An ileostomy is a surgical procedure that modifies how digestive waste exits the body, becoming necessary when the colon, or large intestine, cannot properly process and eliminate waste. During this procedure, a surgeon creates an opening in the abdominal wall, known as a stoma. The end of the small intestine, specifically the ileum, is connected to this new opening. Digestive waste, which is typically fluid, passes through this stoma and collects into an external pouch. An end ileostomy is a specific type where the end of the ileum is brought to the surface to form the stoma, often after a portion or all of the large intestine has been removed.
Medical Reasons for an End Ileostomy
An end ileostomy is a necessary intervention for various medical conditions affecting the lower digestive tract. Inflammatory bowel diseases like Crohn’s disease and ulcerative colitis are common reasons, as these conditions cause severe inflammation and damage to the colon that can hinder its function. When the colon is too diseased to function or needs to heal, diverting waste through an ileostomy provides relief and allows for recovery or bypass.
Colorectal cancer also frequently necessitates an end ileostomy, especially if a significant portion of the colon or rectum must be removed due to cancerous growth or obstruction. Other conditions include familial adenomatous polyposis (FAP), a genetic disorder causing numerous polyps that can become cancerous, and severe bowel injuries from trauma. Additionally, complications like severe diverticulitis or toxic megacolon, which involve serious infections or extreme swelling of the colon, can lead to the need for this procedure. In these instances, the ileostomy ensures waste can exit the body, bypassing the compromised part of the intestine.
How an End Ileostomy is Formed
The formation of an end ileostomy is a surgical procedure performed under general anesthesia. The surgeon begins by making an incision, typically on the right side of the abdomen, to access the intestines. The ileum, the final segment of the small intestine, is identified and separated from the large intestine.
The end of the ileum is carefully brought through the opening created in the abdominal wall. This portion of the intestine is everted, or folded back on itself, to create a spout-like structure. The everted end of the ileum is stitched to the skin around the opening, forming the stoma. The stoma will appear reddish, similar to the inside of the mouth, and initially, it may be swollen, gradually reducing in size over several weeks.
Daily Life with an End Ileostomy
Living with an end ileostomy involves adapting to a new way of waste elimination, which is managed through an external pouching system. The stoma itself has no nerve endings, meaning there is no sensation of output or pain when touched. Waste, which is typically fluid or paste-like, continuously exits the stoma and collects into a specialized pouch.
Pouching systems are designed to securely attach around the stoma, collecting output and protecting the surrounding skin. These systems come in one-piece designs where the adhesive and pouch are combined, or two-piece systems with a separate adhesive barrier that remains on the skin while the pouch can be detached and reattached. Emptying the pouch is a routine task, typically performed several times a day when it is about one-third to half full, while the entire system is usually changed every few days. Proper skin care around the stoma is important to prevent irritation, involving gentle cleaning with water and avoiding harsh soaps or lotions that could interfere with adhesion.
Dietary considerations are part of daily life, particularly in the initial weeks after surgery, when a low-fiber diet is often recommended to allow the bowel to heal. Over time, most individuals can return to a varied diet, though chewing food thoroughly and maintaining adequate hydration are important to prevent blockages and dehydration, respectively. Some foods may increase gas or odor, and individuals often learn which foods to limit based on personal experience. With proper management, an end ileostomy allows individuals to maintain an active lifestyle, including participation in sports and other physical activities, with clothing choices often accommodating the pouch discreetly.
Reversibility and Long-Term Outlook
The permanence of an end ileostomy depends on the underlying medical condition and the individual’s recovery trajectory. While some end ileostomies are permanent, especially if the colon has been entirely removed or is severely damaged beyond repair, others can be temporary. A temporary end ileostomy allows the lower part of the bowel to rest and heal before a potential reversal procedure, known as an ileostomy take-down.
Reversal surgery is considered when the underlying condition has resolved or significantly improved, and the remaining bowel is healthy enough to be reconnected. This procedure involves rejoining the ileum to the remaining large intestine or rectum, restoring the natural pathway for waste elimination. The decision for reversal is made after careful evaluation by a surgical team, considering factors like overall health and the condition of the bowel.
The long-term outlook for individuals living with an end ileostomy is generally positive. While adapting to life with a stoma requires adjustments, many people experience a significant improvement in their quality of life, as the procedure often resolves chronic symptoms from their previous medical condition. Although some studies suggest potential impacts on quality of life compared to the general population, primarily related to stoma care and nutritional considerations, ongoing support systems and advancements in ostomy care products help individuals manage these aspects effectively. An ileostomy does not typically reduce life expectancy, with overall longevity more dependent on the initial medical condition that necessitated the surgery.