Ileostomy

The last segment of the small intestine (connected to the large intestine) is called the ileum; its job is to digest food and absorb water and nutrients. Sometimes, an obstruction from cancer or damage that occurs from cancer treatment (radiation therapy) can affect digestive system function. When this happens, an ileostomy may be required. 

An ileostomy is a procedure where part of your ileum is attached to the outside of the abdominal wall, creating a new exit site for waste to leave your body. This way, waste does not have to pass through your colon.

Types of ileostomy

There are three types of ileostomy:

Standard (or Brooke) ileostomy: During this procedure, the ileum is pulled through the abdominal wall and sewn to the skin, forming a smooth, round hole called a stoma. From here, stool passes into a collection device (an ileostomy bag or pouch) worn on the outside of your body. Because there is no sphincter muscle controlling the release of waste, the collection pouch, which adheres to your body, must be worn constantly and emptied six to eight times each day.

Continent ileostomy: In this type of ileostomy, also called a K-pouch, your surgeon attaches the small intestine to the abdominal wall just as in a standard ileostomy, but instead of a stoma, an internal pouch is created. A valve is sewn into the new pouch in the small intestine in order to prevent waste leakage, and a catheter must be used to empty it.

Ileo-anal reservoir: In this kind of ileostomy, also known as a J-pouch, your surgeon will use the ileum and rectum to create an internal pouch where waste collects and passes to the anus.

Why is an ileostomy performed?

• Temporary ileostomies are performed to keep the lower bowel empty and give it a chance to heal from damage or inflammation. It can be surgically reversed, typically after three to six months. 
• A permanent ileostomy is typically performed when the ileum is not working properly, or a diseased colon must be removed. Your care team may also perform an ileostomy if the large intestine is blocked. 

How to prepare for an ileostomy

The ileostomy procedure is performed under general anesthesia, and your doctor will give you specific instructions to follow. These include:

• Meeting with an ostomy nurse: An ostomy nurse specializes in ileostomy placement and will provide post-operative care instructions. 
• Preparing for surgery: You’ll undergo a bowel preparation before surgery in order to clear all fecal matter out of your colon. This may involve medication and dietary changes, a clear liquid diet and a specific regimen of laxatives and enemas. 
• Following pre-surgery guidelines: Be sure to adhere carefully to the instructions your surgeon provides prior to the procedure. This usually involves avoiding food and liquids for a period of time to ensure your bowels are empty. If you’re prescribed antibiotics to prevent infection, take them as directed.

What you can expect after an ileostomy

Most people can expect to stay in the hospital for up to a week after ileostomy surgery, but it can take up to two months to fully recover. While the small intestine heals, your diet and activity level will be limited. During recovery, your care team will provide individualized care instructions and help you: 

Learn how to empty your ileostomy pouch or use a catheter: If you have an external pouch, empty it regularly (six to eight times a day), never allowing it to become more than half full. You’ll also need to change the pouch system regularly, so work with an ostomy nurse to set up a schedule. If you have an internal pouch, the surgeon will leave a drain tube inside it to allow the pouch to mature and heal for about three to four weeks post-operation. After that, you’ll need to drain it regularly with a catheter.  

How to take care of your skin: Your skin may become sensitive and sore from the products used to adhere the ileostomy pouch to your skin, or you may develop allergies to the products. A period of trial and error may be necessary to find a combination of adhesives, skin barriers, paste/tape and pouch system that work best. Ask your care team for recommendations and pay close attention to the appearance of your stoma; it should look pink and healthy. If you have a lot of hair around your stoma, it may be helpful to keep it shaved.

Make changes to your activity level: Immediately post-surgery, your body will require rest to heal. Your doctor can let you know when it’s OK to resume normal movement, but once you’ve healed, you’ll likely be able to engage in most of the things you enjoyed before. Be sure to get the green light from your care team before restarting any activities.

Have plenty of supplies on hand at home: Your doctor may have prescribed pain medication and antibiotics. Have these prescriptions ready before you return home. Once home, take your temperature regularly, as a fever can be a sign of infection.

Know what type of foods you can eat: While foods will likely affect you in much the same way post-surgery as they did before, a good rule of thumb is to introduce foods slowly to see how you tolerate them. It also helps to chew your food slowly and drink plenty of water to aid digestion.

Follow your specific recovery protocol: Heed your doctor’s instructions when it comes to bathing and showering or getting your stitches wet. Your care team will advise you on recommended diet and medications, how to care for your stoma, and guidelines on when it’s safe to resume sexual activity.

Take measures to become more comfortable with an ileostomy bag: Try to choose clothing that doesn’t irritate your stoma and have the supplies you need to clean and change it readily available.

What to do about common ileostomy risks and problems

Getting used to life after ileostomy surgery may feel daunting, but most issues can be managed swiftly. These are some common risks and problems you may encounter:

High stool output or diarrhea: Normal output will be liquid to pasty in consistency. Loose bowel movements occurring in higher-than-normal volume may signify infection or food poisoning, but can also be caused by certain medications. Food intolerance is the most common culprit, but in this case, diarrhea should resolve quickly. If diarrhea is ongoing, reach out to your care team.

Excess gas: It’s common to experience excessive gas after any type of abdominal surgery, and this is harmless. If flatulence continues to be a problem even after you’ve fully recovered, eat small, frequent meals and pay attention to what you are eating. Foods that are more likely to cause gas include: asparagus, broccoli, cauliflower, Brussels sprouts, cabbage, legumes, soda and other carbonated drinks, and onions.

Odor: Cut back on odor-producing foods like dairy, garlic, coffee, fish, eggs and cabbage. There are odor-resistant pouches as well as deodorant liquids and tablets you can insert into your pouch. These products should be available at a medical supply store.

Blockage of the stoma: While it’s normal not to have any waste output for a period of time, if you are experiencing nausea, cramps or pain, and have not had movement for four to six hours, you may have a blockage. You can try drinking more fluids or taking a warm bath, but if you’ve been in pain with no output for over two hours, go to the emergency room.

Changes to your stoma: If your stoma or surrounding skin begins to bleed or becomes irritated (red, sore or weeping), contact your care team for treatment instructions. If the stoma becomes cut or injured or you experience ulcers, swelling or a bad odor, seek medical attention immediately to rule out infection.

Electrolyte imbalance: It’s important to keep electrolytes, the salts and minerals in the blood, balanced. Stay hydrated and watch out for diarrhea, vomiting and excess sweating, all of which can contribute to electrolyte imbalance.

Finding medicine in your pouch: Some medications, such as time-released capsules and coated tablets, may pass through to your pouch without being absorbed. If this happens, contact your care team or pharmacist for recommendations on alternative medicines that absorb more quickly.

Pain or bleeding: While it’s normal for your stoma to bleed mildly when you change the pouch or skin barrier, the bleeding should stop rather quickly. If it doesn’t, or you detect blood in your waste, contact your care team. If your stoma or the surrounding area hurts, changes color or has a burning sensation, you should also alert your care team.

Phantom rectum: It’s normal to feel the urge to move your bowels even after surgery, and you may even pass mucus if the rectum hasn’t been surgically removed. If this feeling occurs, it can be helpful to sit on the toilet as if you are going to have a bowel movement.

Short bowel syndrome: When a large portion of the small intestine is removed, there may not be enough left to absorb the nutrients your body needs. In this case, your care team will closely monitor your dietary intake, and you’ll need to do everything you can to avoid diarrhea, which further contributes to malabsorption (when your body isn’t getting enough nutrients).