence in GCC linked to dietary westernisation, obesity, and sedentary lifestyle. Mean age at presentation in GCC is ~55 years — younger than Western cohorts.

Change in bowel habit >4 weeks
Rectal bleeding (frank or occult)
Unexplained iron-deficiency anaemia
Abdominal mass / tenesmus
Unintentional weight loss

🟠 Diverticular Disease

Herniation of mucosa through muscular wall. Most common in sigmoid colon. Low-fibre diets prevalent in GCC populations increase risk.

Diverticulosis – asymptomatic pockets
Diverticulitis – inflammation; LIF pain, fever, leucocytosis
Complicated – perforation, abscess, fistula, obstruction (Hinchey classification)
Surgery – Hartmann's procedure or primary resection & anastomosis

🟢 Inflammatory Bowel Disease (IBD)

Crohn's disease – transmural; any GI segment; skip lesions; fistulae
Ulcerative colitis (UC) – mucosal; rectum to proximal; continuous
Surgery for UC: total proctocolectomy ± ileal pouch-anal anastomosis (IPAA)
IBD incidence rising in Arabian Gulf — likely environmental & microbiome factors

🟩 Anorectal Conditions

Haemorrhoids – grades I–IV; rubber band ligation, haemorrhoidectomy
Anal fistula – Parks classification (intersphincteric, transsphincteric, suprasphincteric, extrasphincteric); seton suture
Rectal prolapse – full-thickness; Delorme's / Altemeier / abdominal rectopexy
Pilonidal disease – higher incidence in hirsute males; GCC population susceptible

GCC Colorectal Cancer Epidemiology

🌎 Regional Burden & Risk Factors

Colorectal cancer is among the top 3 cancers in UAE, Saudi Arabia, Kuwait, and Qatar. Key regional drivers:

High consumption of red/processed meat
Low dietary fibre intake
Rising obesity and type 2 diabetes rates
Physical inactivity (climate-driven sedentary lifestyle)
Genetic predisposition (HNPCC, FAP families)
Younger age of onset vs Western populations

Late Presentation Studies across GCC show 40–60% of colorectal cancers present at Stage III or IV due to lack of screening awareness, cultural reluctance for colonoscopy, and symptom normalisation.

Expat Population The large South Asian and Southeast Asian expat workforce (40–60% of GCC population) brings different genetic risks and dietary patterns, requiring culturally tailored screening strategies.

Staging Systems

📊 TNM & Dukes Classification

Stage	TNM	Dukes	Description	5-Year Survival
I	T1-2 N0 M0	A	Tumour within bowel wall; no nodal spread	~90%
II	T3-4 N0 M0	B	Through bowel wall; no lymph nodes	~75%
III	Any T N1-2 M0	C	Lymph node involvement; no distant mets	~50%
IV	Any T Any N M1	D	Distant metastases (liver, lung, peritoneum)	~15%

CT staging (chest/abdomen/pelvis) + MRI rectum for rectal cancers. CEA baseline for surveillance.

Pre-admission Assessment

📋 Nurse-Led Pre-operative Assessment

History & Risk Stratification

Comorbidities: DM, hypertension, cardiac, renal
Medications: anticoagulants, immunosuppressants, steroids
Allergies (povidone iodine, latex — common in GCC settings)
Nutritional status: weight loss >10%, albumin <30 g/L
Smoking / alcohol / Shisha use
BMI (obesity prevalent in GCC: UAE ~37% adult obesity)
Performance status (ECOG / ASA grade)

Investigations

FBC, U&E, LFT, coagulation, group & save
HbA1c, fasting glucose (DM optimisation)
CEA baseline
ECG, ECHO if indicated
Chest X-ray / CT chest-abdomen-pelvis
MRI pelvis (rectal cancer, CRM assessment)
Cardiopulmonary exercise testing (CPET) if high-risk

ERAS Protocol for Colorectal Surgery

Enhanced Recovery After Surgery (ERAS) Multimodal evidence-based pathway reducing complications by 30–50%, hospital stay by 2–3 days, and readmission rates. Mandated in most GCC tertiary centres.

