Ileostomy Creation

WHAT YOU SHOULD KNOW:

Ileostomy Creation (Aftercare Instructions) Care Guide

  • An ileostomy is a stoma, created from your ileum, for bowel movements (BMs) to pass through. Your ileum is the last part of your small intestine. A stoma is a temporary or permanent opening in your ileum brought out through a skin cut. Your small intestine is a long tube that connects to your stomach at the top. The bottom of your small intestine (ileum) connects to your large intestine (colon). You digest (break down so your body can absorb it) your food in your small intestine. Your colon absorbs extra fluid and nutrients from your digested food, and turns the food into BMs.
    Anatomy of Small Intestine


  • When you have an ileostomy, your digested food does not enter your colon. Your digested food leaves your body though your stoma in the form of mushy BMs. You may need an ileostomy to allow your colon time to heal after colon surgery. Colon surgery may be done to remove a blockage, polyp (growth), infection, or cancer. After colon surgery, there is a risk your BMs will leak through the area that has been sewn together. A leak can lead to a life-threatening infection in your abdomen. You may also need an ileostomy if you have an abdominal injury or a spinal cord injury causing paralysis. Paralysis means you cannot move areas of your body.

  • An ileostomy can decrease the risk of infection after colon surgery. An ileostomy allows BMs to leave your body if you need part, or all, of your colon removed. An ileostomy may allow you to care for yourself better if you are paralyzed from the waist down. An ileostomy may allow your colon to heal after a major surgery or injury to your abdomen.

INSTRUCTIONS:

Medicines:

  • Keep a current list of your medicines: Include the amounts, and when, how, and why you take them. Take the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Throw away old medicine lists. Use vitamins, herbs, or food supplements only as directed.

  • Take your medicine as directed: Always take your medicine as directed by caregivers. Because your surgery shortens your intestines, you may not be able to fully absorb some pills. Ask your caregiver how to get your medicine in liquid and other easily absorbed forms. Call your caregiver if you think your medicines are not helping, or if you feel you are having side effects. Do not quit taking your medicines until you discuss it with your caregiver.

  • Pain medicine: You may need medicine to take away or decrease pain.

    • Learn how to take your medicine. Ask what medicine and how much you should take. Be sure you know how, when, and how often to take it.

    • Do not wait until the pain is severe before you take your medicine. Tell caregivers if your pain does not decrease.

    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling someone when you get out of bed or if you need help.

  • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

  • If your ileostomy is temporary, you may need tests before you have surgery to close it. The tests check for leaks where your colon was sewn together. Testing for colon leaks may be done about six weeks after your ileostomy surgery. If you had surgery for bowel cancer, ask your caregiver about any follow-up tests that you need. You may need tests to check if all of your cancer was removed, or if it has returned. Ask your caregiver for more information about these or other tests you may need.

Avoid swallowing air:

Smoking, chewing gum, and drinking quickly or through a straw may cause you to swallow air. Swallowing air can cause you to have gas, and lead to a bad odor coming from your stoma. If you have gas, press your hand or arm against your stoma to block the sound of escaping gas.

Diet tips:

  • Eat small amounts of foods that are high in insoluble fiber to decrease your risk for liquid BMs. Foods high in insoluble fiber include bran cereals, vegetables, and whole grain breads. Avoid prune juice and cabbage, as they may lead to large amounts of liquid BMs and dehydration. Dehydration occurs when you lose too much fluid from your body.

  • Take small bites and make sure you chew your food well. Food that has not been chewed well can block your stoma. When your stoma is blocked, your BMs will not pass through easily.

  • Sodium (salt) can help your body hold on to fluids and prevent fluid loss. Ask your caregiver how much sodium you should eat each day.

Drink liquids:

If you have many liquid BMs coming from your stoma, you may be losing too much body fluid. You may need to drink about 1 to 2 extra glasses of liquid each day. Be sure to drink enough liquids when the weather is hot. Becoming dehydrated can be dangerous. Ask your caregiver how much liquid you should drink each day.

Find an ostomy caregiver:

An ostomy caregiver is someone who can answer questions about caring for your ileostomy. An ostomy caregiver may be able to help you resolve problems, such as skin breakdown. He will know how and where to get the supplies you need, and which supplies are best. Yearly visits with an ostomy caregiver may help prevent stoma problems. Ask your caregiver how often you should see an ostomy caregiver.

Caring for your internal abdominal reservoir:

If you have an internal reservoir (pouch) attached to your stoma, ask your caregiver how to use and care for it. You may need to empty the reservoir 3 to 4 times each day. BMs may be emptied from the pouch using a thin tube. If your BMs are hard and you cannot empty them, your caregiver may have you add warm liquid. Ask your caregiver if you should make any changes to your diet. Avoid medicines containing wax, as the wax can build up in the pouch and block your stoma. Ask your caregiver if you are taking any medicines that contain wax.

