· For Ileostomates
· Ileostomy Do's and Don'ts
· Medical Aspects of an Ileostomy
· Ileostomy Study
· When an Ileostomy Fails to Function
· Living with Your Ileostomy
· Before Donating Blood
Adapted by The New Outlook
Ileostomates should not give blood. Dehydration, which occurs when blood is given, places stress on the kidneys. Serious kidney damage may occur. Ileostomates are always at risk for dehydration, and giving blood may create a dangerous health situation.
If diarrhea is active when you are about to put on a new appliance, an ice cube in a paper towel applied to the stoma may shock it into inactivity long enough for your change. Do not hold ice on the stoma for more than a few seconds at a time.
In a bathroom away from home, check the toilet paper supply before emptying your appliance.
Gas at night may be largely controlled by not eating after 6:00 p.m. This will allow the small intestine to quiet down for bedtime.
Ileostomy Do's and Don'ts
Adapted by The New Outlook, Chicago's North Suburban Chapter UOA
A collection of ileostomy don'ts:
Fasting can lead to serious electrolyte imbalances, even when adequate fluid intake is maintained.
Don't limit fluid intake
Ileostomates are always slightly dehydrated due to the constant outflow of fluids, so maintaining
fluid intake at all times is a must. You need to drink at least two quarts of fluids a day.
Don't eliminate salt from your diet
Since salt is also lost with the fluid outflow, even those with high blood pressure should not eliminate salt altogether. Be careful adding excessive salt to your diet. The normal American diet is already loaded with more than enough salt for your needs. Consult your physician for your recommended salt intake when other physical problems are a consideration.
Don't put things into your stoma
Do not allow anything to be put into your stoma without your own doctor's personal supervision. Less familiar doctors have sometimes given incorrect routine orders in hospitals for enemas, etc. Question any procedure that intrudes upon the stoma, including suppositories. Do know how to irrigate your stoma in case of a blockage.
Don't take any medication unless you know it will dissolve quickly and be fully absorbed
Before filling new prescriptions, be sure to ask your pharmacist whether it will dissolve in the stomach quickly. Coated and time-released medications will not be absorbed, and will pass through without benefit. If in doubt, purchase only six pills, and try them before getting the rest of the prescription. Women should be especially alert when taking birth control or estrogen replacement medications.
Don't take any vitamin B-12 product for granted
Have your doctor check your B-1 2 level whenever you have a blood test taken. Some ileostomates with some of the small intestine missing may require B-12 injections when they do not absorb enough of this vitamin.
Don't give blood
Ileostomates cannot afford to lose fluids even though they are healthy. Giving blood may lead to a serious dehydration issue.
Medical Aspects of an Ileostomy
By Dr. R.B. Kelleck
The new ileostomate may find it difficult to believe that life without a colon can be completely healthy. To understand this one needs to know what is the normal function of the colon, also called the large intestine, which has been removed.
This organ is only found in land animals. Its major functions are to absorb water from the food residue and store it until elimination. When animals first moved from the sea to the land, they moved from a world where water was plentiful to one where it might be very scarce. The necessary adaptation to survival in this environment is a colon as the means of avoiding dehydration.
The only other substance that is known to be absorbed from the colon is salt. All the other things we get from our food which we need for energy and health are absorbed from the small intestine. The small intestine is unaffected by the usual operations for such diseases as ulcerative colitis or familiar polyposis.
People with an ileostomy get just as much food--whether carbohydrates, fats or proteins--as anyone else. The other major function, storage of waste, is simply taken over by the pouch, whether external or internal.
Adhesions are bands of tough, string-like fibrous tissue which may form spontaneously. They are more common after any type of surgery. When the body is disturbed during surgery, the body repairs itself and this leads to the development of fibrous tissue called adhesions. Some people form adhesions more easily than others. Some people have post-operative complications from them while others do not.
If adhesions interfere with the normal motion of the intestine, a blockage or obstruction may occur when food, liquid or even air is unable to pass the closed off intestine. Severe bloating, abdominal pain, vomiting and constipation may occur. Emergency surgery may be necessary to remove the obstructive adhesion bands.
In many cases the possibility of adhesions is wrongly diagnosed for a variety of abdominal pain. A frequent cause for such pain is a spasm of the muscles responsible for peristalsis. This propels the bolus through the intestines. A muscle spasm in the calf is commonly referred to as a charley horse. Spasms in your intestines are essentially the same thing, but assume the name irritable intestine.
The removal of the colon does not guarantee immunity from painful spasms in the small intestine. Thus, the ileostomate may occasionally suffer from pain that cannot be readily explained on the basis of blockage. Adhesions may be thought to be responsible while the real cause may actually be spasms.
By Dr. Phillip Kramer, Boston University
Dr. Kramer has been doing studies for years in which UOA ileostomy members have participated. The following are some of the conclusions of these studies:
The average output per day for an ileostomy is about a pint. It is composed of 90% water and 10% solids. Normal fecal matter is 70% water and 30% solids. Overeating will increase the output of an ileostomy the same as it will for a normal person.
he fat and nitrogen content of the ileal discharge is normal. This indicates that the food absorption in the ileostomate is normal. Additional studies are being conducted as to the exact subtle differences in how absorption is handled for all types of nutrients.
