An ileostomy is a surgical procedure that creates an opening or stoma in the abdomen to divert the end of the small intestine (ileum) outside the body. Stomas are typically located in the lower right side of the abdomen and covered with pouches or bags that collect waste. The colon (large intestine) or rectum is usually damaged or diseased and unable to function properly, which leads to an ileostomy.
An ileostomy may be needed for various reasons, such as:
Inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis, that causes inflammation, ulcers, bleeding, or obstruction in the colon or rectum
Colon or rectal cancer that requires the removal of part or all of the colon or rectum
Familial adenomatous polyposis (FAP) or Lynch syndrome, which are inherited conditions that increase the risk of developing colon or rectal cancer
Diverticulitis, which is an infection or inflammation of small pouches (diverticula) that form in the colon
Trauma or injury to the colon or rectum
Birth defects or congenital anomalies that affect the development of the colon or rectum
Depending on the condition and extent of surgery, ileostomies can be temporary or permanent. Temporary ileostomies are often performed after surgery or treatment to allow the colon or rectum to heal, and can be reversed at any time. A permanent ileostomy is done when the entire colon or rectum is removed or cannot be reconnected.
An ileostomy can cause some changes and challenges in the daily life of the patient, such as:
Having to empty and change the pouch or bag several times a day
Having to monitor the stoma for signs of infection, irritation, or blockage
Having to adjust the diet and fluid intake to prevent dehydration, malnutrition, or diarrhea
Having to deal with odor, noise, or leakage from the pouch or bag
Having to cope with the emotional and social impact of having an ileostomy
Some common complications or problems that may occur after an ileostomy include:
Skin irritation or infection around the stoma
Stoma prolapse or retraction, which is when the stoma sticks out or sinks in too much
Stoma stenosis or narrowing, which is when the stoma becomes too small or tight
Parastomal hernia, which is when a part of the intestine bulges through the abdominal wall near the stoma
Dehydration or electrolyte imbalance, which is when the body loses too much water or minerals
Bowel obstruction or blockage, which is when the ileum becomes twisted or kinked
Bleeding or ulceration of the ileum or stoma
An ileostomy is usually planned and discussed with the patient before the surgery. The patient may undergo some tests and examinations to prepare for the surgery, such as:
Blood tests to check the blood count, clotting, and electrolytes
Urine tests to check the kidney function and infection
Stool tests to check the presence of blood, bacteria, or parasites
Colonoscopy or sigmoidoscopy to examine the inside of the colon or rectum
Barium enema or CT scan to obtain images of the colon or rectum
Abdominal X-ray or ultrasound to obtain images of the abdomen and other organs
The patient may also meet with a stoma nurse or therapist to learn about the care and management of the ileostomy, and to mark the best location for the stoma on the abdomen.
The treatment of an ileostomy involves surgery to create the stoma and the postoperative care and follow-up. Depending on the surgeon's preference and expertise, the surgery can be performed openly or laparoscopically. It usually takes two to four hours, and general anesthesia is necessary. The patient may need to stay in the hospital for up to seven days after surgery.
The postoperative care and follow-up include:
Taking pain relief and antibiotics as prescribed by the doctor
Keeping the stoma and the surrounding skin clean and dry
Using the appropriate pouch or bag system and accessories as recommended by the stoma nurse or therapist
Emptying and changing the pouch or bag as needed, usually 4 to 6 times a day
Eating a balanced and nutritious diet and drinking enough fluids to prevent dehydration, malnutrition, or diarrhea
Avoiding foods that may cause gas, odor, or blockage, such as beans, cabbage, nuts, seeds, popcorn, or dried fruits
Gradually resuming normal activities and exercise as tolerated and advised by the doctor
Seeking medical attention for any signs or symptoms of complications or problems, such as fever, pain, bleeding, swelling, or discharge
Having regular check-ups and tests to monitor the ileostomy and the overall health
An ileostomy cannot be prevented in most cases, as the cause is often unknown or unavoidable. However, some possible ways to reduce the risk or severity of an ileostomy include:
Avoiding smoking, alcohol, and drugs that may harm the colon or rectum
Taking medications and treatments as prescribed by the doctor for conditions that affect the colon or rectum, such as IBD or cancer
Having regular screenings and tests to detect and treat any problems or diseases in the colon or rectum, such as colonoscopy or stool tests
Following the doctor’s advice and instructions before and after the surgery
Having regular follow-ups and evaluations to monitor the ileostomy and the long-term outcomes
An ileostomy is a life-changing but manageable condition that affects the small intestine and the abdomen. With proper surgery, care, and support, most patients can have a good quality of life and a normal life expectancy.