📅 Pre-operative ERAS Elements

Patient education & expectation setting
Carbohydrate loading (400 mL CHO drink 2–3 hrs pre-op)
Shortened fasting: clear fluids until 2 hrs, solids until 6 hrs
Prehabilitation: exercise, physiotherapy, smoking cessation 4–6 wks
Nutritional optimisation (immunonutrition 5–7 days pre-op if malnourished)
VTE assessment and initiation of LMWH
Selective bowel preparation (per surgeon preference)
Stoma siting by ET nurse if applicable
Anxiolytic premedication (minimise opioids)

⚙ Intra-operative ERAS Elements

Laparoscopic / minimally invasive approach preferred
Goal-directed fluid therapy (avoid over/under-hydration)
Short-acting anaesthetic agents
Epidural / TAP block for open surgery
Normothermia (Bair Hugger, warmed fluids)
Avoid routine nasogastric tube
Minimise drain use (selective)
Antibiotic prophylaxis (cefuroxime + metronidazole within 60 min)

Bowel Preparation

💊 Mechanical Bowel Prep (MBP)

Historically standard; evidence now supports selective use. MBP alone is NOT recommended; combination with oral antibiotics (OABP) is preferred for colonic surgery.

Agents: Polyethylene glycol (PEG), sodium phosphate, sodium picosulfate
Nurse role: Ensure adequate hydration, monitor electrolytes (risk of hyponatraemia in elderly/renal impairment)
Contraindications: Obstruction, megacolon, ileus

GCC Note Patients may be fasting for Ramadan; coordinate bowel prep timing carefully with the surgical team.

💊 Oral Antibiotic Bowel Prep (OABP)

Reduces surgical site infection (SSI) by targeting intraluminal flora. Combined MBP + OABP shows best outcomes in colorectal trials (SWAMP trial, MOBILE trial).

Regimen example: Neomycin 1 g + metronidazole 500 mg at 2 pm, 6 pm, 10 pm the day before surgery
Alternative: Neomycin + erythromycin base (if metronidazole intolerance)
Nurse role: Confirm administration, document, counsel on GI side effects (nausea)

Stoma Siting

📌 Pre-operative Stoma Site Marking by ET Nurse

Enterostomal therapy (ET) nurse should site and mark the stoma before surgery. Optimal siting reduces complications by up to 70%.

Principles of Stoma Siting:

Within the rectus abdominis muscle
Away from bony prominences, scars, umbilicus, skin folds
Visible to patient (below waistline, above skin fold)
Marked with indelible ink + verified with pouching system
Assessed supine, seated, standing, bending
Consider clothing (thobe/abaya in GCC — waistband position)

Site by Procedure:

Right hemicolectomy – ileostomy: RIF (right iliac fossa)
Left hemicolectomy / sigmoid – colostomy: LIF (left iliac fossa)
Anterior resection (loop) – loop ileostomy: RIF
APR (Abdominoperineal resection) – end colostomy: LIF
Hartmann's – end colostomy: LIF

VTE Prophylaxis

💉 Venous Thromboembolism Prevention

HIGH RISK — Colorectal Cancer

LMWH: Enoxaparin 40 mg SC daily
Start 12 hrs post-op (or pre-op if no epidural)
Continue 28 days post-op (extended prophylaxis) for cancer patients

MECHANICAL

TED stockings pre-op and post-op
Intermittent pneumatic compression (IPC) intra-op & post-op
Early mobilisation — Day 0 post-op (ERAS)

NURSE MONITORING

Assess calf tenderness, leg swelling daily
Tachycardia / desaturation → Doppler / CTPA
Bleeding risk: surgical site, epidural space (withhold if spinal)
Renal impairment: adjust dose (CrCl <30 mL/min → UFH)

Nutritional Optimisation & Immunonutrition

🌿 Nutritional Assessment

Screen with MUST (Malnutrition Universal Screening Tool)
Dietitian referral if MUST score ≥2 or weight loss >10%
Serum albumin <30 g/L: high post-op complication risk
Pre-operative nutritional support 7–14 days if severely malnourished
Target: protein 1.2–1.5 g/kg/day pre-op
Post-op: oral diet from Day 0–1 (ERAS); NG feeding if unable

🧪 Immunonutrition

Oral supplements enriched with arginine, omega-3, ribonucleotides. Reduces SSI and length of stay in colorectal cancer patients.

