Surgical Procedures: Ileostomy
What is an ileostomy and how is it performed?
An ileostomy is a stoma (hole) on the surface of the belly that allows stool to pass through. A surgery is done to attach the end of the small intestine, or ileum, to the inside of the abdominal wall. This allows stool to pass from the intestine, through the stoma, into an external collection device.
The stoma is created in the abdominal wall. The stoma is made from the intestine. It should be pink to red in appearance, warm, moist and is able to secrete mucus. There is no sphincter control of passing stool. However, some types of ileostomy allow the person to be continent of stool.
An ileostomy can be temporary or permanent. This will depend on the type of surgery you are having.
- Permanent ileostomy may be necessary after surgery to remove the large intestine, colon, rectum or anus.
- Temporary ileostomy may be done if only part of the colon is removed and the rectum is left.
Your healthcare provider will talk to you about the need for a temporary or permanent ileostomy, based on your personal situation and health status.
Food exits the body earlier in the digestion process when you have an ileostomy. This will cause a change in the consistency of your stool. The stool you pass from the ileostomy will be liquid to pasty in consistency and contain digestive enzymes.
An ileostomy can be used to treat some cases of:
- Rectal cancer.
- Colon cancer.
- Benign inflammatory bowel conditions, such as Crohn’s disease and ulcerative colitis.
- Familial polyposis.
- Certain birth defects.
- Injury or trauma.
- Hirschprung’s disease.
There are a few types of ileostomy:
- Standard Ileostomy (Brooks Ileostomy): Connects the ileum to the abdominal wall, exposing the intestinal mucosa to form a smooth external stoma. You will not be able to control your stool after this surgery, so there is the need to wear an external bag for stool collection.
- Continent Ileostomy: Provides stool continence but the need for frequent drainage with a catheter. There is no need for an external collection bag. To do this, your surgeon forms a pocket within the abdomen (taking the place of the rectum) and a small external valve in which the catheter will be placed to drain stool.
- Ileo-anal reservoir (J-pouch, S-pouch, W-pouch or pelvic pouch): Allows for the passage of stool from the anus. During this procedure, your surgeon creates a collection pouch from the ileum and rectum, which will collect the stool. The stool can then be passed from the anus.
What are the risks associated with an ileostomy?
There are risks and side effects related to having a small bowel resection. Risks and side effects may be:
- Blood clots.
- Damage or injury to nearby organs.
- Adhesion/scar tissue formation. (An adhesion is scar tissue that joins 2 pieces of tissue that should not be joined. They are often painless and do not need treatment. Serious cases can cause a blockage in the bowel or limit blood flow.)
- Bowel obstruction. (This is a blockage in the bowel that can limit digestion or the removal of stool.)
- Wound separation or issues with healing.
- Electrolyte abnormalities, most commonly sodium and potassium.
- Issues with the stoma such as skin irritation, infection and leaking.
- The feeling of the need to have a bowel movement called phantom rectum.
- Short bowel syndrome, which may lead to vitamin and nutrient absorption issues.
What is recovery like?
Recovery from an ileostomy will depend on the extent of the procedure have had. How long you stay in the hospital will depend on the procedure you had and how well you are recovering.
You will be told how to care for your surgical incisions/stoma and will be given any other instructions before leaving the hospital. Full instructions on caring for your stoma will be given to you by a specially trained stoma nurse/therapist.
Your medical team will discuss with you the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention, management of diarrhea and/or other conditions. They will also discuss with you the need and type of follow up care you will require, such as evaluation of electrolyte levels.
Your provider will tell you what you should and should not do when you go home. This will often include:
- Ask your care provider about activity restrictions such as bending, lifting and exercising.
- Do not drive while taking narcotic pain medication.
- Return to work in 2-4 weeks, depending on your occupation and work demands.
- Speak with your healthcare team about showering, submerging your surgical incisions in water, diet recommendations, sexual activity and stoma care.
What will I need at home?
- Thermometer to check for fever, which can be a sign of infection.
- Incision and stoma care supplies, typically supplied by the hospital, your healthcare team or the stoma nurse/therapist.
When to call your doctor?
- Signs of infection including fever and redness, odor or drainage at the incision.
- Nausea, vomiting, abdominal bloating, or cramps lasting more than 2 hours.
- No ileostomy output for 4-6 hours with cramping and nausea.
- Leg swelling and/or sudden onset of shortness of breath.
- Any new or worsening pain.
- Decrease in urination.
- Blood in the ostomy pouch.
- Abnormalities in the presence of the stoma including retraction (pulling inward), changes in size or color, stoma blockage or bulging, bleeding, wounds, injury to the stoma, skin irritation/sores and/or watery stool for 5 or more hours.
How can I care for myself?
You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.
Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.
There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.
Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.
- Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.
This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.
American Cancer Society. Ileostomy. 2017. Found at: http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/ostomies/ileostomyguide/ileostomy-what-is-ileostomy
Augusta University. Colostomy and Ileostomy Surgery. Found at: http://www.augusta.edu/mcg/surgery/midds/patient_education/colostomy_surgery.php