When is an ileostomy needed?
An ileostomy is created when part or all of your colon needs to be removed. This might be necessary for several reasons:
- Inflammatory bowel diseases like ulcerative colitis or Crohn's disease
- Bowel cancer
- Diverticulitis
- Severe abdominal trauma or injury
- Congenital abnormalities
How does the ileostomy surgery work?
Your surgeon makes a small incision in your abdomen and brings the end of your small intestine (ileum) to the surface. This opening is then stitched to your skin to create your stoma. Immediately after surgery, a clear pouch is attached to collect your waste. Depending on your situation, the procedure can be performed as open surgery or through laparoscopy (keyhole surgery).
Types of ileostomies
End ileostomy
This is the most common type of ileostomy. Your entire colon is removed permanently and cannot be restored. The stoma is usually located in your lower right abdomen. Since your colon (which normally absorbs water) is gone, your output will be thinner than you might expect, which is completely normal.
Loop ileostomy
This type is usually temporary. It's created to protect and allow certain sections of bowel to heal. The stoma has two openings, but only one directs waste into your pouch. Once your bowel has healed, the stoma can be reversed in another operation.
The first weeks after ileostomy surgery
Adjusting to an ileostomy is both an emotional and physical challenge. Some people experience relief from pain and discover a new quality of life whereas others initially struggle to accept their changed body. Both reactions are completely normal.
What’s really important is knowing that your body isn't less valuable or less beautiful because of your stoma. It takes time to adjust. Counselling and support groups can be invaluable in helping you process your feelings and rebuild your confidence.
Eating with an ileostomy
With an ileostomy, you don't have to give up your favourite foods. Most people return to eating normally fairly quickly after surgery: what your body tolerated before, it will usually tolerate afterwards.
The key is listening to your body and learning what works for you. Some foods might cause bloating, odour, or looser output, but this varies from person to person.
Some nutrition tips for an ileostomy:
- Eat a balanced diet and favour easily digestible foods
- Drink about 2 to 2.5 litres of fluid daily
- Chew thoroughly and take your time with meals
- Eat several small meals throughout the day at regular intervals
- Prepare food in low-fat, gentle ways
- Stay physically active: Movement supports digestion
- Maintain a stable weight, as significant fluctuations can shift your stoma's position
Staying hydrated is critical
With an ileostomy, adequate fluid intake is especially important. Your colon (which normally absorbs most of the water you need) is either gone or not connected. This means your body loses more fluid than it did before.
Watch for these signs of dehydration:
- Headaches
- Increased thirst
- Dry mouth
- Dark urine
- Fatigue and difficulty concentrating
Stoma care and hygiene
Proper stoma skin care is essential to prevent skin irritation and infection. The skin around your stoma is sensitive as it's affected by regular pouch changes and potentially leaking output.
Care for your stoma properly:
- Gently clean your stoma and surrounding skin with warm water
- Avoid perfumed soaps, lotions, and creams as they irritate skin
- Pat your skin gently dry after washing
- Change your pouch regularly
- Watch for any redness or signs of irritation
If your skin is already irritated, special skin barrier products can help. Unscented wipes are useful when you're out and about, but only as a last resort. If skin problems persist, talk to your stoma care nurse.
Sport and physical activity
Exercise is very important: Yes, even with an ostomy. After an appropriate recovery period (rest immediately after surgery), you can do almost any sport that feels comfortable for you.
Tips for staying active with an ostomy:
- Wear an ostomy belt or supportive clothing for security and to reduce the risk of a stoma hernia
- Start slowly and build up gradually
- Stay well-hydrated
- Check with your doctor before attempting extreme sports like contact sports or heavy lifting
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FAQ: Ileostomy
What is an ileostomy?
An ileostomy is a surgically created stoma (opening) through which your small intestine is brought to the surface. The word "stoma" comes from Greek and means "opening." The surgery becomes necessary when part or all of your colon needs to be removed, whether due to inflammatory bowel disease, bowel cancer, or trauma. Waste passes directly from your stoma into a special pouch.
What's the difference between a colostomy and an ileostomy?
The main difference is in the type and rhythm of output. With a colostomy, your colon (large intestine) is used: output tends to be firmer and occurs less frequently, often just once daily. You may have some control over timing.
With an ileostomy, your small intestine (ileum) is used, so output is thinner and happens continuously, several times daily. This is because your colon, which normally absorbs water, is either removed or not connected. An ileostomy means you need a pouch at all times.
Colostomies generally have less impact on your diet, while people with ileostomies need to pay particular attention to fluid intake.
What foods should I avoid with an ileostomy?
There's no universal "forbidden list.” You just need to find out what works for your body. Everyone responds differently.
But generally, be cautious with:
- Raw vegetables high in fibre (especially celery and asparagus)
- Nuts and seeds
- Corn and popcorn
- Tough skins and hard-to-digest foods
These can cause bloating, odour, or loose output; but not for everyone. Some people tolerate them well.
Keep a food diary. Over time, you'll learn which foods suit you and which don't. What you managed fine before surgery, you'll likely manage fine after.
What is output like with an ileostomy?
Output with an ileostomy is quite different from people without one:
- Continuous: Your stoma produces output constantly, not just at certain times
- Liquid: The consistency ranges from pasty to liquid because your colon (which normally absorbs water) is gone
- Frequent: Output can occur several times daily, this is completely normal
- No control: Unlike with a colostomy, you have no control over timing, which is why you need a pouch at all times
The exact amount and frequency varies based on your diet, fluid intake, and metabolism. Drinking enough is crucial because your colon isn't there to absorb water as without adequate intake, you risk dehydration.