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.

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.

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.

• 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.