ileostomies

Patient Care. Patients with an ileostomy require physical care similar to that given patients with a colostomy. The major difference is that the fecal material from an ileostomy will be more liquid and the passage of feces through the stoma less predictable than in a colostomy. The farther along the intestinal tract a stoma is located, the firmer the stool.

The psychosocial impact of surgery for either urinary or fecal diversion is a major concern of patients and their professional caregivers, families, and significant others. The problems related to this kind of surgery and the changes it brings in self-concept and fulfillment of roles are shared by all patients who must live with a stoma. Hence the emotional and psychological care of these patients is presented under stoma.

The appliance for collection of feces is worn continuously and emptied every 4 to 5 hours. There is a continuous flow of liquid feces through an ileostomy. There should be no problem with persistent odor if the appliance is well made, worn correctly, and washed and rinsed frequently. Manufacturers of collection devices provide detailed information about cleaning and storage of their products.

Obstruction and diarrhea are common problems to be avoided. In regard to obstruction, the major offenders are foods that absorb water, for example, hard nuts, dried fruits, corn (including popcorn), and foods high in fiber. Particles from these foods are not small enough to pass through the ileostomy stoma; hence they inhibit the passage of feces and produce abdominal cramping and vomiting. Relief of blockage requires oral administration of enzymes to promote digestion, gentle lavage, and massage of the abdomen to encourage passage of the obstructing material. As a last resort, surgery may be necessary to remove the obstruction. Laxatives are never given; they will only aggravate the problem. Patients are taught the symptoms of obstruction and the necessity of consulting a health care professional should they occur and self-care measures not be effective.

Diarrhea is a more frequent problem in patients with an ileostomy than in patients with other types of fecal diversion and it is more likely to result in fluid and electrolyte imbalance than it would in a person who defecates normally. Although the fecal material passing through an ileostomy is already semi-liquid, patients can learn the difference between what is normal for them and what is indicative of diarrhea.

Dietary restrictions, other than the foods that could cause an obstruction, are not severe. The ostomate usually begins with a bland diet and gradually adds foods one at a time, noting whether a particular food causes problems of flatus, abdominal cramps, or diarrhea. Patients are warned that eating too quickly, not chewing food thoroughly, and swallowing air while eating can contribute to the problem of flatulence.