- Introduction
Your specialist care team, which includes the surgeon, the stoma care nurse and many other healthcare professionals is there to
help you, your family and carers before and after the operation, in hospital and when you go home.
The aim of this article is to help explain some of the issues concerned with having an ileostomy - but inevitably there will be
some issues that it does not address or you would like more information about. The members of your specialist care team will
be able to give you the help that you need.
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- Before your operation
To help you understand what is involved in your operation, we should first look at the
digestive system and how it works.
When you eat, food passes down the oesophagus to the stomach where the digestive
juices begin to liquidise it before it is passed to the small bowel (or ileum). Here, more
digestive juices are secreted so that your body can begin absorbing the nutrients it needs.
The remaining food then passes through to the large bowel (or colon), where water is
reabsorbed, leaving the solid waste matter (or faeces). This is then passed through to the
rectum, where, with the aid of the sphincter muscles, it leaves the body through the anus
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- What is an ileostomy?
During the operation part of the ileum is brought to the surface of the abdomen to form the stoma,
usually on the right hand side. This is where the faeces will now pass from the body. The stoma is
moist, pinky red in colour, and may protrude about an inch from the abdomen
Despite being red, there is very little sensation in the stoma and it is not painful. Unlike your back
passage, there is no sphincter muscle around the stoma, therefore you will have no control over your
bowels and you will need to wear a bag (or puch) to collect the faeces. The colon is responsible for
absorbing water, and, as part of it has been removed, you will find that the output from the stoma is
rather liquid.
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- The operation
An ileostomy may be performed for a number of reasons and your surgeon or stoma care nurse will explain the type of surgery
you will be having.
Three of the more common procedures are shown below:
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- How can your stoma care nurse help?
The stoma care nurse is a qualified nurse with special additional training in all apsects of stoma care who will be able to help
you and your family before, during and after the operation. The stoma care nurse, with the help of many other healthcare
professionals, will provide you with as much help as you need, for as long as you need it - not only when you are in hospital
but also when you have gone home.
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- Just after your operation
An ileostomy is a major operation so it's not surprising that you will feel weak afterwards. However, with the appropriate use
of modern pain-killers you should not expect to experience any more than a mild level of discomfort.
When you wake up after the operation you will be wearing your first bag. This will probably be a clear one so that your nurses
will be able to check on your new stoma easily.
You will also find that you will have drips in your arm, a tube up your nose and a drain in your abdomen - but don't be alarmed
as these are all perfectly routine. For the first few days you will be fed with fluids only and gradually these will be increased and
light foods added until you will be eating normally.
Your stoma will begin to work very shortly after the operation and the output will be a watery liquid. The consistency of the
output will thicken slightly as you resume a more balanced diet. It is also likely that a certain amount of wind (or flatus) will
come from the stoma - again this is perfectly normal.
Your stoma care nurse is there to help you always, but particularly in these early days, so please ask about anything that may
be bothering you - you can be sure that your concerns will have been raised before. Please ask any questions about looking
after your stoma and changing your bag.
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- Learning to care for yourself...and your stoma
Your stoma care nurse will help to teach you to look after your stoma and change your bag - but really it is quite simple when
you get used to it.
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- Looking after your stoma
One of the most important things to remember is to take good care of the skin around the stoma. If the bag does not fit as
snugly around the stoma as it should then the skin becomes exposed to the harmful effects of the faeces. Leakage, as well as
the too frequent removal of the bag and the use of harsh skin cleansers, can also cause some irritation to the skin. Over
enthusiastic cleaning can lead to some slight bleeding from around the stoma, but this is not a cause for alarm. However, if
bleeding comes from inside the stoma you should see your doctor urgently. The use of soft cleaning wipes will help to avoid
this sort of surface bleeding. You may be able to obtain these wipes from your local pharmacy.
Even though the rectum has been removed it is not uncommon for patients to experience the desire to defaecate. This is normal
and should ease with time. If the back passage is still present there may be some mucus discharge from it. Again this is normal.
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- Changing the bag
It is a good idea to begin to establish a routine for changing the bag. As you get used to your stoma you will find that at certain
times of the day it is more active that others. Don't choose this time to change the bag but select a time when it is relatively
inactive - perhaps first thing in the morning. Before starting to chage the bag make sure you have everything to hand that you
will need to complete the process. Just like everything else in life, a little bit of forward planning can help a lot. Here is a simple
guide to the changin routine:
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- Equipment needed
- Check you have everything you need:- toilet tissue, soft wipes, warm water, a new bag and a plastic disposal bag.
- Remove the clip at the bottom of the bag and drain the contents of the bag into the toilet before removing it. To do this
you can sit well back on the toilet seat, although some people find it easier to kneel or bend over the toilet.
- Now remove the bag, working slowly and gently from the top to the bottom.
- Wash the stoma and surrounding skin with the warm water and tissues.
- Use the soft wipes to dry the area. Don't use harsh solvents, soaps or disinfectants.
- Fit the new bag, making sure that it is secure all the way around.
Periodically, when changin you bag, check the size of the stoma with the guide provided with your bags to make sure that you
are still using the correct size.
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- Disposal of used bags
Once it has been emptied and removed, the bag should be sealed inside a plastic bag and put in the dustbin. Don't try to flush it
down the toilet as it will cause a blockage.
