Ileostomy

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What is an ileostomy?

A ileostomy is a surgical procedure that brings the end of the small intestine (also known as the ileum) through the front of the abdomen, most commonly on the right side, where a stoma (opening) is created allowing attachment of an ostomy pouch for collecting stool.

Image of an ileostomy

What exactly is the stoma?

A stoma (Greek meaning "mouth") is what you see when you look at your ostomy. It is the actual opening of the bowel or intestine through the abdomen that allows for the passage of stool. It usually sits just below the navel but may be higher up depending on your surgery. The size of your stoma will diminish for up to two months after your surgery.

Image of an ostomy stoma

The color of your stoma will be pink or red, somewhat like the inside of your mouth. A little bit of normal bleeding may occur during the cleaning of your stoma. Stomas vary in size, shape, and location. They usually are about one inch around, but may be smaller or larger. Some protrude while some lay flatter.

There are two basic kinds of stomas, depending on which kind of surgery was performed:

  1. End Stoma - the bowel is cut and the end is brought to the surface; the rectum and the anus may or may not be left intact
  2. Loop Stoma - a loop of bowel is brought to the front of the abdomen usually when the stoma is intended to be temporary; following surgery this type of stoma may be temporarily supported by a bridge or rod

Stomas do not cause pain and in fact sensation on the stoma is diminished. You will also not need to worry about the stoma getting infected as this is very rare. Stomas, by design, are intended to come in contact with stool; however, it is important to keep the surrounding skin clean to prevent skin complications.

What will the stool be like?

Ileostomy output usually begins the first day or two after surgery and often is almost all liquid at first. After that it eventually starts to become semi-liquid depending on what has been eaten. The stool will be rich in digestive enzymes which can be irritating to the skin.

How often will I have to empty the pouch?

Normally you will be emptying your pouch around five to six times a day which includes gas just as if it were stool. If your output is really watery or excessive, try eating foods that tend to thicken stool such as bananas, rice, applesauce, cheese, toast and peanut butter, pasta, or marshmallows. If the problem continues, contact your physician to ask if you can take some medicine to slow it down.

How will my eating be affected?

At first, it is best to avoid hard-to-digest foods such as celery, mushrooms, nuts, popcorn, Chinese food, coleslaw, wild rice, peas, and dried fruits. Add these foods slowly and in small quantities to your diet to see how well you tolerate them, making sure to chew them well and eat them in moderation. Chewing your food thoroughly will help assure that you get the full nutrient value and do not get a blockage (see What is a blockage? below).

With a lot of output, you may lose sodium and potassium, which are necessary electrolytes. Eat bananas and other fruits and vegetables for natural replacement of these nutrients. Sports drinks may increase output because of the high sugar content.

What about fluids?

People with ileostomies can easily get dehydrated because they lose more fluids in their stool so it is very important that you increase your water intake. If possible, drink 8 to10 glasses of water every day to prevent dehydration.

Can I keep taking the same medications?

You should be able to. However, do not take any controlled release or extended release medications because these may not be properly absorbed. People who have had extensive bowel surgery may want to consider liquid medications if possible. It's best to discuss this matter with your doctor.

What about gas?

Everyone expels some gas (also called "flatus"). This is especially true during the early weeks and months after surgery. The following are ways to help control and deal with gas:

Things that may increase gas:
  • Foods: cucumbers, cabbage, broccoli, mushrooms, onions, fish, dried beans, milk, cheese, carbonated drinks, and beer
  • Chewing gum
  • Swallowed air (this can be reduced by eating leisurely in a relaxed atmosphere with your mouth closed and by chewing well; also, do not use a straw)

There are pouches available that come with filters built-in that vent the gas without releasing odor. There are also commercially available air release vents that you can insert into your pouch. Contact us for further information regarding either of these options.

What is a blockage?

As the name implies a blockage is when the passage of waste is physically blocked and cannot exit the body through the stoma. If partially blocked, liquid may still pass through the stoma but if fully blocked nothing will pass.

Symptoms of a blockage:
  • Output changes from a semi-liquid to thin and watery, and has a strong smell
  • Output amount decreases and then may stop
  • Stoma becomes swollen
  • Cramping and a distended abdomen
  • Progresses to vomiting
Possible causes of a blockage:
  • Adhesions from previous surgery
  • A mass of food that has become lodged in the bowel, usually caused by improper chewing or hasty eating, especially with fibrous foods
  • Dehydration
What to do in the case of a blockage:
  • Stop all solid foods!
  • Increase fluids to try to move the blockage through - try warm liquids such as tea or broth
  • Do NOT take any laxatives or stool softeners
  • Take a warm shower or bath to relax your muscles
  • Massage your abdomen
  • Lie on your back, pull your knees to your chest and rock from side to side, or position yourself on all fours and rock back and forth
  • If a blockage lasts more than 6 to 8 hours, or if you start to vomit or the pain increases, call your doctor or ostomy nurse, or go to the emergency room