What is it?
An ileostomy means that your small intestine is brought out through an opening in your abdomen to form a stoma. This means that food waste will be bypassing the colon, rectum, and anus. In some cases, it might be that a part of your lower digestive tract is removed after the procedure. An ileostomy is usually done when part of the small or large intestine doesn’t work properly or is diseased or needs to be removed. The stoma will usually be placed on the right-hand side of your abdomen and it means that food waste will no longer be able to leave the body in the natural way. Instead, it will exit the body through your stoma and is then collected in a stoma bag that is attached to your skin.
The food waste passed through your ileostomy is generally runny and passed quite frequently. This is because the stools didn’t have the chance to go through the colon where most of the water is absorbed. Because the output is so constant, your pouch will have to emptied somewhere between 5 and 8 times a day.
Types of ileostomies
Not all ileostomies are the same, however, so let’s take a look at the different options out there.
Permanent & temporary ileostomies
A permanent ileostomy is generally required when all or part of the colon has been removed and the small intestine can no longer be connected to the rectum or the anus. This can be caused by certain medical conditions like Crohn’s disease or cancer.
A temporary ileostomy is generally performed when a part lower down in the digestive tract needs time to rest and heal. This might be the case after surgery. When the injured or diseased part of the digestive tract is fully healed, the ileostomy can simply be reversed and your bowels will work as they did before. Sometimes, a temporary ileostomy might also be performed as a first stage of creating an ileo-anal reservoir or J-pouch.
End & loop ileostomy
Whether your surgeon will perform an end or loop ileostomy fully depends on the underlying condition and the level of bowel function and recovery period that is required.
An end ileostomy is generally done when a part of the colon is removed or simply needs to rest. Although it can be both temporary and permanent, it is more often a permanent procedure. With this type of ileostomy, the end of the small intestine will be separated from the large intestine and brought to surface of the abdomen.
A loop ileostomy is often a temporary procedure to protect the bowel after surgery. With this type of ileostomy, a loop of the small intestine is brought through a hole in the abdomen. Your surgeon will then make a cut on the exposed bowel loop and the ends are rolled down and sewn into the skin. This means that a loop stoma actually consists of 2 stomas that are joined together. If it’s a temporary procedure, it can easily be reversed in a 2nd operation.
Reasons for an ileostomy
There are many different reasons why you might need an ileostomy. Let’s take a look at the most common ones.
Healing: An ileostomy allows lower parts of the digestive tract to heal, for example after an operation or a prolonged period of illness.
Inflammatory Bowel Disease (IBD): There are two types of IBD – ulcerative colitis and Crohn’s disease. Ulcerative colitis causes the lining of the colon and rectum to become inflamed and to develop ulcers. This leads to symptoms including bloody diarrhoea with mucus, abdominal cramps, fatigue, unexplained weight loss, and anaemia. Crohn’s disease can involve any part of the digestive tract – from mouth to anus. It generally causes symptoms including pain, bloody diarrhoea, fatigue, mouth ulcers, unexplained weight loss, and anaemia.
Cancer: You may need an ileostomy if you suffer from colon or rectal cancer. Women will sometimes also need an ileostomy if they suffer from ovarian cancer.
Problems with the large intestine: When your large intestine is blocked or damaged, part of the colon is removed, or when the colon was ruptured due to an infection or an injury, you might need an ileostomy.
Familiar adenomatous polyposis (FAP): FAP is an inherited condition that affects the colon and the rectum. If you suffer from this condition, you might develop polyps in your colon which can become cancerous if they are not treated. Sometimes, if the condition gets out of hand, an ileostomy is needed.
Injuries or accidents that involve the intestines: Trauma to your bowels might cause injuries that need time to heal or part of your colon might need to be removed. This means that you might need a permanent or temporary ileostomy
Intestinal birth defects: Certain birth defects, like spina bifida, can lead to your bowels not working as they should, and a permanent ileostomy might be required.
Hirschsprung’s disease: This is a rare condition that causes stools to become stuck in your bowel causing you to need a temporary ileostomy. Often, especially if spotted early, Hirschsprung’s disease can be cured via surgery.
