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What is a Ileostomy?

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.

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Types of Ileostomies

An ileoanal reservoir (J-Pouch) is a 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 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 where a reservoir pouch is created inside the abdomen with a portion of the end of the ileum. 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 discussed 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 procedure. 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.

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Reasons for a Ileostomy

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
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Ileostomy Stomas

Stomas are typically round, but aren't perfectly round in shape, and can vary greatly in size. Stomas vary in color and are generally shades of red and pink, and are fleshy and moist. 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 your body's process 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 frequency of the output of the stoma is affected by food and liquid intake. Medications and treatment prescribed by your doctor may 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, regardless of whether the abdomen is fleshy or flat. Protrusions can vary in length and can slightly retract or extend throughout the life of the ileostomy.
  • Flush stomas are flush with the surface of the skin. The best way to deal with a flush stoma is to use a wafer system that has convexity, which will help the stoma stand out more against the skin in order to achieve a better seal.
  • Rather than protruding, retracting stomas are pulled inward from the skin's surface. Retracting stomas require a wafer system with high convexity, which helps the stoma to stand out more against the skin, creating a better seal and reducing irritation.
  • End stomas are created by dividing either the large or small intestine and bringing the closest end through the abdominal wall.
  • Loop stomas can also be created in either the large or small intestine by bringing a loop of intestine to the abdominal wall. The portion above the skin's surface is made into two stomas - one opening releases the stool, while the other releases mucus. Occasionally, a rod will be placed underneath the loop of the intestine to support the stoma on the skin's surface. This rod should only be removed under the guidance of a physician.
  • Like End and Loop stomas, 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 separate stomas. One stoma releases the stool while the other releases mucus.

Challenging Stomas

  • Prolapsed stomas are typically found in patients who are overweight or have weak abdominal muscles. Prolapsed stomas continually protrude one to four inches as time goes on. The treatment for a prolapsed stoma is to use a flat and flexible pouching system, which prevents trauma to the stoma when pouching. Additionally, the use of a support belt can prevent trauma and prevent the stoma from protruding further.
  • Parastomal stomas are caused by weak muscles in the abdominal wall, which allows the intestine to come through the muscle, particularly 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. Also, 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 becomes separated. This often occurs when the patient contracts an infection or there is too much tension on the sewn stitch. If Mucocutaneous Separation occurs, call your physician. A wound care product can also 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 immediately if you suspect Stomal Necrosis. The stoma will slough off and an ileostomy deodorizer will be used during the process.
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Ileostomy System Products
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 each use.

  • Two-Pouch Systems allow the patient to change pouches while leaving the barrier/wafer attached to the skin. This wafer/barrier is part of a "flange" unit. The pouches in this pouching system include a closing ring that attaches mechanically to a mating piece on the flange. A common connection mechanism in the two-pouch system consists of a pressure fit snap ring, similar to that found in Tupperware™.
  • One-Pouch Systems comprise 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 wafer/barrier, each time the pouch is changed.
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Life after a Ileostomy
  • Work: With the possible exception of jobs that require heavy lifting, having an ileostomy should not interfere with work or one's professional life at all. People with ileostomies hold careers in countless different fields.
  • Sex and social life: Physically, an ileostomy should in no way affect sexual function. If there is an issue, it almost always tends to relate to the removal of the rectum. In females, the position and structure of the vagina may feel slightly different. The ileostomy itself should not interfere with normal sexual activity or pregnancy, and does not prevent one from dating, marriage, or even having a family.
  • Clothing: Typically, ileostomates are able to wear the same clothing as they did before surgery, including swimwear.
  • Sports and activities: With a pouch that is securely attached and properly fitted, you can swim, go camping, and participate in practically any type of sport. However, caution should be taken when participating in activities that involve heavy body contact. If desired, special small pouches can be used when swimming or playing sports. And be sure to check for a proper seal when spending time in a sauna or hot tub as the heat may loosen the barrier.
  • Travel is not restricted for ileostomates in any way. Just remember to pack all of your ostomy supplies for the trip and keep them where you can easily reach them.
  • Bathing and showering may be done with or without the pouching system in place. If you shower/bathe with your pouch off, be sure to choose a soap that is free of oils and residues as they can affect the adhesive the ileostomy system uses.
  • Diet: Unless your doctor has prescribed a specific diet, there should be no diet restrictions and you can enjoy your favorite foods as you did before.

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Learning How to Care for Your Ileostomy

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

  • Empty your pouch frequently and never allow the output to reach a certain point (one-third to half full) in the collection bag. A full pouch is heavy, may break loose from the skin, and is also more difficult to drain.
  • Replace your pouching system at least three times every week. For children and infants, the pouching system will need to be changed more frequently.
  • Try to change your pouch in the morning before your ileostomy becomes too active.
  • Make sure to care for your skin by using a clean washcloth or wipe, and avoid soaps with oils, fragrances, or dyes.
  • Ensure that the skin around the stoma is completely dry and be sure to constantly check for any stomal color changes or visible signs of irritation.
  • Be sure that you have an Ileostomy System in place that fits securely and comfortably.
  • If you have any questions about your ileostomy, or would like additional information, contact your physician.

Liberator Medical is committed to providing you with the highest-quality ileostomy supplies and exceptional support to help you care for your ileostomy. We conveniently offer a wide selection of the top ileostomy supplies and fast, discreet delivery to your door to ensure your complete privacy. We know that adjusting to life with an ileostomy can be difficult, but living with one doesn't have to be.

Contact Liberator Medical at 1-866-642-6140 with your questions, or simply to speak with one of our representatives today.

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