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Going Home: Part III

Your surgeon created a temporary "loop" ileostomy to allow the anal area to heal without the danger of irritation or infection from bacteria in stool.

Caring for Your Loop Ileostomy
While you have a loop ileostomy, an ostomy wafer and pouch protect your skin from irritants contained in stool. Stool from the small intestine can literally burn the skin if it is on the skin very long. A home health nurse will visit you at home to make sure that the ostomy wafer fits well and that you empty and change the pouch correctly. The nurse will also help you to order the correct stoma supplies.

If your skin becomes irritated or burned or if you have any questions or concerns, check with your home health nurse who is an enterostomal therapist or contact your surgeon's office.

The stool from an ileostomy does not smell like stool from the colon and may have a pungent odor. The pouches are odor-proof. There should be no odor except when you empty your pouch. You should only need to change the ostomy wafer an average of two times a week.

For more information about caring for your ostomy, you may want to check out the United Ostomy Association's Web site.

The Stoma
The stoma looks like the inside cheek lining in your mouth. Because the stoma has no nerves, it has no feeling.

Don't be surprised if the stoma bleeds easily when wiped. This is normal.

Following surgery, the stoma will be swollen. As the swelling goes down, your pouch must be refitted to protect your skin from getting irritated.

Since the stoma has no muscle, you will not be able to control the flow of stool. The small intestines make stool all the time, so trying to keep the pouch empty and clean all the time is impossible. The volume of stool will vary, depending on how much you eat or drink.

Blockages
A person with an ileostomy cannot get constipated. If the output stops for more than six hours, something is wrong.

An obstruction occurs when stool or vegetable matter plugs up—blocks—the bowel, usually near the stoma.

What causes blockages? In the early postoperative days, substantial swelling in the small intestine and in the tissues surrounding the stoma can cause blockages.

Other times, blockages can occur for a number of reasons, including:

  • Not chewing your food sufficiently
  • Eating too much fibrous food in combination with binding food, i.e., peanut butter and bananas

    Note: It's especially important to avoid crunchy peanut butter, which can block the stoma.
  • Eating fibrous foods such as broccoli and popcorn that can cause obstructions. Be sure to check the "foods to avoid" list for other such foods in "Going Home: Part I."
  • Not drinking enough fluids
  • Scar tissue in the abdomen causing a "kink" in the bowel. Sometimes, scarring also can cause the opening of the stoma to be too small for stool to pass through.

About one of ten patients develop a blockage after surgery. These usually go away on their own and rarely require surgery.

What Are the Symptoms of a Blockage?
Usually, people complain of feeling all right and then getting nauseated and having abdominal cramps. They also complain of decreased or noisy stoma output or an increased volume of clear watery stool. Sometimes, the stools stop completely. A person may also have abdominal distension, abdominal pain, and vomiting, or the stoma may become swollen.

What Should You Do?

  • Try a clear liquid diet (i.e., chicken broth, Gatorade, Jell-O) for a day or so.
  • A heating pad placed on your abdomen might help ease the cramping—do not burn yourself! A hot bath is often helpful.
  • Stop taking any antidiarrheal medications (i.e., Imodium, Lomotil, and codeine).
  • If you don't see any swelling, lie down and try to relax. Try lying in the knee to chest position with the buttocks in the air.

If the symptoms persist beyond 24 hours, call your doctor. Tell your surgeon what your symptoms are and what remedies you tried. You may need to be admitted to the hospital for fasting and intravenous fluids for several days before the symptoms go away. Surgery to fix this problem is seldom required.

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