What Is an Ileostomy?

If you have a large intestine problem that can’t be treated with medications, you might need an ileostomy. One of the most common reasons for an ileostomy is inflammatory bowel disease (IBD). The two types of inflammatory bowel disease are Crohn’s disease and ulcerative colitis.

Crohn’s disease can involve any part of the digestive tract, from the mouth to the anus, causing inflammation of the lining with sores and scarring.

Ulcerative colitis also has inflammation, sores, and scarring but involves the large intestine and rectum.

People with IBD will often find blood and mucus in their stool, and experience weight loss, poor nutrition, and abdominal pain.

Other problems that might require an ileostomy include:

• rectal or colon cancer
• an inherited condition called familial polyposis, in which polyps form in the colon that can lead to cancer
• intestinal birth defects
• injuries or accidents that involve the intestines
• Hirschsprung’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
• work
• 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 maintain a healthy diet in the weeks leading up to your surgery.

Follow your surgeon’s instructions regarding diet in the days prior to surgery. At some designated time, they 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 surgeon 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 will either make a cut down your midline or perform a laparoscopic procedure using smaller cuts and lighted instruments. You will know prior to the surgery which method is recommended for your condition. Depending on your condition, your surgeon may need to remove your rectum and colon.

There are several different types of permanent ileostomies.

For a standard 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. This part of your intestine is turned inside out, exposing the inner surface. It’s soft and pink, like the inside of a cheek. The 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, won’t 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 often the preferred method of ileostomy because it eliminates the need for an external pouch.

A different procedure, known as the J-pouch procedure, may be performed if you’ve 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 typically 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 changes.

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, whether you have an internal or external pouch, you’ll start to learn how to manage the 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’ve 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:

• infection
• blood clot
• bleeding
• heart attack
• stroke
• 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 external 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 four to six hours and you feel nauseous or have cramps, call your doctor. You might have an intestinal blockage.

People who’ve 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 fluids 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:

• swim
• hike
• play sports
• eat in restaurants
• camp
• travel
• 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.

Read this article in Spanish.