Further Reading - Ileostomy
What is an ileostomy?
To help you understand what is involved in the operation, you may wish to first look at the Digestive System and how it works. Definition of an Ileostomy "A surgically created opening on the abdominal wall to which part of your bowel, i.e., ileum is attached, also known as a stoma." Stoma is a Greek word meaning mouth or opening. An ileostomy can be temporary or permanent, dependant on the reason for the surgery. It is normally red in colour, similar to the inside of your mouth, and bleeds easily if handled roughly. Round or oval in shape, it has no nerve supply or muscles, therefore, it cannot be voluntarily controlled.
End ileostomy
This type of stoma is usually created as a small spout on the right side
of your abdomen. All the remaining colon and rectum is removed, creating
a permanent stoma. This operation is called a pan-procto-colectomy with
ileostomy. However an end ileostomy can sometimes be given and the rectum
and/or anus left in place. This operation is called a sub-total colectomy
with ileostomy and can be either permanent or temporary depending on the
reason for operation.
Loop ileostomy
This type of stoma is created from a loop of ileum usually on the right
side of your abdomen, but occasionally could be on the left depending on
the section of bowel used for the operation according to the need for surgery.
A loop is created to direct the faecal flow away from the lower part of
the bowel either to protect an injury or anastomosis (the joining of bowel
together following removal of a section) or to relieve an obstruction. This
is usually a temporary stoma and may be closed at a second operation. If
you have part of your large bowel or rectum left in place you may experience
an occasional mucus (slime) discharge, which will cause the sensation of
needing to go to the toilet to have your bowels opened. This is quite normal.
Why an ileostomy?
An ileostomy is often created following removal of the inflamed/diseased
colon due to:
- Ulcerative Colitis: which causes inflammation and ulceration to the colonic mucosa (lining of large bowel) leading to diarrhoea with blood and mucus.
- Crohn's disease: which is an inflammatory disease affecting anywhere along the digestive tract (alimentary canal) and can give rise to pain and diarrhoea with blood and mucus.
- Cancerous growths: affecting the colon, or injury/trauma causing damage to the colon.
How frequently you change your ostomy appliance will depend on you and the type of pouch you use. As a rough guide: These are only guidelines and you will eventually establish your own routine. If the appliance leaks it should be changed immediately to prevent your skin from becoming irritated. For advice on preventing leaks see Problems Which May Arise and How to Deal With Them.
1. Preparation Before changing your appliance, ensure that you have all of your equipment prepared. You may find it handy to keep a small supply in a container in the bathroom (e.g. an old plastic ice-cream tub). You will need:
- A clean appliance plus any accessories (i.e. paste, skin protective wipes if used etc).
- Warm water - do not use disinfectant or a perfumed soap - special ostomy soap is available.
- Wipes (kitchen roll is a good substitute, but cotton wool and tissues are not generally advised).
- Disposable plastic bag.
- Scissors and template if required.
- Secure clothing out of the way (clothes pegs or large safety pins may help). It may help to place newspaper on the floor to place your soiled bag on.
- Empty your appliance down the toilet as directed.
- Remove appliance carefully working from the top down, supporting the skin. Place it in disposable bag.
- Clean skin and stoma with warm water and wipes. It may help to use a dry wipe first to remove any residue and mucous from the base of the stoma. Use wet wipes to wash the stoma and skin (NOTE: any soap used (e.g., ostomy soap) must be washed off before drying). Dry skin thoroughly with a dry wipe. Do not worry if your stoma bleeds slightly when washed. This is normal. If blood comes from inside your stoma you should seek the advice of your GP or Stoma Care Nurse.
- Apply skin protection as required. If using alcohol type wipes ensure that the skin has dried before proceeding. Do not use any creams, ointments or powders of your own which have not been recommended by your Stoma Care Nurse.
- Remove appliance backing paper. Put into position carefully and slowly (it may be easier to do this standing upright). A mirror may help you to see your stoma. Ensure that once in place the flange is smooth and stuck firmly to the skin, paying particular attention to the base. When using 2-piece products then apply pouch to flange.
3. Disposal If your appliance is full, empty contents down the toilet.
- Do not put pouch down the toilet unless it is specifically designed for this purpose.
- Place SOILED APPLIANCES AND WIPES in disposal bag and secure.
- Place in dustbin. Do not flush down the toilet or burn on an open fire.
- Tidy up and wash hands.
- Re-stock container with all equipment to ensure that you are always prepared.
It is important to eat as varied a diet as possible in order to maintain health, being too restrictive with what you eat may lead to Nutritional Deficiencies and almost certainly boredom.
