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” 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 disease, colonic dysmotility, ulcerative colitis, familial polyposis, diverticulitis, 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
I have an colostomy which I have had since 1977 when I was 17 years old. I have dealt with every kind of problem you can think of including trying to find the appliance that works best for me. I now use the Convatec Pouch with the Stomahesive Wafer Ring. I usually get 7 days out of this appliance inbetween changes unless I have an overly active week of working or exercise. I have suffered from bloating, blockage and stoppage in digestion and it always ties back to either a consumption of ruffage or easily meshing foods. By this I mean salads, nuts, heavy fruits or foods that that do not digest easily. The only way to decide what is best for you. I find that way is to monitor the output of your stoma to see what doesn’t fully digest. As far as bloating goes I find that this happens from tomato base products, certain greens and tubars. Mostly over my laying life it has always been trial and error for foods and activities as well. I find that always making sure to completely chew all food well and make sure to drink lots of fluids all day. The fact that I am usually always thirsty helps to keep me hydrated. I stay away from anything carbonated or anything high in sugar or even juices because they can cause gas. I study to mostly bottled water, fresh brewed Coffee and Teas. Coffee and Teas, I find, have very little gas effect but do aid in digestion and even promote quicker action. I was closely followed by doctors and nurses at first but now I usually see my Gastro Doctor only once a year and usually it is more of a general checkup than anything else. I consider myself fortunate in this as I have not had to deal with any really critical setbacks and my ostomy rarely stops me in day to day activity from enjoying life to it’s fullest. I have even participated in sports and family activities that most doctors or specialist would consider a hazard. I swim, bowl, bike, do lawn work and just about anything else I like that I physically can at 63 years of age. The only drawbacks I have come from my artificial knee replacement more than from my ostomy. Basically it all comes down to these facts. Appliances and comfort are a trial and error experience until you find that one that suits you best and it might even be a combination of products instead of a singular one. I even use cut pieces of a 4" X 4" Stomahesive Water to fill in low spots and gaps. This same material also aids me in healing irritations from digestive fluids and raw spots when they occur. For Activities, the same follows in playing or doing things. Start slow, ease into and your body and ostomy will tell you if it is good for you. Never ignore any pain in the ostomy area because it is susceptible to all kinds of injury and pain. I am fortunate as I am hearty enough for many different activities. Last is Good and Beverages and this is the most important of trial and experimenting. Regardless of what the experts say everybody’s body reacts differently to all food. I have found that many things I did not enjoy early in life are now some of my favorite foods. However, I still monitor intake and always consider where I might be after my next meal and plan accordingly. That All You Can Eat Buffet might be something you do as the last activity of the day before heading home. Remember that your Ostomy is a direct result of a procedure that might just have saved your life. In my case, I was mere hours from death, caused by a horrendous case of Ulcerative Colitis, and the Surgeon who performed my surgery not only saved my life but also became my biggest supporter as he watched me get back to and exceed my abilities that were there before I became sick. So every thing in life is not bad, a Ileostomy is not the end of your life. I find there are great joys in life thanks to a curative procedure and a Stoma that is not a hinderance, just a necessary part for me to enjoy my life. By the way, I got married to a Beautiful Woman with whom I have Four Children and Nine Grandchildren. Life has been Wonderful and Hard but I can say for a fact that my Ileostomy didn’t make any differences in any of it other than maybe a few more bathroom breaks than anybody else.