Choosing the right size stoma pouch:

There are many different pouch sizes available. Ask your caregiver to help you choose the right pouch for your ileostomy. Your pouch needs to stick well to your skin so it will not leak. Make sure your pouch fits securely over the skin folds that surround your stoma. As swelling from your surgery decreases, the shape of your abdomen and stoma may change. Ask your caregiver how to make sure your pouch is the right size as your swelling decreases.

Emptying your stoma pouch:

Always empty your pouch when it is one-third to one-half full. If your pouch is too full, it may become heavy and pull on your skin. To remove the contents of your pouch, do the following:

  • Hold the end of the pouch upward and remove the clamp.

  • Form a cuff with the pouch by turning the end back on itself.

  • Pour the contents of the pouch into the toilet. The contents will splash less if you put toilet paper in the toilet first.

  • Clean the cuffed end with a tissue or wet wipe.

  • Undo the cuff and put the clamp back on.
Picture of emptying, cleaning and rinsing an ostomy bag

Stoma and skin care:

Skin care is very important when you have an ileostomy stoma. Drainage (BM) from an ileostomy is filled with enzymes (proteins) that break down the food you eat. The enzymes can also break down your skin. Pectin-based pastes will help prevent skin breakdown. Ask your caregiver where you can get pectin-based pastes. The following can be done to make a paste and protect your skin when changing your pouch:

  • Clean the skin around your stoma with water and dry your skin completely.

  • Sprinkle pectin powder on the skin around your stoma, and dust off the extra powder.

  • Use a wet finger or a plasticizing wipe to moisten the powder. Ask your caregiver where you can get plasticizing wipes.

  • If your skin is moist and damaged, repeat the layers of paste to form a crust.

Changing your stoma pouch:

  • Ask your caregiver how often you should change your ileostomy pouch.

  • Gently clean the skin around your stoma with warm water and pat your skin dry. If your skin is wet, the pouch may not stick well, and it may damage your skin. If you use soap to clean around your stoma, do not use soaps with oil in them. Make sure you rinse the soap off completely.

  • Size the opening of your pouch as needed. The opening must form a complete seal over your skin. The opening must be small enough so that extra skin is not exposed to stoma drainage. For above-the-skin stomas, the pouch opening should be one-fourth inch larger than your stoma. For stomas at or below skin level, the opening should be one-half inch larger than the stoma. Ask your caregiver what size opening is best for your stoma.

  • Remove the paper and plastic backing so you can see the barrier and tape surfaces.

  • Put on your skin protection products as directed by your caregiver. Use plasticizing wipes if you have sensitive skin. When putting paste around your stoma, make sure the paste is flat, so the seal remains tight.

  • Use paste, rings, and barrier strips to fill in any gaps and to create a flat surface.

  • Center your pouch around your stoma, and press it down on your skin into place. Hold the pouch down for 10-15 minutes to help the pouch remain firmly in place. If a two-piece pouch system is used, check that the pouch is secured well to the skin attachment.

  • Close the opening of the pouch and dispose of your old pouch as directed by your caregiver.
Picture of how to measure and apply an ostomy bag

Going out with an ileostomy:

When you leave your home, be sure to bring extra supplies with you in case your bag leaks. Supplies may include extra pouches, skin protection products, and a change of clothing.

Stoma care during cancer treatment:

If you have colon cancer and need radiation and chemotherapy treatment, the treatments may damage your stoma. Ask your caregiver how to care for your stoma when you receive these treatments. If you are receiving radiation, you may also become constipated (hard, dry BMs). Ask your caregiver what to do if you become constipated.

CONTACT A CAREGIVER IF:

  • The skin around your stoma is red, sore, itchy, or has a rash.

  • You are drinking less fluid due to illness.

  • You feel very full or bloated. You may have cramping pain in your abdomen.

  • You have a fever.

  • You have an internal reservoir and you cannot remove the BM, but BM is leaking out.

  • You have chest pain or trouble breathing that is getting worse over time.

  • You have more BM draining from your stoma than is normal for you. Your BM may also be very watery or bad smelling.

  • You have nausea (upset stomach) or vomiting (throwing up).

  • Your stoma opening narrows, your stoma comes out too far, your stoma sinks inside your abdomen.

  • You have questions or concerns about your surgery, medicine, or care.

SEEK CARE IMMEDIATELY IF:

  • No BMs are passing through your stoma.

  • You are urinating very little or not at all.

  • You feel very full and you cannot burp or vomit, but BMs come through your stoma with force.

  • You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.

  • You have pus or a foul-smelling odor coming from your surgery wound or stoma.

  • You suddenly feel lightheaded and have trouble breathing.

  • You vomit blood or have blood in your BMs. Your BMs may look black and tarry.

  • Your abdomen becomes hard and tender (painful to touch). Your stoma may turn from pink to gray or black, and your skin may be blistered.

  • Your arm or leg feels warm, tender, and painful. It may look swollen and red.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of the Blausen Databases or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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