FOR THE FIRST TWO WEEKS ...
you may be advised to follow a low fibre diet (ie: avoid or eat in moderation
fruit, vegetables and wholegrain products)
AFTER THE INITIAL TWO WEEKS ...
it is very important that you follow a normal diet
- Increase your fibre intake, try wholemeal bread (avoid those with seeds). Try Digestives, wholewheat/rye crackers and crisp breads, bran biscuits, try baking with wholemeal flour.
- Select a greater variety of fruit and vegetables. It may be necessary in some cases to peel them.
- Avoid or be wary of seeds, pips and nuts.
- Eat regularly.
- Introduce new foods one at a time so that you can identify those which cause a problem.
- Chew the food well.
- Try to keep to your ideal weight.
Fluid Intake
Be sure to drink ample fluids - at least 2 pints of liquid a day
If you think you are dehydrated drink a glass of coke and eat a packet of salted crisps or you can make the following drink:
1 litre of water2.5gm sodium bicarbonate
3.5gm salt (cooking variety)
20.0gm glucose
Mix these together, add flavouring, for example orange juice, keep in the fridge and drink throughout the day if necessary.
Foods which may cause diarrhoea if taken in large quantities
Spicy foods, onions, pure fruit juice, prunes, rhubarb, chocolate, stewed
fruit, alcohol. Follow the low fibre diet temporarily. If diarrhoea persists
seek medical advice.
Foods which may cause blockage of stoma (ileostomists only)
Celery, nuts, sweetcorn, coconut, seeds, stalks of cauliflower and fruit
peel/skin.
Some foods which may cause an offensive odour
Baked beans, peas, onion, cabbage, egg, fish, certain cheeses, alcohol,
yoghurt.
- Please contact your GP if diarrhoea persists.
- Do not try to alter the activity of your stoma by reducing fluid intake or missing meals. This will either make you dehydrated or make your stoma work more.
- Your stoma will work best if you eat regularly.
- Your own personal experience of food is what matters and you may find that you never have any problems.
- Remember - these guidelines are general guidelines. Experiment along these lines and you will soon find out which is best for you.
Wind
- Certain foods may cause wind - sprouts, peas, cauliflower, baked beans.
- Eat slowly.
- Chew food well with mouth closed - don't gulp air.
- Washing food down with a drink can sometimes cause wind - especially fizzy drinks. Constipation
This can occasionally cause some problems and there are one or two simple remedies to try before seeking further help.
- Increase fresh fruit and/or fresh fruit juice, vegetables and fibre foods.
- Increase fluids especially when increasing fibre.
- Try, where possible, to do some gentle exercise, i.e., walking, swimming.
If this still does not solve the problem, contact your GP or Stoma Care Nurse for further advice. DO NOT take laxatives without first seeking advice.
Diarrhoea
This can be due to a change of diet, i.e., eating rich or spicy foods, over
indulgence with alcohol, stress and emotional problems or blockage in the
stoma if associated with pain and very watery output. If diarrhoea persists
for more than 48 hours, see your Doctor.
Odour
Having an ileostomy does not necessarily cause more odour, we all produce
an odour when having our bowels opened. Different foods cause more odour
than others (see dietary advice). If you do notice an odour, check that
your pouch is not leaking. Think about your diet over the previous 24 hours.
You can use an ostomy appliance deodorant such as Saltair No-Roma.
Bleeding
If you are too rough when cleaning your stoma slight bleeding can occur.
This is nothing to be concerned about, just be a little more gentle. Bleeding
can also be caused by friction from an ill-fitting appliance, to help reduce
this see Stoma Paste, Cohesive and Salts Medilink's Cut-to-Fit Service.
You may need to re-measure your stoma and change the size of your pouch.
Your Stoma Care Nurse will be able to help you.
If there is blood in the contents of the pouch, consult your Doctor.
Sore Skin Around the Stoma
There are a number of causes of sore skin and different ways to deal with it:
- Too frequent pouch changes: - try using a two-piece appliance
- Allergy to pouch adhesive: - either try an alternative pouch or use skin protectors such as Protective Wafers or Protective Wipes
- Leakage of faeces onto the skin: - this can make the skin very sore and can be the result of an ill-fitting pouch. Your stoma may have changed size, so measure it and check you are using the correct size appliance. If you have uneven skin around your stoma, e.g., scarring or creases, you can use a seal/washer or a paste to create a smooth surface to apply your pouch to. This often prevents leaks.
- Infection due to body hair growth under the adhesive: - shave the area carefully as required.
- Sore skin may also be caused by pre-existing skin allergies or by food and drink allergies. Always consult your Stoma Care Nurse and Doctor if you have any persistant problems
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Further Reading
Colostomy
Urostomy
Ileostomy
Hints and tips for Skin Care around your Stoma (496k)
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