What Is an Ileostomy?

During an ileostomy the colon (large intestine) and sometimes part of the last section of the ileum (small intestine) are removed or disconnected. If they were diseased, they may be removed. If they were injured, they may be disconnected for a short time while they heal. The end of the ileum is brought through the abdominal wall. This makes an opening, called a stoma, for stool and mucus to pass out of the body.

An End Ileostomy

The most common type of ileostomy is the end ileostomy.

  • The colon and sometimes part of the ileum are removed or disconnected. The rectum and anus may be removed or just disconnected
  • The stoma is most often on the lower right side of the abdomen
  • Stool tends to be quite liquid because there is no colon to absorb water from the stool. The stool also contains digestive juices, so it is very irritating to the skin
  • An end ileostomy is most often permanent. It may be done to treat inflammatory bowel disease (IBD) or polyps (growths) in the intestine
  • Sometimes an end ileostomy is temporary. It may be done to let the colon heal, as after an injury

There are other types of ileostomies. These can be temporary or permanent.

Ileostomy: Caring For Your Stoma

The Stoma

The stoma is created by bring the end of the ileum through the abdominal wall and turning it back on itself, like a cuff.

You need to take care of your stoma and the skin around it (peristomal skin). That means keeping the stoma and the skin clean. It also means protecting the skin from moisture and contact with stool. This helps prevent skin problems and odor.

Check the Stoma

Check your stoma and the skin around it each time you change your pouch. Stand in front of a mirror, or use a hand mirror so that you can see all the way around the stoma. It should look shiny, moist, and dark pink or red. The skin around it should be smooth, with no red or broken spots.

Clean Around the Stoma

Clean around the stoma with warm water and a soft washcloth each time you change the pouch. Water does not harm the stoma.

Protect the Skin Around the Stoma

For the pouch to stick well, the skin around the stoma needs to be dry and smooth. If the skin is moist or uneven, the pouch is more likely to leak. A leaky pouch will irritate the skin. That’s because digestive juices in the stool break down skin just as they break down food. A leaky pouch can also cause odor

Common Causes of Skin Problems

Call Your ET Nurse or Other Healthcare Provider If:

  • The skin around the stoma is red, weepy, bleeding, or broken.
  • The skin around the stoma itches, burns, stings, or has white spots.
  • The stoma swells, changes color, or bleeds without stopping.
  • The stoma becomes even with or sinks below the skin, or it sticks up more than normal.

Ileostomy: Selecting Your Pouch

After a colostomy, stool is collected in a pouch that attaches to your body around the stoma. An adhesive skin barrier holds the pouch in place and keeps stool from leaking onto the skin. Most pouches are made of lightweight, odor-proof plastic. They lie flat against the body so they don’t show or make noise.

Having Hernia Surgery: Traditional Repair

Surgery treats a hernia by repairing the weakness in the abdominal wall. An incision is made so the surgeon has a direct view of the hernia. The repair is then done through this incision (open surgery). To repair the defect, a mesh patch may be sewn (sutured) in place, to make a “traditional repair.” Follow your doctor’s advice on how to get ready for the procedure. You can usually go home the same day as your surgery. In some cases, though, you may need to stay in the hospital overnight.

Types of Pouches

There are many styles of pouches. Your healthcare provider will help you select the one that’s best for you. The skin barrier has to fit around the stoma without touching it. And it must stick well so there is no leaking or odor from the pouch.

One-Piece Drainable

Two-Piece Drainable

Sizing the Stoma Opening

For the pouch to fit around the stoma, the skin barrier must have an opening. Some skin barriers have precut openings, and some you size and cut yourself. To find the correct size opening for your stoma, use a measuring guide. Most pouches come with a guide in the box. Your healthcare provider may also give you one.

Pouch Accessories

You can buy other stoma care products through special catalogs, at medical supply stores, and at some drugstores.

Ileostomy: Emptying Your Pouch

Your pouch needs to be emptied whenever it gets to be about one-third full. This keeps the pouch from bulging under your clothes. It also helps prevent leaking and odor. To empty your pouch, follow the steps below.

1. Empty the Pouch

2. Clean the Pouch

3. Reclamp the Pouch

Releasing Gas

Gas can collect in the pouch even if there is no stool. Never puncture the pouch to release gas. If you do, you’ll break the odor proof seal. Stool can also leak if the pouch is punctured. To release gas, follow these steps:

Ileostomy: Changing Your Pouch

Stool starts to pass from the stoma soon after surgery. At first a nurse will change your pouch.
But you’ll need to learn how to change it yourself before you go home. A drainable pouch needs
to be changed 1–2 times a week. To change your pouch, follow the steps below.

Start by gathering what you’ll need:

1. Remove the Used Pouch

2. Clean Around the Stoma

3. Put On the New Pouch

Call Your ET Nurse or Other Healthcare Provider If:

  • The skin around the stoma is red, weepy, bleeding, or broken.
  • The skin around the stoma itches, burns, stings, or has white spots.
  • The stoma swells, changes color, or bleeds without stopping.
  • The stoma becomes even with or sinks below the skin, or it sticks up more than normal.

Ileostomy: Changing Your Pouch

After an ileostomy, it may be harder to digest foods that are high in fiber, such as raw vegetables, popcorn, and nuts. Eaten in large amounts, these foods can clump together. Then they get stuck in the small intestine, causing a blockage. You need to know the signs of a blockage and what to do if you have one.

Signs of a Blockage

A blockage can be an emergency. That’s because you can become dehydrated quickly. The intestine can also rupture. Most likely you’ll never have a blockage. But you need to know the signs just in case you do.

What to Do

You can try one or more of the following:

When to Call Your Doctor:

Call your doctor or ET nurse, or go to the nearest hospital emergency room if:

Ways to Help Prevent a Blockage

Sometimes a blockage occurs no matter what you do. But you can help prevent a blockage.

Ileostomy: Nutritional Management

Avoiding Digestive Problems

You don’t have to eat a special diet just because you’ve had an ileostomy. Most foods, chewed
well and eaten slowly, won’t give you problems—unless they did before. But you may need to
be more aware of foods that make your stool more watery than normal and foods that cause gas
or odor. You also need plenty of fluids and vitamins.

Choosing Foods

Learning which foods cause gas or odor or make your stool too watery takes a little time. You may want to add foods back to your diet one at a time

Preventing Fluid Loss

The small intestine doesn’t absorb as much water as the colon. That means your body loses
fluids and can become dehydrated more quickly. To prevent this, drink at least 8–12 cups (2–3
quarts) of fluids, such as water or juice, each day.

Taking Supplements and Medications

When the large intestine is removed or disconnected, some vitamins and medications cannot be absorbed.

Causes of Diarrhea

Stool that’s more watery than normal (diarrhea) can be a sign of an illness, such as the flu. Some foods and medications can also cause more watery stool.

Causes of Diarrhea

Some gas is normal, but constant gas is not. Neither is constant odor from stool. What causes gas
or odor can differ from person to person

Call Your ET Nurse or Other Healthcare Provider If:

  • You have nausea, vomiting, pain, cramping, or bloating
  • You have a change in your normal bowel habits, such as little or no stool.
  • Your stool is more watery than normal for more than 5–6 hours.
  • The stoma changes size, or the stool is black (blood in the stool).