What is an ileostomy?
A surgically produced opening in the abdominal wall is known as an ileostomy. The ileum (the bottom section of the small intestine) is pulled through the abdominal wall to produce a stoma, which is generally located on the lower right side of the belly. When you look at your stoma, you are looking at the lining (or mucosa) of your gut, which is similar to the lining of your cheek.
An ileostomy may only be required for a short period (temporary), perhaps 3 to 6 months because that portion of the colon needs rest and healing after a problem or disease. However, other diseases, such as cancer, are more serious, and an ileostomy may be required for the rest of a person’s life (permanent).
Depending on the cause of surgery, an ileostomy may be permanent or temporary. Normal colon and rectal functions are no longer present since the whole colon, rectum, and anus are removed or bypassed by a permanent ileostomy. A temporary ileostomy involves the removal of all or part of the colon, but the rectum is left intact and may later be reversed.
The small intestine’s primary job is to absorb nutrients and water from the body. Enzymes secreted into the small intestine break down food into small pieces, allowing proteins, carbs, lipids, vitamins, and minerals to be absorbed. These enzymes are also found in ileostomy discharge and can induce skin deterioration. This is why the skin around an ileostomy must be guarded all the time.
Output of ileostomy
Waste no longer exits the body through the rectum and anus once the colon and rectum have been removed or bypassed. Digestive contents are now expelled from the body via the stoma. The drainage is collected in a pouch that adheres to the skin around the stoma. The bag is custom-made for you. It is always worn and maybe emptied as required.
Depending on what you eat, your medications, and other variables, your ileostomy output will range from liquid to pasty. Because the output is consistent, you should empty the pouch 5 to 8 times each day.
Types of ileostomy
(a) Temporary ileostomies:-
Certain bowel disorders can be treated by resting a section of the intestine or by removing the damaged section surgically. To heal, the bowel must be maintained empty. A short-term (temporary) ileostomy is established to prevent feces from entering the intestine. The ileostomy will eventually be surgically reversed (removed), and the bowel will function normally again. A temporary ileostomy can also be performed as the initial stage in the formation of an ileoanal reservoir (or J-pouch).
(b) Permanent ileostomies:-
When a section of the bowel gets infected, a long-term (permanent) ileostomy must be performed. The diseased part of the bowel and anus are either excised or permanently rested. In this situation, the ileostomy is considered permanent and will never be closed (removed).
There are three major types of ileostomies which are as follows.
(c) Standard or Brooke ileostomy:-
It is the most common type of ileostomy. The small intestine is pushed through the right lower portion of the abdomen and attached to the skin on the outside. You, therefore, need to wear a pouch at all times in order to collect feces that passes through the opening.
When feasible, the stoma is positioned in the right bottom quadrant and on a flat surface that is sufficiently free of irregularities.
(d) Continent ileostomy (abdominal pouch):-
This ileostomy does not necessitate the use of a collecting bag. At the end of the small intestine, the surgeon constructs a pocket and a valve. You then place a catheter into the pocket many times each day to empty the waste.
(e) Ileo-anal reservoir (J-pouch or pelvic pouch):-
The surgeon creates a pouch from the small intestine and rectum. He or she attaches the bag to the anus in order to store waste. The stool can then be expelled from the pouch via the anus. Typically, these treatments need more than one operation. To prevent the pouch from leaking, the sphincter muscle around the anal opening must be intact. Diet influences the consistency of the output of the pelvic pouch, which may be aided by medicines.
Choosing a pouching system
Selection can be influenced by a variety of variables. The length of the stoma, abdominal firmness and curves, stoma placement, scars and folds in the abdominal area, and your height and weight must all be considered when deciding what is ideal for you. Stomas around the hipbone, waistline, groin, scars and other sensitive areas may necessitate special adaptations. Some companies provide custom-made products to fit unusual situations.
The ideal pouching system for you is a very personal matter. It is important that you are properly fitted, just as for eyeglasses.
A good pouching system should:
- Stay secure, with a good leak-proof seal that lasts for up to 3 days
- Be odor-resistant
- Protect the skin around the stoma
- Be nearly invisible under clothing
- Be easy to put on and take off
- Allow you to shower or bathe with the pouch on if you wish to do so.
Types of pouching system
There are 2 main types of systems available:
- One-piece pouches have both a pouch and skin barrier attached together in the same unit. When the pouch is removed, the barrier also comes off.
- Two-piece systems have a pouch and a separate skin barrier. When the pouch is taken off, the barrier stays in place.
They all have a collection pouch to collect stool drainage that comes out of the stoma and an adhesive barrier (called a flange, skin barrier, or wafer) that protects the surrounding skin.
Belts and tape
Wearing a belt is a highly personal choice. Some people with ileostomies wear belts because it makes them feel more secure or because it supports the pouching system. Others find belts cumbersome and prefer to use tape instead. Tape can be used to form a frame around the outside border of the skin barrier. If you decide to wear a belt, make sure there are two finger widths between the belt and your waist to avoid a deep groove or cut in the skin surrounding the stoma.
