What is a Ileostomy?question01

An ileostomy is a surgically created opening in the abdominal wall through which digested food passes. The end of the ileum (the lowest part of the small intestine) is brought through the abdominal wall to form a stoma. An ileostomy may be performed when a disease or injured colon cannot be treated successfully with medicine.

The part of the ileostomy that you see is called the stoma. A stoma is typically positioned around the abdomen depending on the type of the ileostomy. The stoma is where the stool will now leave the body and empties into a pouch.

Types of Ileostomiesquestion02

A Ileoanal Reservoir (J-Pouch) is now the most common alternative to the conventional ileostomy. Technically, it is not an ostomy since there is no stoma. In this procedure, the colon and most of the rectum are surgically removed and an internal pouch is made out of the end of the ileum (small intestine). An opening at the bottom of this pouch is attached to the anus such that the existing anal sphincter muscles (controlling muscles) can be used for continence. This procedure should only be performed on patients with ulcerative colitis or familial polyposis who have not previously lost their anal sphincters (controlling muscles). In addition to the "J" pouch, there are "S" and "W" pouch geometric variants. It is also called ileoanal anastomosis, pull-thru, endorectal pullthrough, pelvic pouch and, perhaps the most impressive name, ileal pouch anal anastomosis (IPAA)..

A Continent Ileostomy is surgical variation of the ileostomy, a reservoir pouch is created inside the abdomen with a portion of the end of the ileum (small intestine). A valve is constructed in the pouch and a stoma is brought through the abdominal wall. A catheter or tube is inserted into the pouch several times a day to drain feces from the reservoir. This procedure has generally been replaced in popularity by the ileoanal reservoir (above). A modified version of this procedure called the Barnett Continent Intestinal Reservoir (BCIR) is performed at a limited number of facilities.

Depending on the reason for the ileostomy, a surgeon can make the ileostomy permanent or temporary. The temporary ileostomy is created to let the lower part of the small intestine to rest or heal. The temporary ileostomy can have one or two openings. One of the stomas release bowels, the other releases the mucus. The doctor can connect the small intestine back together and normal bowel function can continue.

A permanent ileostomy usually involves the complete loss of a portion of the small intestine. The very end of the remaining portion of the small intestine is brought to the abdominal wall to form the stoma.

Reasons for a Ileostomyquestion03

There are several reasons a doctor will recommend an ileostomy. This is done to alleviate or cure symptoms of a disease or condition. Some of the reasons for this surgery are:

• Ulcerative Colitis
• Crohn's Disease
• Familial Polyposis

 

Ileostomy Stomasquestion04

Most stomas are typically round, although not perfectly round in shape. Stomas vary in shades of red and pink, are fleshy and moist. They also greatly vary in size (circumference). If you or your healthcare provider happen to note a stomal color like brown, purple or black (especially black), the surgeon must be notified at once. The stoma has no nerve endings, so it will not hurt when touched. You may see the stoma move slightly. This is completely normal. It is just part of the process your body is doing to help drain the stool into the pouch. The flow of stool cannot be controlled because there are no sphincter (controlling) muscles in the stoma.

The frequency of the output of the stoma is affected by food and liquid intake. Medications and treatment prescribed by your doctor can also have an affect on the stoma output. The stoma can also bleed slightly while releasing the stool.

There are many different types of stomas as well, some of which include:

Normal Stomas

• Protruding stomas are stomas that protrude from the skin's surface of the abdomen. It does not make a difference if the abdomen is fleshy or flat. The protrusion varies in length and can slightly retract or extend throughout the life of the ileostomy.
• A flush stoma is a stoma that, as its name implies, is flush with the skin's surface. The best way to deal with this is to use a wafer system that has convexity. This will help the stoma stand out more against the skin so that a better seal will form.
• Retracting Stomas are stomas that are pulled inward from the skin's surface. These types of stomas will require a wafer system that has a high convexity. This will help the stoma stand out more against the skin so that a better seal will form and irritation occurs much less.
• An End Stoma is made by dividing the intestine and bringing the closest end through the abdominal wall. An End Stoma can be in the large or small intestine.
• Another type of stoma is called the Loop Stoma which can also be created in either the large or small intestines. A loop of intestine is brought to the abdominal wall. The portion above the skin's surface is opened and made into two stomas. One (functioning) releases the stool, the other (non-functioning) releases mucus. Occasionally a rod is put underneath the loop of the intestine to support the stoma on the skin's surface. The rod should only be removed under the physician's guidance.
• A Double-Barrel Stoma can be made in the large or small intestine. The intestine is separated and the two ends are brought through the abdominal wall and made into two stomas. One (functioning) releases the stool, the other, (non-functioning) also called the mucous fistula, releases mucus.