Indication: Malnourished patients, major resection
Timing: 5–7 days pre-op (e.g., Impact Oral, Reconvan)
Dose: 3 cartons/day (Impact)
GCC availability: Available in UAE/Saudi; check formulary
Halal certification: Confirm for patient acceptability in GCC

Consent Counselling & Procedure Marking

📝 Laparoscopic vs Open Surgery Counselling

Factor	Laparoscopic	Open
Incision	3–5 small ports (5–12 mm) + specimen extraction	Midline laparotomy (15–25 cm)
Hospital stay	2–4 days (ERAS)	4–7 days
Return to activity	2–4 weeks	6–8 weeks
Pain	Less; less opioid requirement	More; epidural often used
Oncological outcome	Equivalent (CLASSIC, COLOR trials)	Standard
Conversion risk	5–15% to open	N/A
Robotic option	Available at GCC tertiary centres	N/A

Procedure-Specific Marking Surgeon marks operative side before induction. Nurse confirms: correct patient, procedure, site, consent signed, allergies documented (WHO Surgical Safety Checklist). Never proceed without completed sign-in.

Surgical Approaches

Procedure	Indication	Anastomosis	Stoma	Notes
Right Hemicolectomy	Caecal / ascending / hepatic flexure cancer	Ileocolic (side-to-side or end-to-end)	Usually none; ileostomy if high risk	Laparoscopic preferred; resect terminal ileum
Left Hemicolectomy	Descending colon / splenic flexure cancer	Colorectal or colocolic	Rarely; Hartmann's if perforated	IMA ligation; splenic flexure mobilisation
Anterior Resection (AR)	Upper/mid rectal cancer (>6 cm from AV)	Colorectal (stapled)	Loop ileostomy (protective, temporary)	TME technique; preserve autonomic nerves
Low Anterior Resection (LAR)	Lower rectal cancer (5–6 cm from AV)	Coloanal (hand-sewn or stapled)	Loop ileostomy mandatory	LARS syndrome post-op; longer recovery
Hartmann's Procedure	Emergency: perforated diverticulitis, obstructed cancer	None (oversewn rectal stump)	End colostomy (LIF)	Reversal possible 3–6 months later
APR (Abdominoperineal Resection)	Very low rectal / anal canal cancer (<4 cm AV)	None (permanent)	Permanent end colostomy (LIF)	Perineal wound; combined abdominal & perineal incisions
Subtotal/Total Colectomy	UC, FAP, emergency obstruction/volvulus	Ileorectal or IPAA	Ileostomy (temporary or permanent)	Multiple stages may be required

Stoma Formation: Colostomy vs Ileostomy

🟢 Colostomy

Type: End or loop; left iliac fossa
Output: Formed/semi-formed stool (sigmoid); looser (transverse)
Volume: 200–600 mL/day
Appearance: Flush or slightly raised; pink/red; moist
Management: Closed/drainable pouch; irrigation possible for end colostomy
Complications: Retraction, prolapse, parastomal hernia, skin excoriation

🔵 Ileostomy

Type: End or loop; right iliac fossa; spout 25–30 mm above skin
Output: Liquid to porridge consistency
Volume: 800–1200 mL/day (up to 2000 mL = high output)
Electrolytes: High sodium loss → dehydration & AKI risk
Management: Drainable pouch; change every 3–5 days
Complications: Dehydration, renal impairment, skin excoriation (proteolytic enzymes)