Some local authorities provide a collection service for used bags. Your stoma care nurse will be able to tell you more about
this.
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- What sort of bag should I choose?
With an ileostomy you will need to use a drainable bag. There are a number of different bags available and your stoma care
nurse will be able to help you choose the most appropriate sort for you. For example you may wish to move away from the
clear bag fitted immediately after your operation to an opaque version.
There are two main sorts of bag, and they are known as the One Piece and Two Piece Systems.
A One Piece System comprises one simple unit which is made up of the collection bag and the adhesive ring which firmly
attaches the bag around your stoma. A Two Piece System has the collection bag separate from the adhesive ring and the two
halves are securely clipped together. This means that you do not have to remove the advesive ring from around the stoma
every time you change the bag.
Whichever sort you choose, they will be kind to your skin, lightweight, leakproof and odourproof which means that they willbe
virtually undetectable to anyone else, so you can carry on with your life as normal. bags are available in a variety of sizes to suit
your specific needs.
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- Going home
When you go home there is no reason why, with time, you will not be able to resume the life you were leading before the
operation. here is some specific advice that you may find helpful.
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- Obtaining supplies
On leaving hospital your stoma care nurse will provide you with enough bags and other necessary bits and pieces to keep you
going until your own supply is sorted out. You may also be given a car, listing all the things you will need, which you should
take to your doctor. Your doctor will write a prescription which you should take to your local chemist or specialist supplier
who will provide the products for you - you won't have to pay a prescription charge. Ask for form P11 at your local Post
Office or doctor's surgery.
Be careful not the store your bags in direct sunlight or near heat, as this can make them deteriorate.
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- Diet
Just like everyone else, you should eat a well balanced diet, and this can include all your favourite foods. You will find that
certain foods produce more wind than others (just like everyoe else) and if this bothers you then simply cut down on these
foods. Alcohol is fine in moderation, but beer and lager can produce wind and cause the output from the stoma to become
more liquid. With a little experimentation you will soon find a balanced diet that's right for you.
It is particularly important for someone with an ileostomy to remember to chew their food properly in order to give a good
start to the digestive process. foods such as peanuts, which are notoriously difficult to digest should be avoided, or at least
eaten in moderation and thoroughly chewed.
As the output from an ileostomy is of a liquid nature it is obvious that the body has not been able to reabsorb as much water as
usual, so you should make sure that you drink plenty of fluids and take enough salt in your diet to avoid becomming
dehydrated.
Just like everyone else you can pick up a stomach bug which can give you diarrhoea. If this happens, treat the condition
exactly the same way as before, but remember to take plenty of fluids - you might like to try one of the widely available 'enery
drinks'.
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- Travel
There is no reason why having an ileostomy should restrict your ability to travel in any significant way - whther in the UK or
abroad, for business of pleasure. Just remember to pack all the things you will need for your journey and to make sure that you
have enough supplies for the furation of your time away.
It is also a good idea, when travelling, to ensure that you have a couple of changes in your hand luggage. This ensures that you
can change your bag should an 'accident' occur.
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- Exercise
Exercise is good for everyone and just because you have had an ileostomy you are no exception. It is very likely that any
exercise you enjoyed before the operation will also be suitable for continuation afterwards. Special small bags are available for
use when swimming and playing sport so ther is no reason to feel excluded from participating. Obviously you will need to start
with gentle exercise at first but you will soon feel able to do just as much, if not more, than before.
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- What about sex?
Sexuality and sexual activity are important aspects of every person's life. A person is not any less masculine or feminine
because he or she has an ostomy. Ileostomy surgery may have altered some aspects of your body, but it has not altered you as
a person. Many people find that they feel so much better after the surgery, that they now feel well enough to enjoy a sexual
relationship. Many women have become pregnant following ostomy surgery and the ostomy has not interfered with the
pregnancy.
It usually takes three months to regain your strength and physical sense of well-being following ostomy surgery. During this time
you may want to hug, cuddle and kiss other people. You need only be careful of your abdomen where the operation was
done. You will know what is comfortable for you.
After you have recovered from your operation, you will begin to experience the same sexual feelings and desires you felt
before you became ill. Usually you can return to your previous sexual activities with a few minor adjustments. It is important
that you empty and clean your appliance prior to sexual relations. If your appliance is due to be changed, it is best that you do
this before physical activity. This prevents accidents. A plastic or rubber undersheet on the mattress may lessen your worries
about leakages. You may wish to camouflage the appliance with a cover or wear a small cummerbund to secure it. It is helpful
if you discuss things with your partner. Experiment to find what you feel comfortable with in your relationship. Each couple will
find what works best for them.
For individuals who have extensive surgery, there may be some alteration in sexual functioning and the sexual feelings
experienced. Ask your doctor or nurse to discuss this with you.
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- Continuing care
The objective of having an ileostomy is to get you back to enjoying life and that means that you are at home, or at work, or on
holiday - not in hospital - and not 'ill'. But this does not mean that your specialist care team has washed its hands of you once
you walk out o the hospitals gates - quite the opposite. Your stoma care nurse, and colleagues, are always on hand to help you
with any problems or questions that you might have.
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