An ileostomy is a surgical procedure that creates an opening, known as a stoma, from the ileum—the final section of the small intestine—to the outside of the body. This opening allows waste products to exit the body into an external pouch, bypassing the large intestine and rectum. While an ileostomy can significantly improve the quality of life for individuals with certain medical conditions, living with this alteration presents unique challenges for patients. Understanding these common patient difficulties is an important step in managing life with an ileostomy.
Fluid and Electrolyte Imbalance
Individuals with an ileostomy are susceptible to fluid and electrolyte imbalances because their large intestine, which normally absorbs water and electrolytes, is bypassed. Ileostomy effluent is typically liquid or semi-liquid and substantial, leading to higher fluid losses. This output makes dehydration a common and serious concern.
Electrolytes frequently lost include sodium, potassium, and magnesium. High sodium loss contributes to hyponatremia, and potassium depletion leads to hypokalemia. Magnesium deficiency (hypomagnesemia) also occurs. Symptoms of dehydration and electrolyte imbalance include excessive thirst, dry mouth, reduced urine output, fatigue, and lightheadedness. Severe imbalances may cause muscle cramps, weakness, heart palpitations, or confusion.
Managing fluid and electrolyte balance involves oral rehydration. Patients are advised to consume oral rehydration solutions (ORS) with glucose and electrolytes, which are more effectively absorbed than plain water. For severe dehydration or persistent electrolyte abnormalities, intravenous fluid administration may be necessary to restore fluid and electrolyte levels.
Peristomal Skin Complications
Maintaining peristomal skin health is a challenge for many ileostomy patients. Peristomal skin complications are common. These issues arise from continuous exposure of skin to irritating digestive enzymes in ileostomy effluent.
Causes of peristomal skin irritation include effluent leakage under the adhesive barrier, improper pouching system application or removal, adhesive allergies, or fungal infections. Skin issues range from simple irritation and redness to severe conditions like skin breakdown, itching, and ulceration. These complications cause discomfort and impact well-being.
Preventing and managing peristomal skin complications involves meticulous care. This includes ensuring a proper pouching system fit to minimize leakage, selecting an appropriate system for the stoma, and applying it correctly. Skin barriers, such as protective films or powders, create a buffer between skin and adhesive, offering protection against irritation and promoting skin integrity.
Stoma Blockage Risks
A stoma blockage occurs when ileostomy effluent flow is obstructed, often by undigested food or scar tissue. This is a distressing and painful experience. Foods high in fiber or difficult to digest often cause blockages.
Problematic foods include popcorn, nuts, seeds, raw stringy vegetables like celery and corn, and fibrous fruits such as pineapple and oranges. Symptoms include abdominal cramping, decreased or absent ileostomy output, and stoma swelling. Nausea and vomiting may indicate a more severe obstruction.
Preventing blockages involves dietary management. Patients should chew food thoroughly, eat smaller meals, and maintain hydration to help food pass. Limiting or avoiding problematic foods is also important, especially after surgery. If a blockage is suspected, patients can try warm baths, gentle abdominal massage, and temporarily altering their diet to clear the obstruction, while contacting their healthcare provider.
Adapting to Daily Life
Adapting to daily life with an ileostomy involves psychological and social adjustments. Body image concerns are common, as individuals may feel self-conscious about the stoma and pouch. This can lead to anxiety or depression.
Social adjustments include managing odor concerns, especially in public, and questions regarding intimacy and sexual activity. Travel presents considerations for managing supplies and emptying the pouch. Selecting appropriate clothing to discreetly cover the pouch is another practical aspect.
Dietary adjustments include strategies to manage gas or odor from certain foods. Support from healthcare professionals, including stoma nurses, is important for patient education on management techniques. Support groups provide a valuable community where individuals can share experiences and coping strategies, fostering normalcy and confidence.