What is it?
An ileostomy is a surgical procedure where the surgeon makes an opening in your abdomen and brings a part of your small bowel out onto the surface of your abdomen. The opening is called a stoma.
The intestinal waste will no longer pass from your anal canal - it will come out of the stoma into a pouch or bag you stick on your abdomen.
Ileostomy can either be an End Ileostomy (end of the small bowel is brought out) or a Loop Ileostomy (a loop of the small bowel is brought out). It may be temporary and reversed later, or permanent, depending on why it's needed.
Why is it done?
An ileostomy is typically performed in cases where there's a necessity to remove or rest the large bowel (colon) following treatment or surgery.
Common reasons for requiring an ileostomy include:
Presence of growths in the large bowel, such as bowel cancer or polyps that may pose a risk of developing into cancer over time.
Inflammation (e.g., inflammatory bowel disease) or infection (e.g., abscess) in the colon.
Reduced blood supply to the colon, as seen in ischemic bowel disease.
Bowel obstruction, characterized by a blockage preventing the passage of feces and gas through the colon.
Megacolon, where a segment of the colon becomes excessively stretched and swollen, potentially leading to rupture.
Traumatic injury to the colon or abdomen.
Spinal cord injury resulting in loss of bowel control (rectal incontinence).
Hirschsprung's disease, a condition involving nerve-related blockages and infections in the colon.
Severe constipation unresponsive to treatment due to colon or pelvic floor muscle issues.
Bowel complications arising from conditions affecting the brain and spinal cord, such as multiple sclerosis.
The ileostomy might be temporary and reversed later, or permanent, depending on why it's needed.
Preparation
How to prepare for an Ileostomy:
An ileostomy is a big change physically and mentally, requiring significant adjustments. Getting used to it may take time.
Prior to the procedure, it is important to inform your doctor about any medicines that you are taking on a daily basis. Also, inform your doctor if you have any recent symptoms such as fever or cold as these may impact your recovery. It is advisable to stop smoking.
The night before the procedure, you may be administered laxatives or an enema to clear the intestines. Dietary restrictions may also be advised.
How is it done?
What happens during an ileostomy surgery
The surgery is performed under general anesthesia. An incision or a cut is placed on the right hand side of your abdominal wall. A loop or the end of your small intestine is brought out through this cut, forming a ‘stoma’. Fecal matter and intestinal waste will leave your body through the stoma and not through your anal canal. As indications vary and each surgery is unique, your surgeon will discuss with you the type of incision to be used and the further details of the procedure that best suits you.
After the surgery
After the procedure, you'll have a stoma bag attached to your abdominal wall. The stoma is soft, slippery and reddish in colour, like the inside of your mouth. The stoma does not typically hurt, but it can bleed easily when scratched or wiped. It is usually swollen after surgery and might ooze blood at first and shrinks over the next 2 to 3 months.
The fecal matter in the stoma bag is liquid or soft. But you can still become constipated or have diarrhoea. You will not be able to control when the fecal matter, any wind or bowel sounds that come out your stoma. It might happen for a few hours each day or more often and the stoma bag may need to be changed several times a day.
After the surgery, you will be required to stay in the hospital for a few days, depending on your underlying condition and recovery. During this time, you will be trained on how to use the and change your stoma bag and how to take care of your stoma.
Ileostomy Reversal
For individuals with a temporary ileostomy, it is possible to have it reversed with further surgery. Typically, reversals are performed on loop ileostomies, particularly those carried out in emergency situations.
The reversal procedure involves closing the stoma openings, allowing the bowel to be repositioned within the abdominal cavity. Following reversal surgery, bowel movements occur naturally through the anus, eliminating the need for a stoma bag.
While ileostomy reversal is generally straightforward when feasible, it does entail certain risks. Your surgeon may conduct tests to assess bowel function before proceeding with the reversal. The timing of your reversal surgery will depend on your underlying condition and recovery.
Talk to your doctor about whether a reversal is an option for you.
Complications
Possible Complications of an Ileostomy
As with any surgical procedure, complications may arise during or after the creation of an ileostomy. Your healthcare provider will discuss these risks with you prior to the operation.
1. Infection: There is a slight risk of infection developing around the site of your ileostomy. Typically, this is managed with antibiotics.
2. Dehydration: Maintaining hydration can be challenging with an ileostomy. If you experience symptoms such as fatigue, dry mouth, or sudden increase in output from your stoma, it is important to seek immediate professional help.
3. Bowel Obstruction: Reduced output or no output from your stoma may indicate a bowel obstruction. Symptoms such as cramping, nausea, or stoma swelling should prompt you to contact your healthcare professional. They may suggest measures such as dietary adjustments, abdominal massage, or warm baths. In severe cases, surgical intervention may be necessary to address a bowel rupture.
Problems with Your Stoma
Complications related to your stoma may arise, including:
Development of a parastomal hernia, resulting in swelling beneath the skin. This can be managed on a routine visit or may require surgical intervention.
Stoma retraction, where the stoma recedes into the abdominal cavity rather than protruding outward. Various types of bags and accessories can assist in addressing this issue.
Stoma prolapse, characterized by the stoma extending excessively above the skin. Different types of bags can help manage this condition.
Skin damage around the stoma – this can be helped with special products such as sprays or wipes and measuring your stoma regularly to make sure the bag fits well.
Life With An Ileostomy
It usually takes about 6 to 8 weeks to recover from an ileostomy and resume your daily activities. During this time, it is advisable to avoid strenuous activities or heavy lifting for at least 3 months, so as to allow your abdominal muscles to heal.
Resting and giving yourself time to adjust to the changes in your body are crucial aspects of the recovery process. While you may experience some fatigue after the surgery, try incorporating gentle exercises, including short walks, once you feel ready.
Diet: During the recovery phase from ileostomy surgery, a low-fiber diet is recommended. Gradually reintroducing foods into your diet allows for monitoring potential issues. Subsequently, most individuals can resume their usual diet, aiming for a balanced and healthy eating pattern.
Work: Returning to work is possible once you feel physically capable and comfortable managing your stoma. Discuss any concerns regarding job tasks involving heavy lifting or manual labor with your employer.
Body Image: It is natural to have concerns about changes in appearance post-ileostomy surgery. However, modern stoma bags are discreetly designed, allowing for confident wear with regular clothing.
Though certain lifestyle modifications may be requires, having an ileostomy should not stop you from enjoying a full and active life.
Do not hesitate to contact us regarding any queries you may have.