Post-operative Monitoring

📊 Anastomotic Leak — Peak Risk Day 3–5

Early Warning Signs (Day 3–7) Tachycardia >100 bpm (often FIRST sign) · Pyrexia >38°C · Increasing abdominal pain · Change in drain output (turbid / faeculent) · Leucocytosis · CRP >150 mg/L on Day 3

NEWS2 monitoring every 4 hrs minimum
Monitor drain character and volume (document hourly initially)
CRP Day 1, 3, 5 post-op (rising trend is concerning)
CT abdomen/pelvis with contrast if suspicion (water-soluble contrast enema for rectal)
Inform surgical team IMMEDIATELY if signs develop
Prepare for return to theatre or IR drainage

📋 Return of Bowel Function

Flatus expected: Day 1–3 (laparoscopic); Day 2–4 (open)
Bowel movement: Day 2–4 typically
Stoma output: Usually Day 2–4 post-op (green/brown liquid initially)
NG tube: Avoid routine insertion (ERAS); use only for persistent vomiting
Ileus concern: Absent bowel sounds + distension + no flatus by Day 4 → review opioids, encourage mobilisation, consider prokinetics

ERAS Post-op Milestones:

Day 0: Fluids, sit out of bed, remove urinary catheter (laparoscopic)
Day 1: Mobilise, light diet, remove epidural or reduce PCA
Day 2–3: Regular diet, physiotherapy, discharge planning

Pain Management

💊 Epidural Analgesia

Preferred for open colorectal surgery (T8–T10 level)
Local anaesthetic ± opioid (bupivacaine + fentanyl)
Monitor: BP (hypotension), motor block, urinary retention, respiratory depression
Assess dermatomal block every 4 hrs
LMWH: withhold 12 hrs before insertion/removal
Wean Day 2–3 post-op; transition to oral analgesia
TAP block alternative if epidural contraindicated

💊 PCA & Multimodal Analgesia

IV PCA morphine/fentanyl: lockout 5–10 min; 4-hr limit
Paracetamol IV/oral 1 g QDS (regular, not PRN)
NSAIDs: diclofenac/ketorolac — use cautiously (anastomotic leak risk debated)
Gabapentin/pregabalin: opioid-sparing, neuropathic component
Sedation scoring (Richmond Agitation Sedation Scale)
Respiratory rate monitoring (epidural/opioid)
Naloxone available at bedside

Drain Management

🪱 Post-operative Drain Care

Indication

Pelvic drain for low anterior resection / APR
Abdominal drain for contaminated field
Not routinely used for elective colonic resection (ERAS)

Monitoring

Document colour: serosanguinous → serous (normal)
Turbid / purulent / faeculent → leak
Drain amylase Day 3 if doubt (leak if >3× serum amylase)
Volume: >200 mL/hr bright red → haemorrhage alert

Removal

Remove when output <50 mL clear in 24 hrs
Typically Day 2–4 for pelvic drain
Never remove if amylase elevated or output suspicious

Major Complications

🔴 Anastomotic Leak

Critical Complication — 3–10% incidence; up to 30% mortality if delayed recognition

Timing: Peak Day 3–7 (can occur Day 1–14)
Signs: Tachycardia (earliest), fever >38.5°C, abdominal pain/peritonism, faeculent drain, elevated CRP, leucocytosis, clinical deterioration
Investigation: CT abdomen/pelvis with IV contrast (water-soluble contrast enema for rectal anastomosis)
Grade A: Radiological only; conservative management (nil by mouth, antibiotics, drain)
Grade B: Clinical; IR drainage ± defunctioning stoma
Grade C: Return to theatre; Hartmann's procedure
Nursing: NEWS2 escalation, IV access, bloods, surgeon notification immediately