Potential Risks and Complications
As with any surgical procedure, an ileostomy carries a certain risk of complications. These include:
- Urinary tract, abdominal, or lung infections
- Difficulty breathing
- Heart attack
- Damage to nearby organs
- Bowel obstruction
- Internal bleeding or bleeding from the stoma
- Blood clots
- Blockage caused by scar tissue
- Inability to absorb enough nutrients from food – can lead to Vitamin B12 deficiency
Preparing for the ileostomy
Prior to your ileostomy surgery, you should let your doctor know about any medication or supplements you are taking. This applies to both prescription medication and over the counter medicine. You might be asked to stop taking certain medicines up to 2 weeks before surgery. It is important that you don’t stop taking any medication without consulting your doctor first, however! You should also inform your nurse or doctor about any viral infections like the flu, cold, or herpes breakouts. If you’re a smoker, you might want to consider quitting as this can improve your recovery drastically.
A few days before the surgery, your surgeon will give you some guidance regarding your diet. You will likely be asked to not eat or drink anything, including water, during the last 12 hours before the surgery. This is to ensure that no fluids from your stomach can enter your lungs while you’re under general anaesthesia. Your surgeon may also prescribe some laxatives or enemas to empty your intestines. A specialist ostomy nurse and your surgeon will also decide the best spot for your stoma prior to the actual procedure.
The ileostomy surgery is done in hospital under general anaesthesia. After you are unconscious your surgeon will either make a cut down your midline or perform a laparoscopic procedure using multiple small cuts. There are different types of ileostomies your surgeon can perform:
Standard/Brooke ileostomy: Your surgeon will make a small incision that will then be the site of your ileostomy. The loop of the ileum is pulled through the incision in your abdomen and part of the intestine is turned inside out. If you have this type of ileostomy, you won’t have any control of when waste exits your body and you will need to wear an ileostomy pouch.
Continent/Kock ileostomy: Your surgeon will use part of your small intestine to form an internal pouch with an external stoma that can be used as a valve. You will then be able to insert a small, flexible tube through the stoma a few times a day to drain the waste. This means that you don’t need to have an external pouch attached to your stoma and have control over when food waste leaves the body. This type is often preferred because it removes the need for an external pouch.
J-pouch: If your entire colon and rectum have been removed, then your surgeon might create a J-pouch. This means that an internal pouch is created from the ileum that is then connected to the anal canal, allowing you to remove waste from your body via the natural way with no need for a stoma.
You should expect to stay in hospital for 1 to 2 weeks after surgery. In this time, you will be taught how to look after your newly created stoma. During your hospital stay, especially straight after your surgery, your food and water intake will likely be limited to give your small intestine some time to heal. On the day of the surgery, you will likely only get ice chips to still the thirst, then clear liquids on the second day, and, as the bowels adjust, more solid foods will slowly be introduced to your diet again. In the early days after your surgery, excessive gas might occur. This will usually decrease as the small intestine heals but many people find that having 4 to 5 small meals per day works better for them than 3 larger meals do. Your doctor might also suggest avoiding certain foods.
Full recovery generally takes up to 2 months and these 2 months can be very challenging. You might experience short-term physical and psychological problems ranging from skin irritation around your stoma to feelings of anxiety. With the right training and support, you will likely adjust quickly, though. If you’re ileostomy is only temporary, then you will need reversal or closure surgery after the small intestine has healed. The earliest this will take place is usually 12 weeks after the initial ileostomy procedure.
If you have a standard or Brooke ileostomy, then you will need an ileostomy pouch to collect the waste material leaving your body through the stoma. Most often, these external bags are drainable as the waste material will likely have a fluid or porridge like consistency. This means that the pouch will need to be emptied several times per day. As the bag becomes about 1/3 full, it should be drained through the opening at the bottom of the bag. Every 1 to 2 days you will need to replace your ileostomy pouch and dispose of the old one in the general rubbish. Make sure to not flush it down the toilet!
There are two different systems of ileostomy pouches. A one-piece system that means that pouch and adhesive baseplate, or skin barrier, are one unit. This also means that every time the bag is changed, you will also need to change the skin barrier. With a two-piece system, your ileostomy pouch and the adhesive baseplate are two separate units clipped together. This means that you don’t have to remove the skin barrier every time you replace the bag which reduces the risk of skin irritation.
It may take some time for you to get used to the routine of living with an ileostomy bag. But with the support of an experienced stoma nurse, your family, and your friends it will quickly become second nature.
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