A surgeon will usually create an ileostomy after removing some or all of the colon and rectum.
A person with an ileostomy wears an external pouch appliance that collects stool. Caring for the ileostomy requires education and support to maintain skin integrity and overall health.
In this article, we explain the situations in which a doctor will recommend an ileostomy. We also describe the surgical procedure, including preparation and recovery, and the lifestyle adjustments that people will need to make afterward.
What is an ileostomy?
People with an ileostomy will wear an external pouch that collects stool.
An ileostomy is a way to let stool exit the body when the intestines are too damaged, inflamed, or injured for stool to come out of the rectum.
There are different types of ostomy. An ileostomy gets its name from the ileum, which is the end of the small intestine. A surgeon brings this through the opening in the abdominal wall so that stool from the intestine can leave the body.
For a colostomy, the surgeon will connect a portion of the large intestine, the colon, to an opening in the abdominal wall.
The colon is further down the digestive tract than the ileum. As a result, food is more digested by the time it reaches the colon. In a person with a colostomy, the stool will be soft to firm. In a person with an ileostomy, the stool will be more loose and watery.
An ileostomy pouch usually rests on the right side of the lower abdomen. Depending on the type of colostomy, the pouch may be either on the right or left side or in the center of the abdomen.
An ileostomy may sometimes be a temporary solution to give the bowel time to heal. However, if severe disease or damage has affected the colon or rectum, a doctor will recommend removing the damaged portions and creating a permanent ileostomy.
A person may need an ileostomy if they have:
- Crohn's disease
- familial adenomatous polyposis (FAP), an inherited condition in which polyps form in the large intestine
- ulcerative colitis, a long-term condition in which the colon and rectum become inflamed and may develop ulcers
When a person has an ileostomy, they wear a pouch that collects stool. The pouch may have one or two components.
A one-piece pouch has a sticky back that adheres around the stoma. The stoma is the end of the ileum that connects to the surface of the skin.
A two-piece pouch system includes a sticky ring that fits around the stoma. A person connects a pouch to the ring.
A person with an ileostomy must wear a pouch or another device to collect stool at all times. The small intestine continuously moves stool through the body. It does not have the same hold-and-release function as the rectum.
How to prepare
A person will meet with a surgeon before the procedure to discuss life after surgery.
Having an ileostomy will be a significant change in a person's life. A person may experience fewer symptoms associated with bowel damage, but an ileostomy requires regular care.
It is essential to prepare for the changes to physical and mental health that can result from an ostomy. A doctor is likely to mention the following considerations among others:
- physical activity
- sexual health
Before surgery, a person will usually meet with the surgeon and an ostomy nurse. The ostomy nurse, or enterostomal therapist, will present different pouch options and advise on preparing for life after surgery. They can also help a person order supplies.
If a surgeon needs to perform an ileostomy as part of an emergency procedure, the individual should receive education during recovery.
Doctors will usually ask a person not to eat or drink for a period before surgery to ensure that the bowels are empty of stool.
Before the procedure begins, the surgeon and ostomy nurse will mark the location for the stoma.
The individual will receive general anesthesia and be unconscious throughout the procedure.
The surgeon will make an incision in the abdomen and identify the main areas of the bowel, including the colon, rectum, and ileum. They will then make an incision in the ileum and attach it to an opening in the abdominal wall.
The surgeon will sew around the ileum so that it stays attached to the opening.
Depending on the person's condition, the surgeon may then remove the colon. Alternatively, they will sew the colon in such a way that it can rest and heal before they reattach it to the ileum in a later procedure.
Following surgery, the individual will typically stay in the hospital for several days. They will receive pain medication and instructions about diet and caring for the ileostomy.
Doctors and nurses also check patients carefully for postoperative complications, such as infection, bleeding, and intestinal blockage.
Even with lots of counseling before surgery, there are always challenges to navigate and questions to ask. There is no single best way to manage an ileostomy. Over time, a person has to learn what works best for them.
Immediately after surgery, the skin around the stoma may be itchy, red, or generally uncomfortable.
In the first month or two following surgery, a person is likely to have strong gas.
People with an ileostomy should seek immediate medical attention if they notice sudden, significant changes in the stoma's color or shape. For example, if the opening appears blue or dark, this can indicate that the skin is not getting enough oxygen.
A person should also seek urgent medical care if they experience one or more of the following signs and symptoms:
- excessive bleeding from the stoma
- no output of stool for 4–6 hours
- severe diarrhea
These signs and symptoms indicate complications of surgery, and a doctor will need to treat them immediately.
A person should drink plenty of water throughout the day to minimize diet-related ostomy complications.
Having an ileostomy can change many of a person's habits, from their dietary choices to how they bathe. It is important to use doctors and ostomy nurses as a source of information.
Nutrition is an important consideration after surgery. Initially, a doctor usually recommends a low-fiber diet to give the bowel time to heal.
A person can usually minimize diet-related ostomy complications by:
- drinking plenty of water throughout the day
- limiting the consumption of potentially dehydrating beverages, such as those that contain alcohol or caffeine
- restricting foods that cause gas, such as cabbage and broccoli
- avoiding chewing gum, which can also cause gas
- chewing food thoroughly
- introducing new foods one at a time
- eating small meals at regular intervals
It is vital that people with an ileostomy discuss any diet-related challenges with a dietitian or doctor.
Adjusting to an ileostomy can be difficult, and support groups exist for people with ostomies. The United Ostomy Association of America, for example, has compiled a searchable database of online and in-person support groups.
Talking openly about fears, concerns, and challenges relating to an ileostomy can help a person manage and overcome them.
An ileostomy can be life-saving. It is a surgical intervention that allows stool to exit the body without passing through damaged portions of the bowel.
Caring for an ileostomy can represent a significant lifestyle change. It can take weeks, months, or even longer for a person to adjust to their ostomy appliance.
Counseling before and after surgery can help. Doctors, ostomy nurses, and support groups can provide information and assistance.