🟢 Paralytic Ileus

Definition: Functional non-mechanical bowel obstruction; inhibited peristalsis
Duration: Prolonged ileus >3 days (laparoscopic), >5 days (open) is clinically significant
Signs: Abdominal distension, nausea/vomiting, no flatus/stool, high-pitched or absent bowel sounds
Causes: Excess opioids, hypokalemia, hypomagnesaemia, peritonitis, immobility

Management:

Review and reduce opioids; add laxatives
Correct electrolytes (K⁺ >4.0 mmol/L; Mg²⁺ >0.8 mmol/L)
Mobilise aggressively; chewing gum (vagal stimulation)
NG tube if vomiting/distension (decompression)
IV fluids; maintain hydration
Exclude mechanical obstruction: CT if no improvement by Day 5

💉 DVT / Pulmonary Embolism

Colorectal cancer patients are HIGHEST risk group for VTE

DVT signs: Calf tenderness, swelling, erythema, pitting oedema; may be asymptomatic
PE signs: Tachycardia, pleuritic chest pain, dyspnoea, haemoptysis, hypoxia, syncope
Investigation: Doppler USS (DVT); CTPA (PE); D-dimer (if low clinical probability)
Treatment: LMWH therapeutic dose → oral anticoagulation (DOAC or warfarin) 3–6 months; consider 6+ months in cancer

📌 Wound Dehiscence

Superficial: Skin breakdown; secondary healing with dressings
Deep (fascial dehiscence): Burst abdomen — EMERGENCY
Signs of burst abdomen: Sudden serosanguinous soaking of dressing ("salmon-pink" discharge) with sense of "giving way"; bowel visible
Risk factors: Obesity, DM, malnutrition, steroids, wound infection, coughing
Nursing action: Cover bowel with warm moist sterile towels; nil by mouth; IV access; call surgeon immediately; theatre

Stoma Complications

Complication	Definition / Signs	Timing	Management
Retraction	Stoma retracts below skin level; concave appearance; leakage risk	Early or late	Convex baseplate; barrier rings; ET nurse review; surgical revision if severe
Prolapse	Stoma protrudes >6 cm; oedematous; can be reducible or fixed	Weeks–months	Manual reduction (lubrication, cool compression); surgical revision if incarcerated/necrotic
Stenosis	Narrowing of stoma opening; ribbon stool; obstruction symptoms	Months–years	Digital dilation; surgical revision (revision often needed)
Parastomal hernia	Bowel protrusion through abdominal wall around stoma; bulge around stoma	Months–years (up to 50% of colostomies)	Support belt; surgical repair (mesh); resiting of stoma
Skin excoriation	Peristomal skin breakdown from effluent contact (especially ileostomy enzymes)	Any time	Better fit; barrier products; stoma powder; antifungal if candida present
Necrosis	Black/dusky colour; loss of viability	First 24–72 hrs	Immediate surgical review; torchlight assessment; may need revision

Low Anterior Resection Syndrome (LARS)

🔴 LARS — Impact on Quality of Life

Cluster of bowel dysfunction symptoms occurring after low anterior resection. Affects 60–80% of patients to varying degrees. Can significantly impair quality of life and return to work.

Symptoms:

Urgency and frequency (multiple bowel movements per day)
Clustering (several BMs in a short period)
Incontinence (flatus or faeces)
Incomplete evacuation / tenesmus
Constipation alternating with diarrhoea

Assessment & Management:

LARS Score questionnaire (validated tool, 5 questions; score 0–42)
No LARS: 0–20; Minor: 21–29; Major: 30–42
Pelvic floor physiotherapy (first-line)
Dietary modification (low-FODMAP; avoid gas-forming foods)
Loperamide for diarrhoea; laxatives for constipation
Transanal irrigation (TAI) for major LARS
Sacral nerve stimulation (refractory cases)
Reassure: symptoms improve 12–18 months post-op

Anastomotic Leak Risk Calculator

⚙ Anastomotic Leak Risk Score

Select all applicable risk factors to calculate the patient's anastomotic leak risk category and guide post-operative monitoring intensity.

