Ileostomy

An ileostomy is a surgical procedure that creates an opening (stoma) in your belly (abdomen), bringing a part of your small intestine (ileum) to the outside. This new opening allows waste to leave your body and collect in a special bag (pouch) worn over the stoma. It is done when your large intestine or rectum cannot function properly.

What is Ileostomy?

An ileostomy is a surgical procedure that creates a new opening, called a stoma, in your belly (abdomen). During this surgery, a part of your small intestine (specifically the ileum) is brought through the stoma to the outside of your body. This allows stool and gas to bypass your large intestine and rectum, collecting in an external pouch.

The small intestine (ileum) is the final section of your small bowel. When an ileostomy is performed, the end of this section is brought out through an opening made in your abdominal wall. This opening, the stoma, is typically red and moist, similar to the inside of your mouth. It has no nerve endings, so it does not hurt when touched. Because the large intestine, which usually absorbs water, is bypassed, the waste from an ileostomy is generally liquid or pasty. This waste continuously exits the stoma and collects in a special, drainable pouch that sticks to the skin around your stoma. This pouch needs to be emptied several times a day and changed regularly. Ileostomies can be temporary, allowing a part of your bowel to heal, or permanent, if a section of your bowel needs to be removed entirely.

Why it's done

An ileostomy is performed to divert stool away from your large intestine (colon) or rectum when these organs are diseased, damaged, or need to be removed. This allows the affected part of your bowel to heal or provides a permanent way for waste to leave your body if the lower bowel cannot function.

Several medical conditions can make an ileostomy necessary. These often include inflammatory bowel diseases like ulcerative colitis and Crohn's disease, which cause severe inflammation and damage to the digestive tract. An ileostomy may also be needed for colon or rectal cancer, where part of the bowel must be removed. Other reasons include familial polyposis, a genetic condition causing many growths (polyps) in the colon, or severe injuries to the bowel. In some cases, birth defects that affect the intestines may also require an ileostomy. By creating an ileostomy, surgeons can ensure that waste continues to leave your body safely, even when your lower digestive system is unable to do so.

How to prepare

Preparing for an ileostomy involves several important steps, including thorough medical evaluations, adjusting your diet and medications, and meeting with a specialized nurse. These preparations ensure you are physically ready for surgery and understand how to care for your new stoma afterward.

Before your surgery, your healthcare team will conduct various tests to assess your overall health. You will meet with your surgeon to discuss the procedure and a specialized stoma nurse (enterostomal therapist). The stoma nurse will help you choose the best location for your stoma on your abdomen, considering your body shape and clothing, and will teach you about stoma care. You will likely need to follow a special diet for a few days before surgery, often a low-fiber diet, and then a clear liquid diet. You may also need to take a bowel preparation (bowel prep) to clean out your intestines. It is crucial to inform your doctor about all medications you take, especially blood thinners, as these may need to be stopped before surgery to prevent bleeding. If you smoke, you will be advised to stop, as smoking can slow healing.

What happens during

During an ileostomy procedure, you will receive general anesthesia to ensure you are asleep and feel no pain. The surgeon will make an incision in your belly (abdomen) and bring a section of your small intestine (ileum) through this opening to create the stoma.

Once you are under general anesthesia, the surgeon will begin the procedure. The surgery can be performed using an open method, which involves a single, larger incision in your abdomen, or laparoscopically, using several small incisions and special instruments with a camera. The choice of method depends on your specific condition and the surgeon's preference. The surgeon will then bring the end or a loop of your small intestine (ileum) through the prepared opening in your abdominal wall. For an end ileostomy, the end of the ileum is brought out and stitched to the skin to form the stoma. For a loop ileostomy, a loop of the ileum is brought out, and two openings are created, one for stool and one for mucus. The stoma is then carefully shaped and secured, and the surgical incisions are closed.

Recovery & timeline

After an ileostomy, you will typically stay in the hospital for a few days to a week. Your recovery will involve managing pain, learning how to care for your stoma and pouch, and gradually returning to your normal diet and activities. Full recovery can take several weeks to months.