Salt output from an ileostomy is high, around one teaspoon a day. A person with an intact colon has almost no salt output in the feces. The body seems to compensate for this salt and water loss by discharging less salt and water than normal through the urinary tract and through perspiration. The intake of too much salt is to be avoided in that it increases ileal output.
Urine output is generally less in an ileostomate. Therefore, it is necessary to increase his/her water intake above normal, so as to increase urine output. In this way the possibility of kidney stone development may also be kept to a minimum.
Some of the foods which were tried and caused no increase in ileal output were: dark rye bread, milk, cottage cheese, pork, apple juice, grape juice, watermelon and cantaloupe.
Some of the food which increase output were: prunes, raw figs, dates, stewed apricots, strawberries, grapes, bananas, beans and cabbage.
This does not suggest which foods an ileostomate should eat or avoid eating, but rather simply the output of eating these things.
An interesting study involved the intake of high quantities of water—up to a gallon a day. At this level, the ileal output was still not affected. However, the urine output was increased.
When an Ileostomy Fails to Function
Adapted by The New Outlook, Chicago's North Suburban Chapter UOA
It is normal for an ileostomy to cease functioning for short periods of time. But, if such cessation lasts four to six hours and is accompanied by severe cramps and nausea, the small intestine could be obstructed, and a doctor should be called or a visit to the hospital emergency room is needed. Even if the blockage is only partial, allowing some liquid to pass through, it still may be prudent to call a doctor in the event the material in the intestine does not pass on its own.
There are home remedies we sometimes try. At the first sign of an obstruction, remove the appliance, and put on one with a larger opening so the stoma will not be constricted if it swells. It is a good idea to even go without an appliance altogether for a while. This will give the stoma an opportunity to expand and perhaps expel the blockage. Stretching the body out and then tucking the body in may help loosen the blockage or put added pressure on the abdomen to help push it out of the intestine. Taking a warm bath without the prosthetic may relax the abdomen enough to expel the offending material. The blockage is usually right at the skin level.
A Chapter member was advise by his doctor to try the following more aggressive tactic: Lubricate the little finger well, make sure the nail is cut and dulled, place the little finger gently into the stoma pushing the obstruction backwards and then remove the finger. This will probably help break it up. The offending material has a good chance of passing. This procedure is also called dilating the stoma. Never stick an object into the stoma. It could perforate the intestine without you even feeling it causing a life threatening situation.
A blockage is usually caused by high residue foods. Or, foods that do not break down into small pieces or clump when chewed like Chinese vegetables, pineapple, coconut, whole seeds, olive pits, vegetable skins, popcorn, unchewed nuts, mushrooms, fruit skins, fruit pulp, kernel corn, whole peas, shrimp, lobster or gristly meats. It may be caused from overeating foods that usually agree with us when we only eat small helpings. It may also result from internal changes beyond our control.
A partial blockage may have the following characteristics: odorous discharge; cramps; watery squirts; noises and pain from around the stoma. When consulting a doctor because of a partial blockage, advise him/her if you are taking antibiotics, penicillin or other medication. A change of medicine may be needed. Although, the experience of our members shows that most partial blockages pass on their own if we drink plenty of water, move around to give our body a chance to loosen it on its own, and don't compound the problem with volumes of high fiber or any other foods.
Diarrhea may also signal trouble. In this case, intestinal contents pass through the small intestine too quickly for the absorption of fluid, salts and minerals. In fact, illness may cause the tissues to pour out needed fluid, salts and minerals. Electrolytes must be replaced quickly to avoid illness from dehydration and mineral deficiency. Loose stool may result not only from a virus or disease but also from eating certain foods. Such diarrhea is usually temporary. Raw fruits and vegetables, milk, fruit juice, prune juice or strange drinking water may be the culprits. Another possible cause is emotional stress. And for some people with ileostomies, a watery discharge is simply normal for them.
Diarrhea has three characteristics:
· The intestine discharges great quantities of watery stool.
· It comes on suddenly and may be accompanied by cramps.
· It may be caused by intestinal flu or gastroenteritis.
What to do about diarrhea? Take alternately, every hour the following drinks:
· One cup of sweetened tea, or
· One glass of orange juice, or
· One cup salty broth. e.g. a bullion cube in a cup of hot water.
Continue as long as the diarrhea persists. Glucose drinks are also available to help replace electrolyte losses. Most importantly, call your physician, and take whatever medications he/she may prescribe. Diarrhea will probably affect all ileostomates from time to time. It usually passes in a few hours. Take the above drinks. Monitor your progress. You should be back to yourself after taking a few glasses of these drinks.
If you stop urinating after taking these drinks, it means your body is not accepting fluids orally. Your pouch would be full of the liquids you have been drinking. This is a critical situation. If it persists for many hours with no relief in sight, you may want to go directly to a hospital emergency room while you're still conscience. Tell them your circumstances. They should put you on a saline intra-venous feeding tube. The saline I V will re-hydrate your body and you should be able to urinate again. The diarrhea may then be treated. Most of the time, our bodies can fight this temporary illness after receiving fluids and electrolytes. This means the hospital will send you home after a few hours, and you should probably be fine. If you can urinate, you have some time remaining to see if your body accepts the above home treatment.
