An ileostomy is a surgically made opening in your abdominal wall. The ileum, which is the lower end of the small intestine, is passed through this opening and stitched into place. Your digested food is released into a pouch you wear externally. It is basically a bowel diversion procedure. This procedure is done if your rectum or colon is unable to properly function. If your ileostomy is temporary, part or your entire colon is removed, but you keep your rectum. For a permanent ileostomy, the surgeon removes or bypasses the rectum, colon, and anus. In this case, you will permanently wear an external plastic pouch to catch your waste products.
Reasons for Having an Ileostomy
If you have a large intestine problem that can’t be treated with medications, you might need an ileostomy. The most common reason for an ileostomy is inflammatory bowel disease. There are two types of inflammatory bowel disease: Crohn’s disease and ulcerative colitis. Crohn’s disease affects the end of the small intestine, the ileum. It can also affect the large intestine and other parts of the digestive tract. Ulcerative colitis is an inflammation of the inner lining of the intestine that leads to painful ulcers in the colon and rectum. People with inflammatory bowel disease will find blood and mucus in their stool.
Other problems that might require an ileostomy include:
- rectal or colon cancer
- an inherited condition called familial polyposis, in which polyps form in the rectum
- intestinal birth defects
- injury or accidents which involve the intestines
- Hirschprung’s disease
If a surgeon needs to operate on your intestine, he or she might want you to wear a pouch to catch body wastes. If the surgery is a temporary ileostomy, once you recover the doctor can reattach your small intestine so that it works in the usual way.
Preparing for Ileostomy
Getting an ileostomy will result in many changes to your life With proper training in ileostomy management there is no cause for concern regarding future social activities.. Discuss with your doctor any concerns about how this procedure will affect your sex life, work, physical activities, or future pregnancies.
Make sure your doctor knows which supplements, drugs, and herbs you are taking. Many drugs affect the function of the intestine slowing it down. This applies to over-the-counter as well as prescription medications. Your doctor may tell you to stop taking certain drugs two weeks before your surgery. Tell your doctor about conditions that you have, such as flu, cold, herpes breakout, or fever.
Smoking cigarettes makes it harder for your body to heal after surgery. If you’re a smoker, try to quit.
Drink lots of water and eat foods that are high in fiber during the weeks leading up to your surgery.
The day before surgery, eat lightly. At some designated time during the day, your doctor may advise you to switch to clear liquids only. You will be advised to drink nothing, not even water, about 12 hours before surgery.
Your doctor may also prescribe laxatives or enemas to empty your intestines.
An ileostomy is done in a hospital under general anesthesia. After you are unconscious, the surgeon makes an eight-inch cut down your midline. This cut goes through the skin, muscle, and tissues of your abdomen. Depending on your condition, the surgeon may remove your rectum and colon. Your anus is stitched closed.
There are a couple of different types of ileostomies. For a conventional ileostomy, the surgeon makes a small incision that will be the site of your ileostomy. He or she pulls a loop of your ileum through the incision. Your doctor places a rod under the loop. Then he or she cuts the loop open and stitches one side to your abdomen. This part of your intestine is turned inside out, exposing the inner surface. It is soft and pink, like the inside of a cheek. This part that sticks out is called a stoma. It may protrude up to two inches. People with this type of ileostomy, also called a Brooke ileostomy, will not have control of when their fecal waste flows into the external plastic pouch.
Another type of ileostomy is the continent, or Kock, ileostomy. The surgeon uses part of your small intestine to form an internal pouch with an external stoma that serves as a valve. These are stitched to your abdominal wall. A few times a day you insert a flexible tube through the stoma and into the pouch. You expel your waste through this tube. The advantages are that there is no external pouch, and you can exercise control over when you empty your waste. K pouch procedures are now the preferred method of ileostomy as they eliminate the need for an external pouch. K pouch procedures are also sometimes called J pouch procedures.
Recovery from Ileostomy
You’ll need to stay in the hospital for at least three days. It’s not uncommon to remain hospitalized for a week or even longer, especially if your ileostomy was done under emergency circumstances.
Your food and water intake will be limited for a while. On the day of your surgery, you may only get ice chips. Clear liquids will probably be allowed the second day. Slowly, you’ll be able to eat more solid foods as your bowels adjust to the new setup.
In the early days after surgery, you may have excessive intestinal gas. This will decrease as your intestines heal. Some people have found that digesting four to five small meals a day is better than three larger meals. Your doctor may suggest that you avoid certain foods for a while.
During your recovery, you’ll start to learn how to deal with the external pouch that will collect your waste. You’ll also learn to care for your stoma and the skin around it. Enzymes in the discharge from your ileostomy can be rough on your skin, so you will need to keep the stoma area clean and dry.
If you have an ileostomy, you may find you need to make big adjustments to your lifestyle. Some people seek help from an ostomy support group. Meeting other people who have adjusted their lifestyles after this surgery and have managed to return to their regular activities can be reassuring Seek out nurses who are especially trained in ileostomy management who will ensure that you have a manageable lifestyle with your ileostomy.
Risks of Ileostomy
Any surgery brings risks, such as infection, blood clots, heart attacks, strokes, or breathing troubles. Risks specific to ileostomies include:
- damage to the surrounding organs
- internal bleeding
- inability to absorb sufficient nutrients from food
- urinary tract, abdominal, or lung infections
- intestinal blockage due to scar tissue
- wounds take a long time to heal, or they break open
You may have trouble with your stoma. If the skin around it is irritated or moist, you’ll have a hard time getting a seal with your osteomy pouch. This can result in leakage. Your doctor can prescribe a medicated topical spray or powder to heal this irritated skin, if necessary.
Some people hold their pouch in place with a belt. If you wear the belt too tightly, it can lead to pressure ulcers.
You will have periods of time where no discharge comes through your stoma. However, if this continues for more than six hours and you feel nauseous or have cramps, call your doctor. You might be suffering from an intestinal blockage.
People who have had ileostomies may also get electrolyte imbalances. This happens when you lack the correct amount of important substances in your blood, especially sodium and potassium. This risk increases if you lose a lot of water through vomiting, perspiration, or diarrhea. Be sure to replenish lost water, potassium, and sodium.
Once you learn to take care of your new elimination system, you will be able to participate in most of your regular activities. People with ileostomies swim, hike, play sports, eat in restaurants, camp, travel, and work in most occupations. Heavy lifting can be a problem, as this can aggravate your ileostomy. If you have a job that requires heavy lifting, discuss this with your doctor.
Having an ileostomy does not usually interfere with sexual function or the ability to have children. It might require educating your sexual partners, who might be unfamiliar with ileostomies and uncomfortable with your external pouch. If you are dating, discuss your ostomy with your partner before progressing to intimacy.