Ileostomy with Colostomy

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Ileostomy with Colostomy

Question:

How much will a person's life change after having an ileostomy, if the person already has a colostomy?

Answer:

Someone with a colostomy has had a surgery in which a small hole is made in the abdomen, and the colon is then rerouted through this hole to rid the body of feces. The feces collects is a small plastic bag or pouch attached to the person's abdomen. An ileostomy is similar, though intestinal juices, rather than solid feces, leave the body.

A person with a colostomy knows how to attach and remove the bag, protect the skin from irritation, how to clean the area, and control odor. They also know about dietary changes and how to reduce and vent the gas that builds up.

Some colostomy patients also perform colonic irrigations. This promotes the emptying of the feces on a schedule. Those who can manage this successfully can use a small cap instead of a pouch. The cap collects mucous and eliminates odor.

Ileostomies, which are usually placed on the lower right side of the abdomen, require a permanent pouch that must be emptied periodically. Irrigations are not necessary. Because of the loss of fluid through the ileostomy, dehydration is a major risk. The average loss is between one and two quarts a day. It is important to maintain a high fluid intake, and to drink extra amounts when fluid losses are apt to be heavy, as in hot weather, with strenuous exercise and at times when there is excessive drainage from the ileostomy.

Because intestinal juice from an ileostomy is rich in bile and enzymes that can damage the skin, extra precautions must be taken to protect the skin. Topical products have been designed to do this. Specialized nurses can be very helpful in choosing the right products and in showing how they should be applied.

There are two other concerns when you are switched from a colostomy to an ileostomy:

1. The opening of an ileostomy is often narrow enough to be blocked by foods that are high in indigestible fiber. So foods such as coconuts, dried foods and popcorn may pose a problem.

2. The intestine empties its contents into an ileostomy much faster than into a colostomy. For this reason, time-released and coated pills sometimes leave the body without being digested or absorbed. Whenever possible, you should substitute more readily absorbable drugs.

Stephen Goldfinger, M.D., is a professor of medicine at Harvard Medical School. He is a graduate of Columbia College of Physicians and Surgeons, and his clinical base is at the Massachusetts General Hospital.

Last updated:	July 20, 2009