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Ileostomy

Introduction

[Original article on NHS Choices website]

An ileostomy is a surgical procedure to link the end of the small intestine to an opening in the abdomen (stoma) or to an internal pouch.

In an ileostomy, the end of the small intestine (the ileum) is disconnected from the colon (large intestine) and re-routed through a hole made in the abdomen, which is known as a stoma. An external bag (stoma bag) is attached to the opening to collect waste products.

Alternatively, an artificial pouch can be created inside the body, which can be regularly emptied when required.

An ileostomy is a relatively common surgery. In England, an estimated 9,000 are carried out by the NHS each year.

When is an ileostomy needed?

An ileostomy is needed when the colon (large intestine) is damaged, inflamed or loses function. It is also used to treat some types of cancer, where it is necessary to remove part or all of the colon.

Conditions often treated using an ileostomy are:

  • Crohn’s disease: a condition that causes chronic (long-term) inflammation of the digestive system. An ileostomy is usually recommended if the symptoms can't be controlled using medication, or if a serious complication occurs.
  • Ulcerative colitis: a condition that causes inflammation and ulceration of the colon. Permanently removing the colon is usually recommended in a small number of cases when other treatments prove ineffective.
  • Bowel cancer: after chemotherapy or radiotherapy to shrink the cancer, it is usually necessary to remove the section of the bowel or rectum that contains the cancerous cells.

Ileostomies used to treat digestive conditions tend to be carried out in people aged between 15 and 30 years old. Ileostomies used to treat bowel cancer tend to be carried out in older people aged between 60 and 70 years old.

Less often, an ileostomy may be used to treat:

  • A bowel obstruction. It may be necessary to perform a temporary or permanent ileostomy depending on the underlying cause of the obstruction.
  • A significant injury to the colon. For example, if the colon becomes permanently damaged due to a puncture or an impact injury.
  • Familial adenomatous polyposis (FAP). This is a rare condition that affects one in every 10,000 people and triggers the growth of non-cancerous lumps of tissue inside the colon.

Types of ileostomy

There are three main types of ileostomy:

  • loop ileostomy
  • end ileostomy
  • continent ileostomy

Read more about how an ileostomy is performed.

Loop ileostomy

During a loop ileostomy, a loop of the small intestine is brought out through the stoma. The procedure is usually only used as a temporary measure when it is necessary to remove part of the rectum. Once the remaining colon has healed it can be reconnected to the small intestine and the stoma can be closed.

Loop ileostomies are often used to treat bowel cancer.

End ileostomy

During an end ileostomy the colon and rectum are removed and the end of the ileum is brought out through the stoma and attached to an external bag. An end ileostomy is usually permanent.

An ileo-anal pouch (also known as a J pouch) is sometimes used as an alternative to an external bag. This is an internal pouch surgically constructed from the small intestine and connected to the sphincter muscle that surrounds the anus. It means bowel actions can be controlled in the normal way.

Ileo-anal pouches are now preferred because they eliminate the external bag. However, they are not suitable for every patient. Disadvantages include having to go to the toilet frequently to empty the pouch.

Continent ileostomy

A continent ileostomy is similar to an end ileostomy, but rather than having to wear an external bag, an internal pouch is created inside the abdomen. This is connected to a valve that is implanted into the skin, so the internal pouch can be emptied using a catheter (thin tube).

The continent ileostomy provides an option for those unable to have an ileo-anal pouch due to health or technical reasons, or in cases where an ileo-anal pouch stops working and needs to be removed.

After surgery

Recovering from an ileostomy can be challenging. Many people will experience both physical and psychological problems in the short-to-medium term after the operation.

Problems can include:

  • skin irritation around the stoma
  • leakage from the stoma or bag
  • feelings of anxiety and self-consciousness

However, with practice and support from a designated stoma nurse, many people do adjust and often report that their quality of life improves after surgery, particularly where the patient has been living for years with a painful digestive condition, like Crohn’s disease.

There are also recommendations after an ileostomy that may help to treat or prevent some of the issues arising from having an ileostomy. This includes:

  • a low-fibre diet to help digestion
  • drinking plenty of fluid to avoid dehydration
  • dealing with worries about smells or flatulence
  • taking medication 
  • treating soreness due to an ileo-anal pouch

Complications of an ileostomy

Some people may experience complications after an ileostomy, which can include:

  • an obstruction
  • vitamin B12 anaemia, due to removal of part of the intestine that absorbs vitamin B12
  • pouchitis (an inflamed internal pouch)
  • stoma problems, such as widening or narrowing of the stoma, making it difficult to insert the pouch.


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