Caring for an ileostomy
(a) Emptying your ileostomy bag:-
You will need to empty the ileostomy bag many times each day once you have recovered from surgery. You will have no control over when feces and gas enter the pouch. When the bag is less than half-filled, it is preferable to empty it.
The majority of pouches are emptied via an opening at the bottom. Discuss with your health care provider about the type of ileostomy pouch you will be given and how to empty it.
(b) Draining waste with a catheter:-
If you have a continent ileostomy, the surgeon will place an indwelling catheter in the pouch to allow waste to drain continuously. This will last around 3 to 4 weeks. After the indwelling catheter is removed, the pouch must be drained multiple times each day. This frequency will decrease over time.
(c) Caring for your skin:-
Peristomal skin refers to the skin that surrounds the stoma. It will always appear red and may bleed from time to time, which is normal. However, the bleeding should not last long.
It is critical to ensure that your pouch is properly attached to your stoma. A pouch that does not fit properly might irritate your skin. This region should also be kept clean and dry. This skin may be infected if it seems moist, weepy, bumpy, itchy, or painful. Make contact with your medical team.
Your ostomy will not be harmed by water. Normal air exposure or contact with soap and water will not harm the stoma. Water will not enter the stoma. Soap will not irritate it, but it may interfere with the skin barrier’s ability to adhere to the skin. When washing the skin surrounding your stoma, it is preferable to use just water. If you do use soap, make sure to thoroughly rinse it off.
It is advised that you leave the pouch in place when taking a bath. One major reason not to remove your pouch when showering or bathing is to reduce the danger of fecal output, which you cannot control.
(e) Spots of blood on the stoma:-
Spots of blood are not a cause for alarm. Cleaning around the stoma while changing the pouch or skin barrier may result in little bleeding. The blood vessels in the stoma tissues are highly delicate and readily disrupted at the surface. Usually, the bleeding will cease shortly. If it does not, contact your ostomy nurse or doctor.
(f) Shaving hair under the pouch:-
A lot of hair around the stoma can make it difficult for the skin barrier to adhere properly and may cause pain when removed. It is beneficial to shave with a razor or trim hair with scissors. When performing this, extreme caution should always be taken. Because soap and shaving creams contain lotions and oils that may cause the skin barrier unable to stick, it is recommended that you dry shave the skin around your stoma with stoma powder. After shaving, thoroughly rinse and pat dry your skin before applying your pouch.
(g) What to wear when you have an ileostomy
You won’t need any special clothing for everyday wear. The pressure exerted by elastic undergarments will not harm the stoma or impair bowel function.
Snug undergarments, such as cotton stretch underpants, t-shirts, or camisoles, may provide additional support and security and also help in concealing pouches. A simple pouch cover adds comfort by absorbing body sweat and preventing the plastic pouch from touching your skin. Men can wear either boxer shorts or jockey-type shorts.
(a) Flatulence (gas):-
Just like with stool, you will also need to release gas from your ileostomy pouch. The method you use depends on the type of pouch. A filter that deodorizes and vents gas is included in some pouches. This keeps the bag from becoming overly stretched, slipping off the abdomen, or bursting.
Gas will occur less frequently as the tissue swelling decreases. Although drinking from a straw, chewing gum, sodas, and some foods, such as eggs, cabbage, onions, fish, baked beans, milk, cheese, and alcohol, might produce intestinal gas.
Eating regularly will help you avoid having too much gas. Skipping meals to avoid gas or discharge is a bad idea because your small intestine will be more active, resulting in more gas and watery discharge.
Some people find it best to eat a lesser amount of food 4-5 times a day.
For reducing odor follow the below hints-
• Make use of an odor-resistant pouch.
• Ensure that the skin barrier tightly adheres to the skin.
• Empty the bag on a regular basis.
•Put special deodorant liquids and/or tablets in the pouch.
• There are oral preparations available. Consult your doctor or an ostomy nurse about the suitability of these products and the suggested dosage.
• There are air deodorizers in the market that successfully reduce odor while emptying the pouch.
(c) Whole pills or capsules in the stool:-
Coated tablets and extended-release capsules may come out of your bag intact. This might indicate that the medicine was not completely absorbed by your body. Inform your medical team if this occurs. They might be able to prescribe liquid or gel medicines instead.
(d) Stoma obstruction:-
A piece of undigested food or scar tissue can sometimes block your stoma. This implies that feces and gas cannot enter the pouch. This blockage can cause stomach discomfort, edema, nausea, or vomiting.
You might be able to clear the blockage at home. This can be accomplished by avoiding solid meals and consuming more fluids, particularly warm beverages such as tea. Also you can massage your belly around the stoma, etc. If none of these suggestions work, contact your health care provider immediately.
(e) High stool output:-
You may have more than usual stool output in the first few days following surgery. This amount will decrease as your body adjusts to the stoma and ileostomy. If it does not go away after a few days, contact your doctor. If you’re passing a lot of stool, it implies you’re losing a lot of fluids. This may result in an imbalance in your electrolyte levels. Electrolytes are minerals that aid in body regulation.