Ileostomy Tips from a Certified Wound Ostomy Nurse

Posted by Spoonie Threads Staff on

This week, we share some words of wisdom from Carol Marshall-Hanson, RN who is a Certified Wound Ostomy Nurse (CWON) at Seton Healthcare Family in Austin, TX. She gives her tips and best practices for patients with ileostomies.

Medical illustration of an ileostomy by Bruce Blaus

Ileostomy” by BruceBlaus is licensed under CC BY-SA 4.0 

Ileostomy is a surgery in which a small opening, called a stoma, is made in the abdomen. The surgeon brings a piece of the lowest part of the small intestine, called the ileum, through the opening where digested food passes into a pouch attached to the stoma.  A temporary stoma is one that is usually taken down within 6-8 weeks. It can be a loop or end stoma. A permanent ileostomy is one that will stay with the patient for life. These are usually due to cancer. Causes for ileostomies include Crohn’s diseasecolonic dysmotilityulcerative colitisfamilial polyposisdiverticulitis, and some cancers.  

FOOD DO’S and DON’TS 

Don't: 

  • Foods high in non-soluble fiber
  • Foods that do not breakdown during digestions
  • Example: nuts, whole corn, popcorn, and shellfish

Do: 

  • Eat a B-R-A-T diet to thicken stool
  • Examples: bananas, white rice, peeled apples (avoid the skin), and toast
  • It is OK to use Lomotil or other anti-diarrheal meds to thicken stool
  • It is OK to use Beano, Gas-X, etc, to decrease gas production 

HYDRATION AND ELECTROLYTES 

Drink plenty of water, Gatorade, and similar fluids! 

A person with an ileostomy loses a great deal of fluid as it does not stay inside the body long enough for liquids to be absorbed. Probably the most common cause for readmission to the hospital within a week of going home is dehydration accompanied by electrolyte imbalance 

  • Loss of Sodium can cause confusion, seizures
  • Loss of Potassium and Magnesium can cause muscle cramps, irregular heartbeat, and even heart attacks
  • Dehydration can also lead to kidney injury

If dehydration and electrolyte imbalance is suspected, attempt oral intake of food and water or electrolyte-based fluids to replenish. If unable to tolerate food/water or too confused, have family/friend transport or call EMS to transport them to the ER immediately

MEDICATION PRECAUTIONS 

Bowel transit time is at best around 3-hours with an ileostomy, so large hard pills or those with coatings intended to dissolve over several hours will be excreted before they dissolve. 

AVOID: 

  • Long-acting, enteric-coated, sustained-release medications. 
  • Large pills (Potassium, Vitamins). Try Gummy Vitamins instead! 

PERISTOMAL SKINCARE 

Ileostomy stool contains digestive enzymes (bile and pancreatic fluids) that digest food. If they leak onto the skin, they will “digest” the skin causing severe irritation and pain. (See instructions on using Antifungal Powder and No-Sting wipes for skin irritation around the stoma or ask your ostomy nurse for help if irritation develops on the skin around the stoma). 
 
Do not, under any circumstances, let your doctor prescribe ointments or creams to go on the peristomal skin. No pouch will adhere on top of ointments and creams. 
 
To avoid skin problems from enzymatic erosion: 

  • Change the pouch generally about every 3-4 days. 
  • Cut or obtain a pre-sized wafer 1/8-1/4” larger than the stoma. If the stoma is oval, you MUST custom-cut the wafer opening to protect the skin. 
  • Consider using a barrier ring. 
  • These rings look like a gasket and can be stretched or formed to any size/shape needed. They absorb and expand when in contact with liquid stool; compared to stoma paste that is eaten away from liquid stool and can cause leaks. Stoma paste also leaves a very sticky residue that is hard to get off, compared to barrier rings that leave very little residue on the skin. 
  • Call your ostomy nurse if you have frequent pouch leakage and start to develop skin irritation. The worse the skin gets, the harder it is to get ANYTHING else to adhere around the stoma. 

MARSHMALLOWS

Eating marshmallows can slow down output within 5-10 minutes. Eating a few before bedtime can reduce the risk of leakage at night. Marshmallows are also great to carry in an emergency kit for changing appliances and traveling. The best part? It’s okay to make smores! 

Remember to check with your doctor before making any dietary wound care changes. 

Resources

Organizations

United Ostomy Associations of America 

CrohnsandColitis.org 

Crohns & Colitis Foundation 

Crohns and Me 

Blogs & Community

Stolen Colon 

Uncover Ostomy 

Crohnsdisease.com 

Gutless and Glamorous 

The Vegan Ostomy 

10 Spoonie Self-Care Tips

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Comments


  • Thank you for this incitful blog as an Ileostomy wearer for about 6 yrs I have learnt along the way and made my way through learning as I have travelled my ostomy path. I have my ileostomy due to slow digestive transit and severe constipation not many know a lot about this reason and we are a monority so have to be all the more careful when eating and taking meds

    Kelly murphy Aka funbags n shitbags on
  • I am gluten free and if I ate the wrong food the bag blows up like a balloon. I have an ileostomy 13 years and I wear Coloplast. All of a sudden the bag started ballooning whatever I ate and I couldn’t control it so I had to get out of the pouch and go into Convactec with no filter. Also my stoma shunk. That has never happened to me and I don’t know why. So all those Coloplast pouches I just ordered are too big on me. I don’t like Convactec it’s a long bag it’s flimsy and Coloplast is thicker material. Convactec when you try to open up the bag it’s very hard to open. When I put the drops in M9 they don’t go to the bottom and when I have to reopen the pouch to empty the M9 drops right on the top makes a mess. I don’t think Coloplast makes no filter pouch. I cannot eat marshmallows because there’s corn syrup in there and it blows my pouch up and gives me cramps. I have struggled with ballooning for 13 years. All your tips I have read before. Nothing is new. I wish I could find a pouch that is not flimsy that will work for me & Hollister is no different. I also have a divid In the middle of my stomach and I don’t like square wafers I like round wafers it seems like no one makes round wafers anymore and the Assura from Coloplast has been discontinued so I don’t have a round wafer I have is oval wafer and that falls into the divid and can cause leaks. I am very challenged. I have cut it down but it’s a short wait for her to begin with. Thank you.

    Patti on

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