An ileostomy is a surgically made opening in your abdominal wall. Your surgeon will pass the ileum, which is the lower end of your small intestine, through this opening and stitch it into place. You’ll be given a pouch that you’ll wear externally. This pouch will catch all of your digested food.
This procedure is done if your rectum or colon cannot properly function. If your ileostomy is temporary, part or all of your colon is removed, but you keep at least part of your rectum. For a permanent ileostomy, your surgeon removes or bypasses your rectum, colon, and anus. In this case, you’ll permanently wear an external plastic pouch to catch your waste products.
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. The two types of inflammatory bowel disease are Crohn’s disease and ulcerative colitis.
Crohn’s disease affects the end of the small intestine, which is called 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
- injuries or accidents that involve the intestines
- Hirschprung’s disease
Getting an ileostomy will result in many changes to your life. However, you’ll be given training that will make this transition easier. You can talk with your doctor about how this procedure will affect your:
- sex life
- physical activities
- future pregnancies
Make sure your doctor knows which supplements, medications, and herbs you’re taking. Many drugs affect the function of the intestine by 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:
- the flu
- a cold
- a herpes breakout
- a 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.
Eat lightly the day before your surgery. At some designated time during the day, your doctor may advise you to switch to clear liquids only. You’ll be advised not to consume anything, including water, for 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’re unconscious, your surgeon makes an 8-inch cut down your midline. This cut goes through the skin, muscle, and tissues of your abdomen. Depending on your condition, your surgeon may remove your rectum and colon. They’ll also stitch your anus 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. They’ll pull a loop of your ileum through the incision. Your doctor places a rod under the loop. Then, they’ll cut the loop open and stitch one side to your abdomen. This part of your intestine is turned inside out, exposing the inner surface. It’s soft and pink, like the inside of a cheek. This part that sticks out is called a stoma. It may protrude up to 2 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. Your 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 per day you insert a flexible tube through the stoma and into the pouch. You expel your waste through this tube.
The advantages of the Kock ileostomy are that there’s no external pouch and you can control when you empty your waste. This procedure is known as a K-pouch procedure. It’s now the preferred method of ileostomy because it eliminates the need for an external pouch.
A different procedure, known as the J-pouch, may be performed if you have had your entire colon and rectum removed. In this procedure, the doctor creates an internal pouch from the ileum that is then connected to the anal canal, allowing you to expel your waste through the usual route with no need for a stoma.
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 on 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 per 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 irritate your skin. You’ll need to keep the stoma area clean and dry.
If you have an ileostomy, you may find that 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 ease any anxieties you have. You can also find nurses who are specially trained in ileostomy management. They’ll ensure that you have a manageable lifestyle with your ileostomy.
Any surgery brings risks. These include:
- blood clot
- heart attack
- difficulty breathing
Risks that are specific to ileostomies include:
- damage to the surrounding organs
- internal bleeding
- an inability to absorb enough nutrients from food
- urinary tract, abdominal, or lung infections
- an intestinal blockage due to scar tissue
- wounds that break open or take a long time to heal
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 ostomy pouch. This can result in a leakage. Your doctor can prescribe a medicated topical spray or powder to heal this irritated skin.
Some people hold their pouch in place with a belt. If you wear the belt too tightly, it can lead to pressure ulcers.
You’ll have times in which 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 have 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’ll be able to participate in most of your regular activities. People with ileostomies:
- play sports
- eat in restaurants
- work in most occupations
Heavy lifting can be a problem because it can aggravate your ileostomy. Talk to your doctor if your job requires heavy lifting.
Having an ileostomy doesn’t usually interfere with sexual function or the ability to have children. It might require you to educate your sexual partners, who might be unfamiliar with ileostomies. You should discuss your ostomy with your partner before progressing to intimacy.