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Ileostomy Tips from a Certified Wound Ostomy Nurse

by Berlin Schaubhut |

In honor of National Nurses Week, we are sharing some words of wisdom from Carol Marshall-Hanson, RN who is a certified Certified Wound Ostomy Nurse (CWON) at Seton Healthcare Family in Austin, TX. She gives her tips and best practices for patients with ileostomies. 
Ileostomy
Ileostomy” by BruceBlaus is licensed under 
CC BY-SA 4.0
Ileostomy is a surgery in which a small opening, called a stoma, is made in the abdomen. The surgeon brings a piece of the lowest part of the small intestine, called the ileum, through the opening where digested food passes into a pouch attached to the stoma. A temporary stoma is often a “loop” stoma, and a permanent ileostomy usually has an “end” stoma. Causes for ileostomies include Crohn’s disease, colonic dysmotility, ulcerative colitis, familial polyposis, diverticulitis, and some cancers

FOOD DO’S and DON’TS

AVOID:

  • Foods high in non-soluble fiber:
  • Foods that do not breakdown during digestions:
  • (nuts, whole corn, popcorn, shellfish, etc.) 
DO:
  • Eat a B-R-A-T diet to thicken stool:
    • Bananas, Rice (white), Apples (NO SKINS!), and Toast.
  • It is OK to use Lomotil or other anti-diarrheal meds to thicken stool.
  • It is OK to use Beano, Gas-X, etc, to decrease gas production.


HYDRATION AND ELECTROLYTES

Drink plenty of water, Gatorade, and similar fluids!
A person with an ileostomy loses a great deal of fluid as it does not stay inside the body long enough for liquids to be absorbed. Probably the most common cause for readmission to the hospital within a week of going home is dehydration accompanied by electrolyte imbalance
  • Loss of Sodium can cause confusion, seizures.
  • Loss of Potassium and Magnesium can cause muscle cramps, irregular heartbeat, and even heart attacks.
  • Dehydration can also lead to kidney injury.
If dehydration and electrolyte imbalance is suspected, attempt oral intake of food and water or electrolyte-based fluids to replenish. If unable to tolerate food/water or too confused: Have family/friend transport OR Call EMS TO TRANSPORT TO THE ER IMMEDIATELY.

MEDICATION PRECAUTIONS

Bowel transit time is at best around 3-hours with an ileostomy, so large hard pills or those with coatings intended to dissolve over several hours will be excreted before they dissolve.
AVOID:
  • Long-acting, enteric-coated, sustained-release medications.
  • Large pills (Potassium, Vitamins). Try Gummy Vitamins instead!

PERISTOMAL SKINCARE

Ileostomy stool contains digestive enzymes (bile and pancreatic fluids) that digest food. If they leak onto the skin, they will “digest” the skin causing severe irritation and pain. (See instructions on using Antifungal Powder and No-Sting wipes for skin irritation around the stoma or ask your ostomy nurse for help if irritation develops on the skin around the stoma).

DO NOT, under any circumstances, let your doctor prescribe ointments or creams to go on the peristomal skin. NO pouch will adhere on top of ointments and creams.

To avoid skin problems from enzymatic erosion:
  • Change the pouch generally about every 3-4 days.
  • Cut or obtain a pre-sized wafer 1/8-1/4” larger than the stoma. If the stoma is oval, you MUST custom-cut the wafer opening to protect the skin.
  • Consider using a barrier ring.
    • These rings look like a gasket and can be stretched or formed to any size/shape needed. They absorb and expand when in contact with liquid stool; compared to stoma paste that is eaten away from liquid stool and can cause leaks. Stoma paste also leaves a very sticky residue that is hard to get off, compared to barrier rings that leave very little residue on the skin.
  • Call your ostomy nurse if you have frequent pouch leakage and start to develop skin irritation. The worse the skin gets, the harder it is to get ANYTHING else to adhere around the stoma.

MARSHMALLOWS!

Eating marshmallows can slow down output within 5-10 minutes. Eating a few before bedtime can reduce the risk of leakage at night. Marshmallows are also great to carry in an emergency kit for changing appliances and traveling. The best part? It’s okay to make smores!
More resources on Ileostomies and related diseases:

Organizations:

United Ostomy Association of America

CrohnsandColitis.org

Blogs and Communities:

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