Living with Your Ileostomy
By Lawrence P. Davis, M.D.
This article is from a talk about, The Surgeon's Responsibility to You and Your Responsibility to the Surgeon. The talk was on what a physician expects of an ileostomy patient.
"Being an ileostomate myself, I have jotted down things I experienced, and what I expect of you as you learn to cope"
Immediate post-op care…the most important thing the doctor expects is the patient's acceptance of the change in body image. He/she must accept the fact that he/she is changed for the better in most cases. One of the biggest hurdles with patients who will not even look at the stoma is to have him/her take care of it. This is the beginning of the road to recovery and complete recuperation. The patient should and must be independent by the time he/she leaves the hospital. The patient should have a satisfactory ostomy system with resource available for follow up care.
Motivate the patient to look at the positive effects of his/her operation. He/she is free of the disease; of contracting colon cancer; urgent diarrhea; cramping and pain. Most ileostomates say they happy to be rid of 20 or more trips to the bathroom while sometimes getting there too late. Most ileostomy surgery is due to inflammatory bowel disease. Make him/her aware that he/she has not been mutilated, but changed for the better.
The next big challenge is "bagging the stoma". It is most important to find the best appliance for the patient. The patient needs to know that his/her stoma is going to change. After surgery, he/she will gain weight again resulting in additional adjustments to one's pouching system. The ET nurse should be the primary resource for patient consultation. An ET is an expert on post surgical ostomy care, and should fully be utilized.
It is very important to understand the challenges a surgeon faces. Keep in mind that the individual's health problems dictate the surgeon's techniques. Depending on the exact anatomy of each patient, he/she will have a different stoma located in a slightly or more dramatically different area on the abdomen than someone else. One does not swap dentures or eyeglasses, therefore one should not unfairly compare stomas. Patients should attend meetings at the local chapter of the United Ostomy Association. Learn all he/she can about ostomy care. The caring and sharing will help more than anything else.
Usually, the ileostomate has been on or tried special diets for years. After surgery, he/she is desirous to move onto his/her post-surgical life. However, there are foods that may cause concerns, gas or odors. The patient must be aware of correctly introducing foods into his/her diet once again. The patient should also be instructed on what procedures to implement in case of problems like food blockages, dehydration or injury to other parts of the body.
A correct routine in handling these concerns will provide the patient with the best quality of life after surgery.
--Metro Halifax News, Nova Scotia
People with ileostomies often have lower cholesterol than people in the general population. That's because the last part of the small intestine, the terminal ileum, is where the bile acids are absorbed.
Bile acids are made in the liver and help in the digestion of fatty foods. After the terminal ileum is removed during surgery, the body is unable to absorb the bile acids. Consequently, fatty foods, rich in cholesterol, are not broken down and used by the body, resulting in lower levels of cholesterol.
Ileostomates whose ostomy is overactive might remember—the more food you eat the more active your ostomy will be. Abide by a well balanced healthy diet.
Ileostomates experience hunger more often than other people. When this happens, they should drink fruit juice or water and eat soda crackers followed by a meal as soon as possible. An ileostomy keeps working whether you have eaten or not, so don't skip meals to lose weight. Eat regular meals, just don't overeat…ever.
While an apple may have been Adam and Eve's downfall, after it is cooked, it can be a boon to the ileostomate. The large amount of pectin in apples helps solidify the stool and retards diarrhea. Applesauce also tends to lower stomach gas noise and helps counteract the liquid discharge that eating spicy food often causes.
Two teaspoons of pectin powder—Sure-Jel, Certo, etc.—dissolved in six ounces of water or juice may produce the same effect, but applesauce tastes much better.
Keep in mind that the stool changes color at times due to the food you are eating. Bananas may turn the stool black; tomatoes, beets, watermelon, red Jello or red soda will cause red stools . Some medications will also change the color of your stool. Remember what you ate and drank and what medications you took before you press the panic button.
Fasting can lead to serious electrolyte imbalances and/or kidney problems. Sodium depletion symptoms include loss of appetite, drowsiness, abdominal cramps and faint feelings—especially when standing—cold arms and legs.
Never take laxative. Never take an enema or irrigation through the stoma unless given by an informed doctor familiar with ileostomy stomas. Sometimes these may be needed to clear a blockage at a hospital, but only administered under the strictest controls.
Before Donating Blood…
By Lawrence Davis, M.D.
Ostomates considering the donation of blood should consult their physicians before doing so. This being said, bear in mind the experience of a physician who was also an ostomate in Carterville, GA. The following is part of his note:
It is this physician's opinion that an ostomate who has a history of kidney stones or periods of dehydration should never subject him/herself to the dehydration that is present after the blood donation.
My opinion is based on my own personal decision—as an ileostomate—to give blood. After my donation, no amount of fluids I forced on myself relieved the dehydration, which lasted two days. My third kidney stone came ten days later.
I think an ostomate can think of many other ways to serve his/her fellow man and repay medical sciences.