Living with an ileostomy

Although it can be difficult to adjust at first, having an ileostomy doesn't mean you can't have a full and active life.

Many people with a stoma say their quality of life has improved since having an ileostomy because they no longer have to cope with distressing and uncomfortable symptoms.

However, if you're finding it difficult to adjust after your operation, it may help to get in contact with others who have had similar experiences through support groups such as the Ileostomy and Internal Pouch Support Group .

You may alsofind the following information useful if you have an ileostomy, or are due to have one in the near future.

Ileostomy equipment

Before and after the ileostomy procedure, you'll see anurse who specialises in helping people with a stoma. The nurse will advise you about equipment you'll need and how to manageyour stoma.

Stoma bags

Yourstoma will produce liquid digestive waste that canrange from a watery consistency to a consistency similar to porridge, whichis collected in a stoma bag.

There's a wide range of stoma bags available, but aspecialist stoma nurse can help you choose the most suitable appliance for you.

To help reduce skin irritation,stoma bags are made from hypoallergenic (non-allergic) material, and contain special filtersto helpensure thebags don't release any unpleasant odours.

Theycan be easily drained through an opening in the bottom and can be concealed under everyday clothes.

It'susually best to empty your bag into a toilet when it's about one-third fullas this prevents the bag bulging underneath your clothes.

You'll usually be advised to replace the bags and dispose of them in the general rubbish not down the toiletevery one or two days.

At first, living with an ileostomy can be a distressing experience. It may take some time before you get used to it, but with practise and the support of your stoma nurse and family, usingstoma bags will become routine.

Other equipment and products

There are also additional products that can make living with an ileostomymore convenient, including:

• support belts and girdles
• deodorisers that can be inserted into your appliance
• protective skin wipes
• adhesive remover sprays
• protective stomaguards

Your stoma care nurse will be able to advise you about the most appropriate equipment to help you manage your ileostomy successfully.

Ordering and paying for equipment

If you have an ileostomy, you'll be entitled to free NHS prescriptions for necessary products.

You'll be given an initial supply of stoma bags before you leave hospital, as well as your prescription information. Let your GP know your prescription information so they can make a note of it in your medical records and issue prescriptions in the future.

Your prescription can either be taken to the chemist or sent to a specialist supplier who will deliver the appliances. There's no need to stockpile supplies, but it's recommended that you order more appliances while you still have plenty left so you don't run out.

Stoma care

The output of your stoma can cause irritation to the skin surrounding the opening, so it's important to keep the skin clean. You should regularly clean the area using mild soap and water.

You may notice small spots of blood around the stoma when you clean it. This is perfectly normal. It's caused by delicate blood vessels in the tissues of the stoma, which can bleed easily. The bleeding will soon stop.

Burning or itching skin is a sign that you need to change your equipment. Ifa large area of skin becomes inflamed, contact your GP or stoma nurse, who will be able to prescribe a cream, powder or spray to treat this.

Diet

In the first few weeks after surgery, you'll usually be advised to follow a low-fibre diet.

This is because having a high-fibre diet can increase the size of your stools, which can cause the bowel to become temporarily blocked. After around eight weeks, you'll usually be able to resume a normal diet.

As you recover, you should try to eat a healthy, balanced diet that includes plenty of fresh fruit and vegetables at least five portions a day and wholegrains.

If you decide to introduce new foods into your diet after surgery, try to introduce them slowly, at the rate of one type of food each meal. This will allow you to judge the effects of the food on your digestive system.

You mayfind it useful to keep a food diary so you can keep a record of the food you've eaten and how you feel afterwards. For example, you may find you experience diarrhoea after eating spicy foods, or after drinking alcohol or caffeinated drinks.

Dehydration

If you no longer have alarge intestine (colon), you're at greater risk from Dehydration . This is because one of the functions of the colon is to reabsorb water and mineralsback into the body.

It's therefore important to drink plenty of water if you have anileostomy, particularly in hot weather or during periods where you're more active than normal. Sachets of fluid replacement solutions to help reduce dehydration are also availablefrom pharmacies.

Smell and wind

In the first few weeks after surgery, you may experience a lot of gas (flatulence) . This is harmless, but it can be embarrassing and uncomfortable. This problem should subside as your bowels recover from the effects of surgery.

Chewing food thoroughly and not eating foods that cause gas can help. These include:

• beans
• broccoli
• cabbage
• cauliflower
• onions
• eggs

Fizzy drinks and beer also cause gas. Don't skip meals to try to prevent gas because it will make the problem worse.

If the problem persists, your GP or stoma nurse should be able to recommend a medicine that can help to reduce gas.

Many people also worry their externalbag will smell. However,all modern appliances have air filterswith charcoal in them, which neutralises the smell. If necessary,special liquids and tablets that are placed in the bags are available to reduce any odour.

Medication

Many medicines are designed to dissolve slowly in your digestive system. This means some medications may not be as effective if you have an ileostomy becausethey could come straight out into your bag.

Let your GP or pharmacist know about your stoma so they can recommend an alternative type of medicine, such as an uncoated pill, powder or liquid.

In women, having a ileostomy can affect the effectiveness of oral contraceptive pills, so you may want to discuss alternative forms of contraception with your GP or pharmacist.

Activities

Once you've fully recovered from surgery, there's no reason you can't return to most of your normal activities, including work, sports, travelling and having sex.

Speak to your stoma nurse before returning to your normal activities, however, as they can offer advice about issues you may need to take into consideration now you have an ileostomy.

For example, they can advise you about wearing protective stoma guards while playing sports, or stocking up on ileostomy products beforetravelling.

Living with an ileo-anal pouch

Living with an ileo-anal pouch is differentfrom living with an ileostomy because the procedure doesn't involve creating a stoma in the tummy (abdomen). Instead, digestive waste is stored in an internal pouch and excreted through the rectum and anus.

If you've had an ileo-anal pouch, you may find you need to empty it up to 20 times a day during the first few days after the operation.

However, the number of times you need to go to the toilet will slowly reduce as the pouch expands and you get used to controlling muscles that surround it.

Most people find their pouch activity settles down after6 to 12 months, although the number of bowel movements will differ from person to person.

Improving muscle control

Exercising the muscles that control the passing of stools (pelvic floor muscles)can help make going to the toilet easier if you have an ileo-anal pouch. It can also reduce the likelihood of accidental leaks during the first few weeks after the operation.

Pelvic floor exercises, as outlined below, are a good way of improving your muscle control:

• sit or lie comfortably with your knees slightly apart
• without moving your abdominal muscles, squeeze the muscle around the back passage as if you're trying to stop passing wind
• hold this contraction as long as you can at least two seconds, increasing up to 10 seconds as you improve
• relax for the same amount of time before repeating

Ideally aim for 10 short, fast and strong contractions.

Anal soreness

Anal soreness or itchiness is common in people with an ileo-anal pouch. Having regular baths should help to relieve this. Using a skin protection cream is also recommended. Your GP will be able to advise you about the best cream for you.