Ileostomy Information

Ileostomy

An ileostomy is formed by bringing part of the ileum (small bowel) to the surface of the abdomen. An ileostomy can be either an end or loop ileostomy.

An ileostomy is generally sited on the right-hand side of the abdomen and ideally has a spout of approximately 25–35mm. It should be pink in colour and moist.

An ileostomy has no sensation. After surgery it is likely to be swollen and can take 6-8 weeks to reduce in size and shape. Normal output from an ileostomy is between 500–800ml in 24 hours. The consistency of the stool can range between watery to porridge-like.
 

End Ileostomy

This is normally formed when the colon (large bowel) is removed and the end of the ileum is brought out onto the surface of the abdomen.

The end ileostomy may be temporary if the rectum and anus are left in situ (sub-total colectomy).

Sub-total colectomy

If this is the case, the person with the stoma may be suitable for further surgery – for example, formation of an ileoanal pouch. The ileostomy will be permanent if the colon (large bowel), rectum and anus are removed (panproctocolectomy).

Panproctocolectomy
 

Loop Ileostomy

This is usually temporary and is normally created to divert faeces away from a surgical join in the colon (large bowel) or rectum (anterior resection).

Anterior resection

A loop of ileum (small bowel) is brought to the surface of the abdomen and opened to form a loop ileostomy. Its functional end (proximal)​ which produces faeces and a non-functional (distal) which leads to the colon (large bowel) and may produce mucus.

Ileoanal Pouch

This is an alternative operation for people with Ulcerative Colitis or Familial Adenomatous Polyposis, and avoids a permanent ileostomy. The operation involves the removal of the colon (large bowel) and the rectum, with replacement of the rectum by a surgically created reservoir or internal pouch made out of the ileum. The operation can be carried out in 1, 2 or 3 stages, depending on the health and fitness of the person, and the hospital in which surgery is performed.

Three Stages:

• 1. The colon (large bowel) is removed, the rectum is left in place and an end ileostomy is formed. Once the person is fit and well, stage 2 is performed.
• 2. The rectum is removed and an ileal pouch is created and joined to the anus. In order to allow the join time to heal, a loop ileostomy is formed, which creates a temporary diversion for faecal matter.
• 3. The loop ileostomy is closed. The individual now has a functioning ileo-anal pouch.

Two Stages

• 1. The colon (large bowel) and rectum are removed and an ileal pouch is created, with a covering loop ileostomy – all in one operation.
• 2. The loop ileostomy is closed. The individual now has a functioning ileo-anal pouch/ileal pouch.

One Stage

Very occasionally, if there are no technical problems and the person is well enough, the procedure can be carried out at a single operation. The colon (large bowel) and rectum are removed and an ileal pouch created without the need for an ileostomy.

Drainable Products

An individual may wear either a one-piece or two-piece drainable product, depending on their lifestyle and personal preferences. It is normal to empty the pouch between 4–6 times in a 24-hour period, which will include overnight. The majority of ileostomists will wear a one-piece pouch which is normally changed every 1-3 days If they have chosen a two-piece product, the wafer can be changed 2–3 times a week and the pouch changed when the person with a stoma wishes. This can be every day, some may change the size of the pouch they are wearing to use a larger pouch overnight, other individuals living with a stoma may change less frequently.

Drainable products are available in a variety of sizes: mini, standard and large to suit individual requirements. They also come in transparent or opaque, while some have a split cover, which allows the stoma to be seen for inspection. Most modern drainable products have a filter which expels gas to prevent it from building up inside the pouch, and also a soft Velcro® closure for comfort.