BMI >30 kg/m² (obesity) +1

Male sex +1

Anastomosis height <6 cm from anal verge (low anastomosis) +2

Operating time >3 hours +1

Intra-operative blood transfusion (>2 units PRBC) +2

Steroid use (pre-operative or chronic) +2

Malnutrition (albumin <30 g/L or weight loss >10%) +1

Emergency surgery (unprepared bowel) +2

Colorectal Cancer Screening in GCC

🇪🇦 UAE — Dubai & Abu Dhabi

DHA (Dubai Health Authority) National Screening Programme: colonoscopy from age 45 (average risk)
HAAD/DoH (Abu Dhabi) — aligned with US Preventive Services Task Force guidelines
FIT (Faecal Immunochemical Test) offered via primary care for average-risk adults 50–74
Positive FIT → colonoscopy within 8 weeks
National Cancer Registry (NCR) data shows CRC rising 3% per year in UAE

🇸🇦 Saudi Arabia

Saudi Gastroenterology Association guidelines: colonoscopy from age 40–45 (GCC early onset)
Vision 2030 health initiatives include screening expansion
SCFHS (Saudi Commission for Health Specialties) supports colorectal nursing competencies
King Faisal Specialist Hospital — national referral for hereditary CRC
Pilot FIT programs in primary health care centres across Riyadh region

🇶🇦 Qatar

Hamad Medical Corporation (HMC) National CRC Screening Program
Screening age: 45 years (average risk)
Annual FIT for average risk; colonoscopy every 10 years
Qatar National Cancer Registry: CRC #2 cancer in Qatari males
Sidra Medicine — genetic oncology & HNPCC surveillance

🇰🇼 Kuwait & Bahrain

Kuwait Cancer Control Centre: population-based screening piloted
Colonoscopy primary screening tool; limited FIT programme
Bahrain: National Endoscopy Centre; screening age 50 (under review for earlier start)
Both countries working toward GCC unified screening guidelines

Colonoscopy Surveillance Intervals

Finding / Risk	Next Colonoscopy	Notes
Normal (average risk, age 45+)	10 years	Or FIT annually
1–2 small tubular adenomas (<10 mm)	5 years	Low-risk adenomas
3–4 adenomas OR any >10 mm OR villous/HGD	3 years	High-risk adenomas
5+ adenomas	1 year	Consider genetic referral
Post-curative resection CRC (colonic)	1 year then 3 years then 5 years	CEA monitoring concurrent
Post-curative resection rectal cancer	3–6 months (rigid sigmoidoscopy/MRI) then annual	Local recurrence surveillance
First-degree relative CRC <50 years	Begin at 40 years or 10 years before relative's age	Earlier start
IBD (pancolitis) — 8–10 yrs duration	Annual chromoendoscopy	Dysplasia surveillance

Genetic Counselling Referral

🧬 HNPCC / Lynch Syndrome

Hereditary Non-Polyposis Colorectal Cancer (HNPCC) — Lynch syndrome. Autosomal dominant; MLH1, MSH2, MSH6, PMS2 gene mutations. Accounts for ~3% of CRC but proportionally higher in younger GCC patients.

Amsterdam II Criteria (refer if 3 or more):

3 relatives with Lynch-associated cancer (CRC, endometrial, small bowel, ureter)
2 successive generations affected
1 relative diagnosed before age 50
FAP excluded

🧬 FAP — Familial Adenomatous Polyposis

APC gene mutation; autosomal dominant. Hundreds to thousands of colonic polyps from adolescence. Near 100% lifetime CRC risk if untreated.

