An ileostomy is a surgically created opening, known as a stoma, that changes the path of waste material from the body. This procedure involves bringing a section of the small intestine (the ileum) through the abdominal wall. The stoma provides an exit point for stool, bypassing the large intestine and rectum, and diverting digestive contents into an external collection system.
The Physical Characteristics of the Stoma
The stoma’s color is a healthy, bright red or pink, due to the rich concentration of small blood vessels beneath the surface tissue. This tissue is a mucous membrane, similar in structure to the lining of the mouth or gums, and is consistently moist and soft to the touch. The stoma lacks sensory nerve endings, meaning the tissue does not register pain, heat, or cold sensations when touched or when output passes through it. Typically, the stoma is round or oval and designed to protrude slightly, often referred to as being “spouted.” This protrusion, usually about one-half to one inch high, helps direct the liquid output away from the surrounding skin. After surgery, the stoma is swollen, but it matures and shrinks to its final size over six to eight weeks.
Location and Structural Variations
The placement of an ileostomy is generally consistent, usually located in the lower right quadrant of the abdomen. Surgeons determine the precise location pre-operatively to ensure the site is manageable and visible to the patient, avoiding areas like scars, skin creases, or bony prominences. This positioning ensures a flat surface for the adhesive management system to attach securely, allowing the appliance to be worn comfortably and effectively contain waste material.
Structural differences define the two primary types of ileostomy. An end ileostomy is created by bringing the remaining end of the ileum through the abdominal wall to form a single opening. This type is often permanent, as the large intestine may have been removed or permanently bypassed. Alternatively, a loop ileostomy is formed by bringing a loop of the ileum to the surface, resulting in two openings in the stoma. One opening (the proximal limb) passes stool, while the other (the distal limb) may discharge only mucus. Loop ileostomies are most often temporary, created to allow a surgical connection further down the bowel to heal before the stoma is reversed.
Understanding the Effluent and Output
The digestive waste, or effluent, that exits an ileostomy is distinctively liquid or paste-like in consistency. This high-water content results from bypassing the large intestine, the organ primarily responsible for absorbing water and solidifying stool. The color of the output varies depending on diet and hydration, ranging from yellow or green to light brown. Because the ileostomy lacks a sphincter muscle, the flow of effluent is continuous and cannot be consciously controlled.
The volume of output is typically higher than other ostomy types, averaging between 200 and 700 milliliters daily in adults. Output exceeding 1,000 or 1,200 milliliters per day is considered high output, raising the risk of dehydration and electrolyte imbalances. The waste contains highly irritating digestive enzymes, necessitating a well-fitted appliance to protect the surrounding skin. Although the output has an odor, modern collection systems are constructed with odor-proof materials.
The Appearance of the Management System
The visible component of an ileostomy is the management system, worn over the stoma to collect the continuous output. This system consists of two primary parts: the adhesive wafer and the collection pouch. The wafer, also known as the skin barrier, adheres securely to the abdomen and protects the surrounding skin from the irritating effluent. The pouch attaches to the wafer and serves as the reservoir for waste.
Ileostomies almost always require a drainable pouch, which has an opening at the bottom secured by a clamp or integrated closure, allowing for frequent emptying. Modern pouches are made from soft, flexible, and opaque materials, such as beige or white film, to ensure a discreet, low-profile appearance that conforms to the body’s contours beneath most garments. The adhesive wafer is typically worn for three to seven days before the entire system is removed and replaced.