Individuals living with an ileostomy are at high risk for dehydration.  It is important for them to know the signs and symptoms of dehydration as well as preventative measures.  These symptoms can include thirst, dry tenting skin, abdominal cramps, rapid heart rate, confusion and low blood pressure.

Preventing dehydration will become an every day battle but is possibly the most important thing to consider when living with an ileostomy.  The best way to prevent and avoid dehydration is to drink two to three quarts of fluids every day, especially fluids that are high in sodium and potassium.

If any symptom of dehydration presents itself, it is very important to get to the hospital immediately.  Dehydration can lead to many very serious problems including renal failure, cardiac arrest, and even death.

GENERAL INFORMATION:

What is an 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 need 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.

What is the small intestine and where is it located?

The digestive system is made up of the parts of the body that digest food and absorb nutrients.  After food leaves your stomach, it travels to the small intestine.  Nutrients are then absorbed through the small intestine.  Food moves on to the colon where water is absorbed and stool is created.  After surgery, some patients may have had some of their small intestines removed.  The small intestine is about 3-4 meters in length.  The minimum length of small intestines needed is not clearly known but patients have lived with as little as 3 feet of intestines.

Ileostomies leave patients with a stoma on their abdomen from which stool is excreted.  Generally the stool will empty into a pouch or bag attached to the patients abdomen with adhesive.  The excreted stool is often acidic type liquid and can cause severe irritation to the skin surrounding the stoma if not properly taken care of.  There are many different products from which to choose for ileostomy patients.  The ultimate goal is to find the appliance that is right for the patient and allows for the longest wear time.  Security from leakage is very important for patients.

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.  Hopefully the patient will have access to a caring ostomy nurse who will help find the best solution.
• 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 patients stoma.
• Two-Piece- This unit is made up of two seperate 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.

Things to Know When Problems Occur

• Stoma Size- Knowing the size of the stoma will assist in finding the right size appliance for an ileostomy.  Most ostomy supply companies will provide a chart with pre-cut holes.  By placing the chart over the stoma, the size can be quickly determined.
• Protruding or Recessed- If the stoma is protruding, the patient will have less trouble with leakage and longer wear times.  With a recessed stoma, patients will have a hard time without the correct appliance.  A recessed stoma will seem to be level with the skin or sinking into the skin.  The proper appliance in this case is one in which the barrier is convex in shape.  The convex shape will help to protrude the stoma decreasing the chances of leakage.
• Ostomy Belt- When leakage is a problem the use of an ostomy belt may help greatly.  An ostomy belt is an adjustable belt that attaches to each side of the appliance and wraps around the patient.  This will help put pressure on the appliance when the adhesive is not enough.
• High Stool Output- High output can cause some very serious problems.  Not only can high output lead to more frequent leaks and skin irritations but individuals with higher output ileostomies become dehydrated very fast.  Doctors may prescribe an anti-diarrhea medication such as lopermide or a combination of lopermide and a mild narcotic pain killer such as codeine.  The codeine is not being used for its pain killing properties but instead is being used for its tendancy to create solid stool and slow down bowel movements.  Individuals with high output ileostomies should make sure their doctors are aware of the high level of stool output.

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 Guidlines

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.

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.