An Ileostomy is a surgically created opening in the abdomen in which a piece of the ileum (lowest part of the small intestine) is brought outside the abdominal wall to create a stoma through which digested food passes into an external pouching system. The opening is usually made just below the navel to the right side and is called a stoma. It can be as small as 2.5-4cm or as large as 4mm, round or oval in shape, shiny, wet and dark pink in colour, similar to the inside lining of your mouth and occasionally bleeds a little; it will gradually shrink after surgery until it assumes a permanent size some weeks later. Although stomas are rich in blood vessels, they do not transmit pain or other sensations and require little care. Discharge from an ileostomy is fairly constant and often watery and contains digestive enzymes.
Temporary ileostomy: May be required when a surgical site lower in the digestive tract needs time to heal. Examples include colorectal cancer surgeries, diverticulitis surgery, j-pouch surgery for ulcerative colitis or familial polyposis. A temporary ileostomy is usually constructed with a “loop” stoma.
Permanent ileostomy: May be required when the large intestine is removed and reconnection to the anus isn’t feasible. Possible causes include Crohn’s disease, some cancers, colonic dysmotility, some cases of ulcerative colitis or familial polyposis. A permanent ileostomy is usually constructed with an “end” stoma.
Care of an Ileostomy
A Pouching system is usually worn. Pouches are odour free and different manufacturers have a variety to fit one’s lifestyle and needs. Ostomy supplies will come through your Stoma Nurse.
Living with an Ileostomy
Work: With the possible exception of jobs requiring very heavy lifting, an ileostomy should not interfere with work. People with ileostomies are successful businesspeople, teachers, carpenters, welders, etc.
Sex and Social Life: Physically, the creation of an ileostomy usually does not affect sexual function. If there is a problem, it is almost always related to the removal of the rectum. The ileostomy itself should not interfere with normal sexual activity or pregnancy. It should not prevent one from dating and continuing relationships and friendships.
Clothing: Depending on stoma location usually one is able to wear similar clothing as before surgery, including swimwear.
Sports and activities: With a securely attached pouch one can swim and participate in practically all types of sports. Caution is advised in heavy body contact sports and a guard or belt can be worn for protection. Travel is not restricted in any way. Bathing and showering may be done with or without the pouch in place.
Diet: For guidance, follow your nurse or doctor’s orders at each stage of your post-op adjustment. Individual sensitivity to certain foods varies greatly. You must determine, by trial, what is best for you.
When an ileostomy is very new the discharge may be quite fluid. And in order to reduce the amount of output, it can be helpful to avoid highly fibrous foods. It is important to maintain a healthy well-balanced diet being aware of the importance of chewing food well. One of the main functions of the large intestine is to absorb water and salt. Although the small intestine gradually adapts by increasing its own absorption of water, your body will probably need more fluids than it did before surgery. To avoid becoming dehydrated, you need to drink plenty each day. Electrolytes can be helpful with this. A major increase in the ileostomy output (due to several factors including an attack of gastroenteritis or a mild obstruction) must be treated seriously and medical advice should be sought.
Foods that can help thicken your output can include:
- Under ripe bananas
- Marshmallows (approx. 30 a day)
- Jelly babies (approx. 200 grams)
- Smooth peanut butter
- Apple sauce (cooked apples)
- White rice
- Yoghurt (natural, you could flavour it with honey)
- Gravy granules to be used in sauces etc.
- Arrowroot biscuits
Remember to increase your fluid and salt intake.
Blockage: If your ileostomy stops working either by blockage from adhesions (bands of fibrous scar tissue joining together two surfaces which normally should be separate) or undigested food, you may experience abdominal pain, distension, nausea and vomiting. There will be minimal watery or no output from the stoma. Things that may help include drinking clear fluids only and massaging your tummy while relaxing. A food blockage will in most cases resolve spontaneously, but if symptoms persist you may need admission to hospital for observation. If your output changes significantly in consistency, colour or quantity and you feel unwell with stomach pains and/or nausea and vomiting, you should contact your hospital, doctor or stoma nurse. If a blockage occurs, your stoma may temporarily change in size or colour.
Foods that may cause blockage are
- Dried fruit
- Dried vegetables
- High fibre vegetables
- The white pith on citrus fruits (tinned fruit is fine)
- Some Chinese meals (with nuts in)
- Onions and peppers
- Pineapple, melon
- Bean sprouts
- Bamboo shoots
- Tomato/fruit skin
A very good emergency remedy is a Coca Cola (not diet) and a bag of salted crisps.
Medication: With an ileostomy, some medications – including large tablets, coated pills, time release capsules and birth control pills – may pass through your system without being completely digested. Always tell your doctors, dentists, and pharmacists that you have an ileostomy. They can generally prescribe – or help you to select – alternative forms of medication. After your surgery never take laxatives. For a person who has an ileostomy, taking laxatives can cause a severe fluid and electrolyte imbalance. Some medications may change the colour, odour, or consistency of your stool. Non-prescription medications, like antacids, can cause constipation or diarrhoea. If you have questions about any medications, you are taking talk to your pharmacist or doctor.