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.
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 disease, colonic dysmotility, ulcerative colitis, familial polyposis, diverticulitis, and some cancers.
FOOD DO’S and DON’TS
- Foods high in non-soluble fiber
- Foods that do not breakdown during digestions
- Example: nuts, whole corn, popcorn, and shellfish
- 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
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.
- Long-acting, enteric-coated, sustained-release medications.
- Large pills (Potassium, Vitamins). Try Gummy Vitamins instead!
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.
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.