What is a Ileostomy?question01

An ileostomy is created by surgically opening up 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 is performed when a disease or injured colon cannot be treated successfully with medicine.

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

A Ileoanal Reservoir (J-Pouch) is the most common alternative to the conventional ileostomy. Technically, it is not an ostomy because 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. 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 ileal pouch anal anastomosis (IPAA).

A Continent Ileostomy is a surgical variation of the ileostomy. When 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 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.

A surgeon can make the ileostomy temporary or permanent depending on the reason for the ileostomy. A temporary ileostomy allows the lower part of the colon to rest or heal. A temporary ileostomy can have one or two openings. One of the openings releases stool, the other release mucus. After the healing process, the doctor can reattach the small intestine and normal bowel function can resume.

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

Ileostomies are done to alleviate or cure symptoms of a disease or an existing condition. Doctors will recommend an ileostomy for several reasons. Some of the reasons are:

• Ulcerative Colitis
• Crohn's Disease
• Familial Polyposis

Stomas are typically round but aren’t perfectly round in shape. Stomas vary in color and are generally shades of red and pink, and are fleshy and moist. They greatly vary in size (circumference). 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. If you or your healthcare provider note a stomal color of brown, purple or black (especially black), your surgeon must be notified at once. A change in color may mean that the pouching appliance may be on too tight, or an internal problem is present. Any color other than red or pink may indicate that the stoma is not perfused, which may result in death. No matter the reason for the change in stoma color, be sure to call the surgeon. 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 also have an effect. There may be slight bleeding when the stoma releases its output. If there is blood in the stool, or the bleeding is constant, you should contact your doctor.

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

Normal Stomas

• Protruding stomas protrude from the abdomen skin's surface. There is no 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.
• Flush stomas are flush with the skin's surface. The best way to deal with this type of stoma 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 pulled inward from the skin's surface. These types of stomas require a wafer system that has a high convexity. This helps the stoma stand out more against the skin and create a better seal and reduce irritation.
• End stomas are made by dividing the intestine and bringing the closest end through the abdominal wall. An end stoma can be in either the large or small intestine.
• Loop stomas can also be created in either the large or small intestine. A loop of intestine is brought to the abdominal wall. The portion above the skin's surface is made into two stomas. One opening releases the stool, the other 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.
• Double-Barrel Stomas can be made in either the large or small intestine. The intestine is separated and the two ends are brought through the abdominal wall and formed into two stomas. One opening releases the stool, the other opening releases mucus.

Challenging Stomas

• Prolapsed stomas are usually found in overweight patients or patients with weak abdominal muscles. These types of stomas continually protrude 1 to 4 inches 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. Use of a support belt can prevent trauma and prevent the stoma from protruding further.
• Parastomal stomas occur because of weak muscle in the abdominal wall that allows the intestine to come through the muscle, especially if the stoma is placed just outside of the rectus abdominus muscle. This can be prevented by wearing an abdominal support belt when lifting or exercising. A one-piece pouching system or a two-piece adhesive system helps adapt 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 often occurs when you contract an infection or there is too much tension on the sewn stitch. If this occurs, call your physician. A wound care product can 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 when 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 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. One-pouch systems are simpler than two-piece systems but require replacing the entire unit, including the skin barrier, every time the pouch is changed.

• Work: With the possible exception of jobs that require heavy lifting, a ileostomy should not interfere with work at all. People with ileostomies are successful business people, teachers, doctors, writers, etc.
• Sex and social life: Physically, the creation of a ileostomy shouldn’t affect sexual function. If there is an issue, it almost always relates to the removal of the rectum. In females, the position and structure of the vagina may feel slightly different. It is best to be open with your partner of how you are feeling. The ileostomy itself should not interfere with normal sexual activity or pregnancy. It does not prevent one from dating, marriage or even having children.
• Clothing: Usually, you are able to wear the same clothing as before surgery, including swimwear.
• Sports and activities: With a securely attached and properly fitted pouch, you can swim, go camping, play baseball and participate in practically any type of sport. Caution should be taken in activities with heavy body contact. Special small pouches can be used if swimming or playing sports is desired. If you spend time in a sauna or hot tub, the heat may loosen the barrier. Be sure to always check for a proper seal.
• Travel is not restricted in any way. Just remember to pack all of your ostomy 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 the adhesive the ileostomy system uses.
• Diet: Unless your doctor has prescribed you a specific diet, there should be no diet restrictions and foods can be enjoyed as before.

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

• Empty your pouch frequently. Never allow the output to reach a certain point (1/3 or ½ full) in the collection bag. A full pouch becomes heavy and may 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, fragrances and dyes.
• Make sure your skin is completely dry. Constantly check for any color changes or visible signs of irritation.
• Be sure that you have an Ileostomy System in place that fits securely and comfortably.
• For additional information contact your physician.