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Ileostomy

An ileostomy is the result of a surgery in which the lower part of the small intestines (the ileum) is
brought through the abdomen. An opening is made in the abdominal wall and a stoma is formed.
The stoma is usually found on the lower right side of the abdomen. Stool is then drained from the
ileum to the outside of the body into an appliance or pouch. After surgery the stool will have a soft
and sometimes liquid consistency. An appliance is flat in appearance and attaches to the skin with
adhesive to secure the pouch to the skin.

An ileostomy is often needed for patients with Crohn’s disease, ulcerative colitis, cancer, trauma,
and other diseases. Ileostomies are sometimes created after the large intestine (colon) has been
removed. Ileostomies are also sometimes done on a temporary to semi-temporary basis.

Types of Appliances

• Pouch or Bag- The bag will catch the stool draining from the ileostomy stoma. Every pouch
will have a spout or drain at bottom of the bag. The pouch needs to be emptied frequently
to avoid over-filling which might lead to the appliance leaking. There are many different
sizes and styles of pouches. Most are odor proof and some will have a filter used to release
gas prior to emptying.
• One-Piece- A one piece appliance contains the bag and the adhesive skin barrier or flange
together as a one-piece unit. The flange has a hole that may be cut to fit the particular
stoma size before being adhered to the skin. Some one-piece appliances may be pre-cut to
the size of a patient’s stoma.
• Two-Piece- This unit is made up of two separate pieces; the flange or adhesive skin barrier
and the pouch. The flange adheres to the skin and the pouch is attached to it. The flange
can stay in place while the pouch is removed and replaced with another. This type of
appliance is stronger and may be the preferred unit for someone experiencing skin
sensitivity.
• Reusable and Disposable- A reusable pouch has a barrier attached the skin with adhesive
and the pouch can be washed and reused. Disposable pouches have an adhesive barrier
ready to be applied to skin and will be thrown away after each use.

Ileostomy Diet Considerations

Individuals with an ileostomy should generally be able to maintain a regular balanced providing all
the vitamins, minerals, and calories for a healthy diet after surgery. In some cases, stool
consistency may become an issue being more liquid than solid leading to higher stool output and
faster dehydration. In these cases, doctors may recommend or prescribe a vitamin-mineral
supplement.

Special Circumstances
Because each patient is different, there are no set guidelines as to what type of dietary lifestyle is
best. Most individuals can resume a fairly normal diet. Most often, a pattern of trial and error
eating will be needed to determine which foods work best.

Some Guidelines

1. Maintain a regular eating schedule. Eating 4 to 6 small meals a day will promote a regular
bowel pattern.
2. Eating a larger, dinner-like, meal at lunch time and a smaller meal at dinner time will help
decrease stool output throughout the night. Many appliance leakages occur at night while
ileostomy patients are sleeping.
3. Try one food at a time to test what effects it will have on bowel function. If the food
produces an undesirable result the hold off on it for a while. As the body heals and adjusts,
re-introduce the food. The body may be able to tolerate the food better after healing.
4. Completely chew foods to allow for easier digestion. Avoid swallowing large un-chewed
pieces of leafy greens as they can block the stoma opening.
5. Fresh fruits may cause loose stool.
6. Drink 2 to 3 quarts of water per day. This may help keep the stool fluid and will prevent
dehydration. Water is normally absorbed by the colon. Because ileostomy patients do not
have use of the colon, they will lose more water and electrolytes. Do not restrict salt in the
diet due to the lose of electrolytes.
7. In the first weeks after surgery, avoid foods that were a problem prior to surgery as these
foods will probably still cause problems.
8. Medications such as Imodium, Lomotil, Levsin, and Bentyl may help to slow the bowel when
diarrhea is a problem.

Foods that are poorly Food and Medications that Foods that May Thicken
digested and May Block May Control Odor Stool
Stoma Opening

• Buttermilk • Applesauce
• Cabbage
• Charcoal tablets • Pasta
• Celery
• Cranberry Juice • Apple juice
• Coconut
• Parsley • Highly seasoned foods
• Corn
• Yogurt • Breads
• Cucumbers
• Asparagus • Creamy peanut butter
• Dried fruits
• Eggs • Grape juice
• Green peppers
• Fish • Bananas
• Lettuce
• Garlic • Cheeses
• Mushrooms
• Onionis • Starchy foods such as
• Nuts potatoes
• Olives • Prune juice
• Peas
• Pickles
• Pineapples
Things That May Cause Gas

• Jittery or stressed personality and excessive saliva swallowing


• Poorly fitting dentures, smoking pipes or cigarettes, chewing gum or tobacco can cause
increased salivation and swallowing
• Eating fast and swallowing large chunks of food or large amounts of beverages
• Eating fast and swallowing large chunks of food or large amounts of beverages
• Using straws or drinking from a bottle or can
• Inactivity and lying down after eating

Foods That May Cause Gas

Legumes - Most beans, especially dried beans and peas, baked beans, soy beans, lima beans

Vegetables - Cabbage, radishes, onions, broccoli, Brussels sprouts, cauliflower, cucumbers,


sauerkraut, kohlrabi, rutabaga, turnips, asparagus, onions

Fruits - Prunes, apples, raisins, bananas, excessive amounts of fruit

Cereals and Breads - Excessive wheat products, including breads and cereals.

Milk and milk Products - Excessive milk, ice cream, cheese

Fatty foods - Excessive pan-fried or deep-fried foods, fatty meats; rich cream sauces and gravies;
pastries

Liquids - Carbonated beverages

Skin Protection

Output from and ileostomy can be very irritating to the skin surrounding the stoma. Without proper
attention, the skin can become permanently damaged. Skin around the stoma should look and feel
the same as the rest of the abdomen. Following are some tips that may help to minimize skin
irritation.

• The skin barrier and pouch system opening should be the right size for the stoma. If the
opening is too small, the stoma can be injured. If the opening is too large, the skin will be
exposed to output and will become irritated. Be sure to use a pouching system that fits the
stoma.
• Change the appliance quickly if itching or burning occur.
• When changing the appliance, push the skin away from the barrier rather than pulling the
appliance from the skin.
• Clean the area around the stoma with warm water. Mild soaps can be used as tolerated.
Dry the skin thoroughly before applying a new appliance.
• Use skin protection products if the skin is becoming irritated.
Blood spots on the stoma are common. The stoma is very delicate and cleaning around the stoma
can cause minor bleeding. The bleeding should stop very easily and should be minimal.

Prepared by: Justin Ahorro

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