Prophylactic colectomy advised by age 25 (or when polyps dense)
Annual sigmoidoscopy from age 12–14
Upper GI surveillance (duodenal/gastric polyps)
Genetic testing of first-degree relatives
Desmoid tumours: NSAID chemoprevention (sulindac)
GCC genetic centres: KFSH Riyadh, Cleveland Clinic Abu Dhabi, HMC Qatar

Dietary Advice for GCC Patients

🌿 Halal High-Fibre Diet Guidance

Encourage:

Whole grains: whole wheat bread, brown rice, barley (shai & hareesa alternatives)
Legumes: lentils (adas), chickpeas (hummus), fava beans (ful medames)
Vegetables: okra (bamia), zucchini, spinach, carrots — well-tolerated by new stoma
Fruits: dates (moderate), figs, apples, pears (peeled initially)
Fish: 2–3 servings/week (omega-3 protective)
Adequate hydration: 2–3 L/day (especially ileostomy)

Limit / Avoid (especially post-stoma formation):

Processed meats (sausages, deli meats — even halal brands)
Excessive red meat (>3 portions/week)
Spicy foods (increase stoma output)
Nuts and seeds (initially — obstruction risk)
Carbonated drinks (gas formation)
Onions, garlic, leeks (odour/gas via stoma)

Cultural Note Traditional Khaleeji foods (harees, thareed, machboos) can be adapted. Work with dietitian and patient family to create culturally appropriate high-fibre meal plans.

Ostomy Support Groups in GCC

🇨🇦 UAE

Tawam Hospital Stoma Clinic (Al Ain, Abu Dhabi)
Dubai Hospital ET Nurse Department
American Hospital Dubai — ostomy nurse services
UAE Ostomy Association (informal patient networks)
ConvaTec & Coloplast patient support lines (Arabic)

🇸🇦 Saudi Arabia

KFSH & RC Riyadh — dedicated ostomy team
Saudi Ostomy Association (SOA) — patient peer support
Ministry of Health stoma nurse training programme
Online Arabic Ostomy support groups (WhatsApp, social media)

🇶🇦 Qatar & Bahrain

HMC Qatar — Al Khor and Hamad General stoma nurses
Salmaniya Medical Complex Bahrain — ET nurse clinic
IOA (International Ostomy Association) GCC affiliate
3rd Saturday of each month: World Ostomy Day activities

DHA / SCFHS Colorectal Nursing Competencies

🏫 Professional Competency Framework

DHA (Dubai Health Authority):

DHA Scope of Practice: Surgical nurses must demonstrate competency in stoma care, wound management, perioperative care
ET Nurse certification recognised via WOC (Wound Ostomy Continence) Nursing credentials
Mandatory 6-monthly competency validation in stoma assessment
DHA Nursing Policy: Pre-operative education must be documented before consent

SCFHS (Saudi Commission):

Saudi Nursing Specialty Frameworks include "Perioperative Nursing" and "Wound and Ostomy Care"
Nurses must complete approved CPD hours in colorectal nursing annually
Arab Board of Health Specializations — postgraduate surgical nursing pathway
Minimum staffing requirements: 1 certified ET nurse per surgical unit ≥20 beds

Ramadan Adaptations for Stoma Patients

☀ Supporting Stoma Patients During Ramadan

Religious Guidance Islamic scholars and bodies including the Islamic Organization for Medical Sciences (IOMS, Kuwait) have issued rulings that stoma patients may be exempt from fasting (Rukhsa) given the medical need for continuous nutrition and hydration — especially high-output ileostomy patients. Patients should seek personal fatwa from a trusted scholar.

Consult surgeon/dietitian before deciding to fast
Ileostomy patients: high risk of dehydration — generally advised NOT to fast without medical clearance
Colostomy patients: may fast safely if output is controlled and electrolytes stable

Practical Nursing Advice:

Schedule stoma appliance change at iftar or suhoor (easier around mealtimes)
Encourage suhoor high-fibre meal to slow GI transit
Fluid repletion: 2–3 L between iftar and suhoor for ileostomy
Monitor for dehydration, AKI, electrolyte disturbance during Ramadan
Weigh patient twice weekly during Ramadan if fasting
Medications: retime drug schedules to iftar/suhoor doses with pharmacist review
Post-op Ramadan: no fasting for ≥6 weeks post colorectal surgery regardless of stoma type