 

Challenging Stomas

• Prolapsed stomas are often seen in overweight patients or patients with weak abdominal muscles. These types of stomas often continually protrude 1 to 4in as time goes on. The treatment for a prolapsed stoma is to use a flat and flexible pouching system; this will prevent trauma to the stoma when pouching. Using a support belt can prevent trauma, as well as preventing the stoma from protruding further.
• Parastomal stomas occur due to weak muscle in the abdominal wall, which allows the intestine to come through the muscle. Especially if the stoma is place just outside of the rectus abdominus muscle. This can be prevented by wearing some type of abdominal support belt when lifting or exercising. Using a one piece pouching system or a two piece adhesive system adapts to any irregular contours of the skin and/or stoma.
• Mucocutaneous Separation occurs when the sewn intersection between the stoma and the skin separates. This can occur when an infection occurs or there is too much tension on the sewn stitch. If this occurs, call your physician. Typically a wound care product will be used to absorb drainage and prevent excess soiling of separation from stool or urine.
• Stomal Necrosis occurs when there is impaired or restricted blood flow to the stoma. Talk to your doctor if this happens. The stoma will slough off and a ileostomy deodorizer will be used while the necrotic stoma is sloughing off.

 

Ileostomy System Products question05
Pouching systems
Can be either open-ended, requiring a closing device (traditionally a clamp or tail clip); or closed and sealed at the bottom. Open-ended pouches are called drainable and are left attached to the body while emptying. Closed end pouches are most commonly used by ileostomates who can irrigate (see below) or by patients who have regular elimination patterns. Closed end pouches are usually discarded after one use.

• Two-Pouch Systems allow changing pouches while leaving the barrier/wafer attached to the skin. The wafer/barrier is part of a "flange" unit. The pouches include a closing ring that attaches mechanically to a mating piece on the flange. A common connection mechanism consists of a pressure fit snap ring, similar to that used in Tupperware™.
• One Pouch Systems consist of a skin barrier/wafer and pouch joined together as a single unit. Provide greater simplicity than two-piece systems but require changing the entire unit which includes the skin barrier, every time the pouch is changed.

 

Irrigation System
This is also a special system that consists of an irrigation bag with a connecting tube (or catheter), a stoma cone and an irrigation sleeve. Some ileostomates can "irrigate," using a procedure similar to an enema. This is done to clean stool directly out of the intestines through the stoma. A special lubricant is sometimes used on the stoma to make it easier to insert the catheter. Following irrigation, some ileostomates can use a stoma cap, a one- or two-piece system which simply covers and protects the stoma. This procedure is usually done for those who do not wish to wear a pouch.
There are also a number of styles. Keep in mind, there is no right or wrong choice, but each person must find the system that performs best for him or her. For instance there are flat wafers and convex shaped ones. There are fairly rigid and very flexible ones. There are barriers with and without adhesive backing and with and without a perimeter of tape. Some manufacturers have introduced drainable pouches with a built-in tail closure that doesn't require a separate clip.
The decision as to what particular type of system to choose is a personal one geared to each individual's needs. It is not uncommon to try several types until the best solution is found. There is no reason to stay with a poorly performing or uncomfortable pouching system.

Life after a Ileostomy question06

 

• Work: With the possible exception of the types of jobs that require very heavy lifting, a ileostomy should not interfere with work. People with ileostomies are successful business people, teachers, doctors, writers, etc.
• Sex and social life: Physically, the creation of a ileostomy usually does not affect sexual function. If there is a problem, it is almost always related to the removal of the rectum. It is best to be open with your partner of how you are feeling. The ileostomy itself should not interfere with the normal sexual activity or pregnancy. It does not prevent one from dating, marriage or even having children.
• Clothing: Usually one is able to wear the same clothing as before surgery, including swimwear.
• Sports and activities: With a securely attached and properly fitted pouch one can swim, camp out, play baseball and participate in practically all types of sports. Caution should be taken in activities with heavy body contact. Special small pouches can be used if swimming or playing sports if desired. If you spend time in a sauna or hot tub, the heat may loosen the barrier. Always check for a proper seal. Travel is not restricted in any way. Just remember to pack all of your supplies for the trip. Always keep your supplies where you can easily reach them.
• Bathing and showering may be done with or without the pouch in place. If you shower/bathe with your pouch off, make sure that you choose a soap that is oil and residue free. These types of soaps will not affect any adhesive the ileostomy system may require.
• Diet: Unless your doctor has prescribed you a specific diet, usually there are no diet restrictions and foods can be enjoyed as before.

 

Learning How to Care for Your Ileostomyquestion07

There are very important things to remember when caring for your ileostomy.

• Empty your pouch frequently, never allowing the output to reach a certain point in the collection bag such as 1/3 or ½ full. A full pouch can become heavy and break loose from the skin. A full pouch is also more difficult to drain.
• Replace your entire pouching system at least 3 times per week. For children and infants, the pouching system needs to be changed more frequently.
• Plan on changing your pouch in the morning before your ileostomy becomes too active.
• Always care for your skin by using a clean washcloth or wipe, and soap with no oils, no fragrance, and no dyes.
• Make sure skin is completely dry and check for any color changes or irritations.
• Be sure that you have a Ileostomy Product System in place that fits securely and comfortably.
• For additional information contact your physician.