An ileostomy is a surgical procedure that involves creating an opening in the abdomen, known as a stoma. This involves bringing a portion of the small intestine – specifically the small intestine (ileum) – to the surface of the skin.
This procedure is typically performed when there is a need to divert or bypass the lower part of the small intestine and the colon, either temporarily or permanently.
Intestinal waste passes out of the ileostomy and is collected in an external ostomy system – such as a stoma pouch – which is placed over the opening on the abdomen.
Reasons for an ileostomy
Inflammatory Bowel Disease (IBD): One of the most common reasons for an ileostomy is the presence of severe Crohn’s disease or ulcerative colitis. These conditions can cause extensive inflammation and damage to the colon, making it necessary to bypass or remove the affected part of the bowel.
Colorectal cancer: When colorectal cancer is diagnosed it may require the surgical removal of a significant portion of the colon and rectum which has become diseased. An ileostomy can then be created to allow stool to exit the body.
Diverticulitis: Inflammation or infection of small pouches that can form in the walls of the colon, called diverticula, may benefit from the removal of a portion of the affected colon and the creation of an ileostomy.
Trauma: Severe abdominal injuries or accidents can lead to damage to the colon, requiring an ileostomy to allow time for healing or to divert stool away from the injured area.
Birth defects: In some cases, babies are born with congenital abnormalities in their digestive system that may require an ileostomy as part of their treatment.
What are the different types of ileostomies?
An end ileostomy is formed when all or part of the large bowel and or the rectum are removed. Part of the small bowel is brought out to the surface of the abdomen to create a stoma. An end ileostomy can be temporary or permanent. Temporary ileostomies may be reversed further down the line, but this needs to be discussed with the surgeon to see if this is a possibility and whether you are healthy enough to have the surgery done.
A loop ileostomy is created to protect a surgical join in the large bowel or to divert the flow of stool from an obstruction. It is formed when a loop of the small bowel is brought to the surface of the abdomen and opened to form a stoma. This can be temporary or permanent. A loop can also be formed to protect the join following reconstruction surgery, such as an ileo-anal pouch. A loop ileostomy has two openings; only one of these will pass stool, the other may pass mucus.
Types of ileostomy surgeries
There are three types of ileostomies and talking this through with your surgeon and stoma nurse will help you decided which is the most appropriate for you are your situation, taking into consideration your age, general health, and disease process.
Standard or Brooke ileostomy:This is the most common type of ileostomy surgery. The end of the ileum is pulled through the abdominal wall and is turned back and sutured to the skin, leaving the smooth rounded inside out ileum as the stoma. The stoma is usually in the lower right-hand side of the abdomen.
Continent ileostomy: A continent ileostomy is a different type of standard ileostomy. You don’t need to wear an external pouch with this kind of ileostomy. It is created by looping part of the ileum back on itself to form a reservoir or pocket inside the abdomen. A nipple valve is made from part of the ileum, a few times a day a catheter can be inserted to drain the waste out of the reservoir inside your abdomen.
Ileo-anal reservoir (J-pouch or pelvic pouch):The ileo-anal reservoir or pelvic pouch made from the ileum and the rectum and placed inside the body of the pelvis. Other names for this include J-pouch, W -pouch and S-pouch depending on the surgical procedure.
The pouch is connected to the anus. Waste passes into the pouch, where it is stored. When an urge is felt, the stool is passed through the anus, out of the body. The sphincter muscle around the anal opening must be intact to keep the pouch from leaking. In most cases at least two surgeries are required to make the ileo-anal reservoir or pelvic pouch.
What happens during the surgical procedure?
The creation of an ileostomy involves a surgical procedure that can be done as an open surgery or laparoscopically, depending on the specific circumstances and the surgeon’s preference.
Here are the key steps involved in the procedure:
Incision: A small incision is made in the abdominal wall, and the ileum, which is the last part of the small intestine, is brought through this opening to create the stoma.
Stoma formation: The exposed end of the ileum is then folded back on itself and sutured to the skin of the abdomen. This creates the stoma, which resembles a small, pinkish, moist opening.
Collection pouch: A stoma pouch or bag is attached to the skin around the stoma to collect stool as it exits the body. These pouches come in various styles, including one-piece and two-piece systems, and can be either drainable or closed-end.
Closure of the distal end: The distal end of the small intestine, which is no longer in use, is typically closed off or removed.
Dehydration with an ileostomy
Having an ileostomy makes it more difficult to stay well hydrated. The reason for this is the large bowel (colon) is responsible for absorbing most of the body fluids you need. However, following ileostomy surgery, your large bowel will have been ‘taken out of circuit’ and will either be no longer connected, or removed completely.
Need more information? Find out more about managing dehydration with an ileostomy here.
Living with an ileostomy
Adjusting to life with an ileostomy can be a significant challenge, both physically and emotionally.
Here are some important aspects to consider after having ileostomy surgery:
Dietary changes: Patients with ileostomies may need to make dietary adjustments to manage their condition. Certain foods can cause increased stool output or blockages, so it’s essential to talk with your Stoma Care Nurse or dietitian to develop a suitable eating plan.
Stoma care: Proper stoma care is crucial to prevent infection and skin irritation. This involves cleaning and maintaining the stoma and the skin around it.
Stoma bag management: Learning how to use and manage the stoma appliance is essential. Emptying and changing the pouch as needed is a routine part of life for those with ileostomies.
Emotional support: Coping with the physical and emotional challenges of an ileostomy can be overwhelming. Many individuals find it helpful to join support groups or seek counselling to address these concerns.
Physical activity: In most cases, individuals with ileostomies can continue to engage in physical activities and exercise, although it’s essential to consult with your surgeon or stoma care nurse for guidance on how to do this safely following surgery.
For more helpful advice on living with a stoma, visit our advice centre or explore our blog articles.