Immediately after surgery, you will be monitored closely for pain and any complications. You will gradually start with clear liquids and progress to soft foods as your bowel function returns. Nurses and stoma specialists will teach you how to empty and change your ostomy pouch, clean the skin around your stoma, and identify any potential issues. This education is vital for managing your ileostomy at home. Most people can return home within 3 to 7 days, depending on their recovery progress. While at home, you will need to avoid heavy lifting and strenuous activities for several weeks to allow your abdominal muscles to heal. It is important to stay well-hydrated, as an ileostomy can lead to increased fluid loss. Your energy levels will gradually improve, and you can typically resume most normal activities, including work and exercise, within 4 to 6 weeks, though full recovery may take longer.

Risks & side effects

Like any major surgery, an ileostomy carries potential risks and side effects. These can include general surgical complications such as bleeding and infection, as well as issues specific to the stoma, like skin irritation, blockages, or dehydration due to increased fluid loss.

General surgical risks include bleeding, infection at the incision site, and damage to nearby organs. After an ileostomy, specific complications related to the stoma can occur. These include skin irritation around the stoma from leakage, stoma retraction (when the stoma pulls back into the abdomen), stoma prolapse (when the stoma extends too far out), or a parastomal hernia (when part of the intestine bulges near the stoma). Another significant concern is dehydration and electrolyte imbalance, as the large intestine's role in absorbing water is bypassed. You may also experience a small bowel obstruction, where food or scar tissue blocks the intestine. Some people report "phantom rectum" sensations, feeling the urge to have a bowel movement even though the rectum is no longer used or present. Your healthcare team will provide guidance on how to manage these potential issues.

Success rate

For many individuals, an ileostomy significantly improves their quality of life by resolving symptoms from severe bowel conditions. While complications can occur, most people adapt well to living with an ileostomy and successfully manage their daily care, leading to better overall health and well-being.

The "success" of an ileostomy is often measured by its effectiveness in treating the underlying condition and improving a person's daily life. For conditions like severe ulcerative colitis or Crohn's disease, an ileostomy can eliminate chronic pain, inflammation, and frequent urgent bowel movements, allowing individuals to regain control over their lives. Many people report a substantial improvement in their physical health and social activities after recovering from the surgery. While the procedure itself is generally effective in diverting waste, managing an ileostomy requires learning new self-care routines. Complications, such as those related to the stoma or dehydration, are common but often manageable with proper education and support from healthcare professionals. With appropriate care and lifestyle adjustments, most people with an ileostomy can lead full and active lives.

Frequently asked questions

Can I eat normally with an ileostomy?

You can generally eat most foods with an ileostomy, but you might need to make some adjustments. Initially, you'll follow a low-fiber diet. Over time, you can gradually reintroduce foods. It's often recommended to chew food thoroughly, eat smaller meals, and be mindful of foods that can cause blockages (like nuts, seeds, popcorn, and some raw vegetables) or increase gas.

How often do I need to empty my ileostomy pouch?

You should empty your ileostomy pouch when it is about one-third to half full. This usually means emptying it 5 to 8 times a day, but it can vary depending on your fluid intake and diet. Emptying it regularly prevents the pouch from becoming too heavy or bulging, which could lead to leaks.

Can I swim or shower with an ileostomy?

Yes, you can swim and shower with an ileostomy. The ostomy pouching system is designed to be waterproof. You can shower with or without your pouch on, as water will not harm your stoma. For swimming, ensure your pouch is securely sealed, and consider wearing a smaller, more discreet pouch or specialized swimwear.

Will my ileostomy be permanent?

An ileostomy can be either temporary or permanent. A temporary ileostomy is created to allow a part of your bowel to heal, and it can be reversed later in another surgery. A permanent ileostomy is necessary when the large intestine or rectum must be completely removed or cannot be reconnected, meaning the stoma will be a lifelong change.

What are the signs of an ileostomy blockage?

Signs of an ileostomy blockage include a sudden decrease or complete stop in output from your stoma, abdominal cramping, swelling of the stoma, nausea, and vomiting. If you suspect a blockage, contact your healthcare provider immediately. You may be advised to try warm baths, gentle abdominal massage, or specific dietary changes.

Will an ileostomy affect my sex life?

An ileostomy can affect your sex life, but many people continue to have fulfilling intimate relationships. It's normal to have concerns about body image or comfort. Open communication with your partner is key. You might find that wearing a smaller pouch, special covers, or emptying your pouch before intimacy can help you feel more comfortable and confident.

Sources

• MedlinePlus — Ileostomy
• Mayo Clinic — Ileostomy
• Cochrane Library — Ileostomy