Ileostomy: Inflammatory Bowel Disease Explained

Inflammatory Bowel Disease (IBD) is a term that encompasses a group of disorders that cause chronic inflammation of the digestive tract. One of the treatments for severe IBD is a surgical procedure known as an ileostomy. This article provides an in-depth look at what ileostomy is, why it's performed, the different types, the procedure itself, the aftercare, potential complications, and the impact on quality of life.

Understanding the complexities of IBD and the role of ileostomy in its management can be daunting. However, this comprehensive glossary aims to break down these complexities into understandable concepts, providing a thorough understanding of the topic.

Understanding Inflammatory Bowel Disease

Inflammatory Bowel Disease is a chronic condition characterized by persistent inflammation of the digestive tract. It primarily includes two conditions: Crohn's disease and ulcerative colitis. While both conditions share some common symptoms such as abdominal pain, diarrhea, and weight loss, they affect different parts of the digestive tract.

Crohn's disease can cause inflammation anywhere along the digestive tract from the mouth to the anus, while ulcerative colitis affects only the colon (large intestine). The exact cause of IBD is unknown, but it's believed to result from an abnormal immune response to the microbes in the gut.

The Role of Surgery in IBD

Surgery is often considered a last resort for managing IBD, typically reserved for cases where medication and lifestyle changes have failed to control symptoms, or when complications such as fistulas, abscesses, or severe bleeding occur. The type of surgery performed depends on the type and severity of IBD, as well as the patient's overall health.

While surgery for IBD can often provide significant relief from symptoms and improve quality of life, it's important to note that it's not a cure. IBD is a chronic condition, and even after surgery, ongoing treatment is usually necessary to manage the disease.

What is an Ileostomy?

An ileostomy is a surgical procedure that creates a small opening, or stoma, in the abdominal wall. The end of the small intestine, known as the ileum, is brought through this opening to the surface of the skin. This allows waste material to exit the body directly from the small intestine into an external pouch, bypassing the colon.

Ileostomies are typically performed when the colon has been removed or needs to rest and heal. They can be temporary or permanent, depending on the reason for the surgery. Temporary ileostomies are often used to allow the lower part of the digestive tract to heal after surgery, after which the ileostomy can be reversed. Permanent ileostomies are typically performed when the entire colon and rectum need to be removed.

Types of Ileostomies

There are two main types of ileostomies: end ileostomies and loop ileostomies. In an end ileostomy, the entire colon and often the rectum are removed, and the end of the ileum is brought out to form the stoma. This is usually a permanent procedure.

In a loop ileostomy, a loop of the small intestine is brought out through the abdominal wall, and the stoma is created from this loop. This is usually a temporary measure to allow the lower part of the bowel to rest and heal. The loop can later be reinserted into the abdomen, and the stoma closed.

The Ileostomy Procedure

The ileostomy procedure is performed under general anesthesia. The surgeon makes an incision in the abdomen and brings the end or a loop of the small intestine out through the abdominal wall. The exposed end of the intestine is then turned back on itself to create a stoma, a small, round opening on the surface of the abdomen.

The stoma is typically placed on the right side of the abdomen, below the waistline. After the surgery, waste material will pass out of the body through the stoma and into a specially designed pouch that adheres to the skin around the stoma. This pouch needs to be emptied several times a day.

Preparing for the Procedure

Before the procedure, patients will undergo a thorough medical evaluation to ensure they are healthy enough for surgery. This may include blood tests, imaging studies, and a review of the patient's medical history and current medications. Patients may also meet with a stoma nurse or enterostomal therapist (ET) to discuss the procedure, stoma care, and life after surgery.

Patients are usually advised to follow a special diet in the days leading up to the surgery to reduce the amount of waste in the intestines. They may also need to take laxatives or undergo a bowel prep to further clean out the intestines. The night before the surgery, patients are typically instructed to not eat or drink anything after midnight.

Aftercare and Recovery

After the surgery, patients will spend some time in the hospital to recover and learn how to care for their stoma. This includes learning how to clean the stoma, change the pouch, and recognize signs of potential complications. The length of the hospital stay can vary, but it's typically between 3 to 7 days.

Once at home, patients will need to continue to care for their stoma and adjust to life with an ileostomy. This includes maintaining a balanced diet, staying hydrated, and gradually resuming normal activities. Regular follow-up appointments with the healthcare team are also important to monitor healing and manage any potential complications.

Potential Complications

As with any surgical procedure, an ileostomy carries some risk of complications. These can include infection, bleeding, blockage of the stoma, dehydration, and skin irritation around the stoma. It's important for patients to be aware of these potential complications and to seek medical attention if they experience any concerning symptoms.

Long-term complications can include hernias, stoma prolapse (where the stoma becomes longer than normal), and stoma retraction (where the stoma pulls inward). These complications may require further surgery to correct. Additionally, some people may experience psychological challenges, such as anxiety or depression, related to living with an ileostomy.

Impact on Quality of Life

Living with an ileostomy can be a significant adjustment. However, with proper care and support, most people are able to lead a normal and active life. Many find that their quality of life improves after surgery, as they are no longer dealing with the severe symptoms of IBD.

Support groups, both in-person and online, can be a valuable resource for people adjusting to life with an ileostomy. These groups provide a space for people to share their experiences, ask questions, and receive emotional support. Additionally, ongoing communication with the healthcare team is essential for managing any physical or emotional challenges that may arise.

Adjusting to Life with an Ileostomy

Adjusting to life with an ileostomy can take time and patience. It's normal to experience a range of emotions, from relief at no longer dealing with severe IBD symptoms, to frustration or sadness about the changes to the body. It's important to allow oneself time to adjust and to seek support as needed.

Over time, most people find that they are able to return to most of their normal activities, including work, exercise, and social activities. With the right products and care, the stoma and pouch can be discreetly managed, allowing people with an ileostomy to lead full and active lives.

Conclusion

An ileostomy is a significant procedure that can greatly impact a person's life. However, it is also a potentially life-improving treatment for individuals suffering from severe IBD. By understanding the procedure, its potential complications, and the adjustments required post-surgery, individuals can make informed decisions about their health and wellbeing.

Living with an ileostomy can be a challenge, but with the right care, support, and attitude, individuals can lead a healthy and fulfilling life. The journey may be difficult at times, but the end result can often be a significant improvement in quality of life.