An ileostomy is similar in many ways to a colostomy only instead of a section of the colon being brought out to the surface of the belly to form a stoma, the lower end of the small intestines is used. This is done usually when a colectomy has to be performed to remove the entire colon and or the rectum. This may be needed in instances of advanced colorectal cancer, inflammatory bowel disease or severe diverticulitis for example. Many of the same adjustments and potential hardships may be faced by patients of both type of surgical procedures and often advice for a colostomy patient may seem quite similar to that of a patient that has undergone an ileostomy.
Even though there are similarities, there are also a few differences worth noting including the consistency and the make up of waste material that exits the stoma. There are also different types of ileostomies that are quite different than colostomies that may not even require the use of a stoma or an external pouching system.
Types of Ileostomy
There are three basic types of ileostomies that are usually performed each with different end results of how waste material will be managed. Some do not require the use of an external pouching system.
- Standard Ileostomy – This is probably the most popular type of the procedure. Most similar to a colostomy, the very end of the small intestine (the ileum) is brought out to the surface of the abdomen and is surgically attached creating a stoma. Fecal material is very loose and watery and may contain digestive enzymes from the small intestine. Particular care must be observed to keep the skin around the stoma protected as contact with these enzymes and waste material can cause skin irritation and possible infection. A standard pouching system is used to collect material expelled from the stoma.
- Continent Ileostomy (K-pouch) – This type of procedure creates a pouch and a nipple valve made from part of the ileum itself. This is attached to the outside skin of the belly. Waste is stored inside this pouch and the valve prevents material from leaking out. A small thin catheter tube is used to drain waste material out of the internal pouch. Potential for rips and tears caused by repeated inserting of these catheters has caused this type of procedure to be used less often.
- Ileo-anal resevoir (J-pouch, S-pouch) – This variety of ostomy procedure creates a pouch out of a portion of the ileum and connects it to the rectum. Waste material is stored in this internal pouch and can be expelled from the body through the anus much like normal bowel movements. This type of surgery, obviously, requires that the anus and sphincter muscle not be removed and be in place. No pouching system or catheters are needed. When the patient feels the urge to go they can use the toilet and pass stool from the anus as usual.
Which type of ileostomy that is carried out by the surgeon is based on the condition and health of the colon, rectum and anus and your doctor should lay out in detail what is to be expected and walk you through step by step. The ostomy nurse should also explain and teach the patient how to properly care for their ileostomy to prevent any problems.
There are some common complications that might be encountered by those that have undergone this type of operation.
Skin Irritation: Standard ileostomy patients need to be careful when it comes to the skin around the stoma. Because of the type of waste material that is expelled, watery stool that may contain digestive enzymes, proper protection around the stoma site should be maintained to avoid skin irritation. Having a good seal around your stoma is imperative. Any large areas of redness, swelling, skin bumps or irritation should be conveyed to your doctor or nurse right away.
Short Bowel Syndrome: This happens when a large enough section of the small intestine is removed to prevent proper absorbtion of nutrients from food. Careful medical attention is needed in these cases to monitor diet and nutrient intake.
Dehydration: Patients with ileostomies need to ensure that they consume plenty of water and fluids to avoid dehydration. The colon and small intestine normally absorb water, but with parts or all of these organs removed or not in use, water absorbtion becomes harder.
Intestinal Blockage: Hard to digest foods such as nuts and certain vegetables, such as corn, are usually recommended to be avoided to prevent any sort of blockage in the intestines from occuring. A stoma that is unusually inactive for a period of 4 to 6 hours should be a cause for concern and your doctor or nurse should be notified right away.
Living with a Ileostomy
In many ways, coping with and living with an ileostomy is similar to that of a colostomy. It is a huge adjustment at first, but overtime it tends to get a lot easier. Patients of both procedures are able to live very productive and enjoyable lives. Once fully recovered from their surgery, patients are able to travel, swim, golf, work and partake in other activities that they enjoyed before their procedure. Of course, consulting your doctor or ostomy nurse before starting up physical activities is recommended.
A lot of the care regarding the stoma, if applicable, and ostomy supplies is often the same. The advice and experience of the ostomy nurse often times will help easy the worry and guide patients through any of the obstacles they might run into regarding their surgery or how to care for their ileostomy afterwards. As always, doctor’s or nurse’s instructions should be followed as closely as possible when dealing with colostomy or ileostomy care to decrease the chances of injury, complications or setbacks.