A ileostomy is a surgery that makes a temporary or permanent opening called a stoma. A stoma is a pathway from the lowest part of the small intestine, called the ileum, to the outside of your abdomen. This helps solid waste and gas exit the body without passing through the colon or the rectum. The waste is collected in a pouch worn on the outside of your body.
What is the small intestine?
The small intestine, or small bowel, runs between the stomach and the large intestine. The large intestine is made up of the colon and the rectum. The small intestine digests nutrients and absorbs them into blood vessels. Such nutrients include proteins, fats, and carbohydrates. Remaining food that cannot be digested moves from the small intestine to the colon. The colon absorbs water from the waste and stores the waste until the next bowel movement.
Why do I need an ileostomy?
A doctor may perform an ileostomy to bypass or remove part of the intestine. This may be because:
The large intestine is blocked or damaged
A part of the large intestine is surgically removed
A ruptured colon causes an abdominal infection
People with certain types of cancer, such as colorectal cancer, may need a ileostomy. Sometimes women being treated for ovarian cancer need a ileostomy. People with Crohn’s disease, ulcerative colitis, or familial adenomatous polyposis, which is a pre-cancerous condition, may also need an ileostomy.
How long will I need a ileostomy?
Most people who need a cancer-related ileostomy only need it for a few months while the colon or rectum heals. However, some people may need a permanent ileostomy.
Types of ileostomy
There are 3 types of ileostomy:
Standard ileostomy. This is also called a Brooke ileostomy. It is the most common type. The end of the small intestine is pulled through the right lower part of the abdomen and secured to the outside skin. You then wear a pouch at all times to collect stool that moves through the opening.
Continent ileostomy. This ileostomy does not require you to wear a collection bag. The surgeon creates a pocket and valve in the end of the small intestine. You then insert a catheter several times a day into the pocket to drain the waste.
Ileo-anal reservoir. This is also called a J-pouch or pelvic pouch. The surgeon creates a pouch from the small intestine and rectum. He or she connects the pouch to the anus to store waste. Stool can then be passed from the pouch through the anus.
What should I expect during surgery?
You will receive general anesthesia before the surgery. The procedure may be done with:
A surgical incision, which is a large cut in the abdomen
Laparoscopic surgery, which involves less invasive small incisions. This method reduces pain and recovery time.
Surgery may include the following risks:
Bleeding inside the small intestine or from the stoma
Damage to nearby organs
Not being able to absorb enough nutrients from food
Intestinal blockage caused by scar tissue
How long will it take to recover from surgery?
Most patients stay in the hospital for up to 1 week after the procedure. Complete recovery from a ileostomy may take up to 2 months. During this time, you will have limits on what you can eat while the small intestine heals.
If the ileostomy is temporary, you may need a reversal, or closure, surgery after the small intestine has healed. This surgery usually takes place about 12 weeks later.
Emptying your ileostomy bag. Once you have recovered from surgery, you will need to empty the ileostomy bag several times per day. You will not be able to control when stool and gas move into the pouch. It is best to empty it when the bag is less than half full.
Ileostomy pouches come in many sizes and shapes, but there are 2 main types:
One-piece pouches attach directly to the skin barrier.
Two-piece pouches include a skin barrier and a pouch that can detach from the body.
Most pouches are drained through an opening in the bottom. Ask your health care team about which type of ileostomy pouch you will receive and instructions on how to empty it.
Draining waste with a catheter. If you have a continent ileostomy, the surgeon will leave a tube in the pouch so the waste can drain continuously, called an indwelling catheter. This will last for about 3 to 4 weeks. Once the indwelling catheter is removed, you will need to drain the pouch several times a day. This frequency will decrease over time.
Caring for your skin. The skin surrounding the stoma is called peristomal skin. It will always look red and may bleed occasionally, which is normal. However, bleeding should not continue for long.
It is important to make sure your pouch is correctly connected to your stoma. A pouch that fits poorly can irritate your skin. You should also keep this area clean and dry. If this skin appears wet, weepy, bumpy, itchy, or painful, it may be infected. Contact your healthcare team.
High stool output. During the first few days after surgery, you may have a larger than normal stool output. As your body gets used to the stoma and ileostomy, this amount will decrease. If it does not decrease after a few days, call your health care team. Passing large amounts of stool means you may be losing too many fluids. This could lead to an imbalance in your electrolyte levels. Electrolytes are minerals that help regulate the body.
Managing gas. Just like with stool, you will also need to release gas from your ileostomy pouch. The way you do this depends on the type of pouch. Some pouches have a filter that deodorizes and vents gas. This prevents the bag from becoming too stretched, coming off of the abdomen, or bursting.
Amounts of gas deposited into the pouch will vary based on the type of ileostomy and your diet. Foods and drinks such as beans, onions, milk, and alcohol can cause excess gas. Swallowing air can also increase the amount of gas in your small intestine. This happens when you chew gum or drink through a straw. You may have a lot of gas right after surgery. But this should decrease as your body heals. Your health care team can provide information on food and lifestyle choices to help reduce gas.
Whole pills or capsules in stool. Coated pills and extended-release capsules may come out intact in your pouch. This can mean that the medication was not fully absorbed in your body. Tell your health care team if this happens. They may be able to prescribe liquid or gel medications for you to take instead.
Stoma obstruction. Sometimes your stoma may become blocked by a piece of undigested food and scar tissue. This means that stool and gas cannot pass through into the pouch. An obstruction may cause abdominal pain or swelling or nausea or vomiting.
You may be able to remove the blockage at home. This can be done by avoiding solid foods and drinking more fluids, including warm drinks like tea. You can also try massaging your abdomen around the stoma or drawing your knees to your chest and rocking side to side. If these tips do not work, call your health care team right away.