Ileostomy: Causes, Symptoms, Diagnosis, Treatment, and Prevention
An ileostomy is a surgical procedure that creates an opening or stoma in the abdomen to divert the end of the small intestine (ileum) outside the body. Stomas are typically located in the lower right side of the abdomen and covered with pouches or bags that collect waste. The colon (large intestine) or rectum is usually damaged or diseased and unable to function properly, which leads to an ileostomy.
Causes
An ileostomy may be needed for various reasons, such as:
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Inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis, that causes inflammation, ulcers, bleeding, or obstruction in the colon or rectum
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Colon or rectal cancer that requires the removal of part or all of the colon or rectum
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Familial adenomatous polyposis (FAP) or Lynch syndrome, which are inherited conditions that increase the risk of developing colon or rectal cancer
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Diverticulitis, which is an infection or inflammation of small pouches (diverticula) that form in the colon
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Trauma or injury to the colon or rectum
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Birth defects or congenital anomalies that affect the development of the colon or rectum
Depending on the condition and extent of surgery, ileostomies can be temporary or permanent. Temporary ileostomies are often performed after surgery or treatment to allow the colon or rectum to heal, and can be reversed at any time. A permanent ileostomy is done when the entire colon or rectum is removed or cannot be reconnected.
Symptoms
An ileostomy can cause some changes and challenges in the daily life of the patient, such as:
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Having to empty and change the pouch or bag several times a day
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Having to monitor the stoma for signs of infection, irritation, or blockage
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Having to adjust the diet and fluid intake to prevent dehydration, malnutrition, or diarrhea
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Having to deal with odor, noise, or leakage from the pouch or bag
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Having to cope with the emotional and social impact of having an ileostomy
Some common complications or problems that may occur after an ileostomy include:
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Skin irritation or infection around the stoma
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Stoma prolapse or retraction, which is when the stoma sticks out or sinks in too much
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Stoma stenosis or narrowing, which is when the stoma becomes too small or tight
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Parastomal hernia, which is when a part of the intestine bulges through the abdominal wall near the stoma
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Dehydration or electrolyte imbalance, which is when the body loses too much water or minerals
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Bowel obstruction or blockage, which is when the ileum becomes twisted or kinked
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Bleeding or ulceration of the ileum or stoma
Diagnosis
An ileostomy is usually planned and discussed with the patient before the surgery. The patient may undergo some tests and examinations to prepare for the surgery, such as:
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Blood tests to check the blood count, clotting, and electrolytes
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Urine tests to check the kidney function and infection
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Stool tests to check the presence of blood, bacteria, or parasites
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Colonoscopy or sigmoidoscopy to examine the inside of the colon or rectum
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Barium enema or CT scan to obtain images of the colon or rectum
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Abdominal X-ray or ultrasound to obtain images of the abdomen and other organs
The patient may also meet with a stoma nurse or therapist to learn about the care and management of the ileostomy, and to mark the best location for the stoma on the abdomen.
Treatment
The treatment of an ileostomy involves surgery to create the stoma and the postoperative care and follow-up. Depending on the surgeon's preference and expertise, the surgery can be performed openly or laparoscopically. It usually takes two to four hours, and general anesthesia is necessary. The patient may need to stay in the hospital for up to seven days after surgery.
The postoperative care and follow-up include:
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Taking pain relief and antibiotics as prescribed by the doctor
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Keeping the stoma and the surrounding skin clean and dry
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Using the appropriate pouch or bag system and accessories as recommended by the stoma nurse or therapist
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Emptying and changing the pouch or bag as needed, usually 4 to 6 times a day
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Eating a balanced and nutritious diet and drinking enough fluids to prevent dehydration, malnutrition, or diarrhea
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Avoiding foods that may cause gas, odor, or blockage, such as beans, cabbage, nuts, seeds, popcorn, or dried fruits
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Gradually resuming normal activities and exercise as tolerated and advised by the doctor
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Seeking medical attention for any signs or symptoms of complications or problems, such as fever, pain, bleeding, swelling, or discharge
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Having regular check-ups and tests to monitor the ileostomy and the overall health
Prevention
An ileostomy cannot be prevented in most cases, as the cause is often unknown or unavoidable. However, some possible ways to reduce the risk or severity of an ileostomy include:
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Avoiding smoking, alcohol, and drugs that may harm the colon or rectum
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Taking medications and treatments as prescribed by the doctor for conditions that affect the colon or rectum, such as IBD or cancer
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Having regular screenings and tests to detect and treat any problems or diseases in the colon or rectum, such as colonoscopy or stool tests
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Following the doctor’s advice and instructions before and after the surgery
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Having regular follow-ups and evaluations to monitor the ileostomy and the long-term outcomes
An ileostomy is a life-changing but manageable condition that affects the small intestine and the abdomen. With proper surgery, care, and support, most patients can have a good quality of life and a normal life expectancy.
