A B C D E F G H I J K L M N O P R S T U V W

ILEOSTOMY - COLOSTOMY

What is an Ileostomy ?

Ileostomies and colostomies are artificial openings of the intestine onto the abdominal wall. They allow the bowel motions to be diverted into a bag which is changed when full.

Why is an Ileostomy performed ?

An ileostomy is an opening (or stoma) of the small bowel onto the abdomen so that the motions then empty into an attached bag. It is performed when all the large bowel has to be removed. This is usually necessary when an inflammatory disease (such as ulcerative colitis or Crohn's disease) seriously damages the large bowel. It is occasionally performed when there is more than one cancerous growth in the large bowel. When it is performed for inflammatory bowel disease, ileostomy may be permanent. On occasion, it may be used in the emergency situation when most of the large bowel is removed but enough is left to allow reconnection of the intestine at a later date. A colostomy is an opening (or stoma) of the colon or large bowel onto the abdominal wall so that the motions then empty into an attached bag. A colostomy may be permanent or temporary. It is permanent in certain situations with cancerous growths of the rectum. This is because removal of the cancer may mean that there is insufficient rectum (or back passage) left to be joined to the bowel. Temporary colostomies are used as a safety valve to divert the motions away from a newly joined part of the intestine. This gives the new join time to heal. It may also be used in the emergency situation where there may be a blockage of the bowel.

Preparations needed for an Ileostomy

You will often be introduced to a stoma sister (if available). The stoma sister has experience in teaching patients how to look after either ileostomies or colostomies and choosing the most suitable appliance. The patient will be admitted to hospital 24 48 hours before the operation to allow the bowel to be prepared. This may mean that laxatives and enemas are needed to empty the bowel completely. Usually solid food is withheld for 48 hours prior to operation and only liquids allowed. Twenty-four hours before operation, only clear fluids (water, flavoured drinks, or tea and coffee without milk) are allowed.

What Happens during an Ileostomy

The operation is always performed under general anaesthetic. The abdomen will be opened by a cut in the middle. The diseased portion of intestine will be removed, and the ileostomy or colostomy opening placed at a site that will have been decided before the operation after discussion with the stoma sister. The site is tailored to the individual patient to allow for ease of management and the wearing of normal clothes. The following tubes may be inserted for use during and after the operation. An intravenous drip will allow the administration of fluids, drugs, antibiotics or blood, as required during and following surgery. The drips are used until the intake of fluids and food can be recommenced. A tube may be passed through the nose into the stomach to prevent the accumulation of juices within the stomach. This is left in place until there is clear evidence that normal emptying of the stomach has returned. An abdominal drain tube may be placed within the abdominal cavity to drain blood or fluids to prevent accumulation. This will be removed between 2 and 7 days after surgery. A urinary catheter tube may be introduced into the bladder to prevent the need to pass urine immediately after the operation. Small amounts of fluid by mouth may be started immediately after the operation. Larger quantities are withheld until the ileostomy or colostomy has begun to work. This may take between 3 and 7 days. The day following the operation the patient will sit out of bed and physiotherapy will be given to prevent chest infection. Painkillers by injection may be needed for the first 48 hours. The stoma sister will visit you after the operation to check that the stoma is satisfactory and to teach the patient about its management. Most patients learn to manage their ileostomy or colostomy themselves during their hospital stay of 10 14 days.

Possible Complications during an Ileostomy

The complications are those of any major abdominal operation: infections of the chest, wound, urine, and thrombosis (blood clots) in the veins of the leg. When the rectum has to be removed, the surgeon will do his best to avoid damaging the nerves affecting the sexual organs. However, a man may not find it possible to achieve or maintain an erection. Similarly, a woman may find the vagina is scarred or narrowed, and this may cause pain and difficulty during intercourse. The stoma sister or your surgeon may be able to offer helpful suggestions, and give you more information if this should occur.

After an Ileostomy

Your stoma will be cared for by the stoma or ward sister, but as you recover from your operation, you will be taught to look after your stoma and change the appliance yourself. You will soon become confident to take over your own care. The stoma sister may visit your home within the first few days and she will always be available to be contacted via the hospital, should problems arise. Many people who have these operations return to their normal work after a period of convalescence which takes 1 2 months following discharge from hospital. Return to strenuous manual labour may require a longer period. Bathing or swimming can be undertaken as normal. Usually no special diet is required following surgery, although occasionally certain foods may cause your stoma to work excessively. Before leaving hospital, you will be given a supply of your appliances and your GP will be informed so that further appliances can be ordered as necessary. Your confidence will grow with the passage of time and your surgeon, stoma sister or ward sister will always be available to answer your queries.

If an Ileostomy is not performed

This depends on the reason for surgery. The surgery will have been recommended to prevent worsening of the inflammatory bowel disease or for the prevention of progression of a growth afterwards.

Effects on Family of an Ileostomy

In the early days after the operation, you will be attached to various tubes. It is sensible to warn your family so that they do not become alarmed. If your friends and family wish to bring you food or drink, it is sensible to check with the ward sister that they are suitable. All steps will be taken to reassure you and your family that you will be able to return to a full and active life.