ISCCNA

Even though the rectum has been bypassed it is not uncommon for people to experience the need to go to the toilet as you did previously. Sometimes a little blood, mucous, wind and occasionally bowel motion may be passed but this is normal. Just sit on the toilet and clean yourself in the usual way.

If the rectum has been removed, people may still expereince this urge and again this is normal and should ease with time.

After the operation you may see the stitches that have been used to hold the stoma in place. These will eventaully dissolve away as the stoma shrinks, or can be removed by your stoma care nurse.

Looking After Your Stoma

One of the most important things to remember is to take good care of the skin around the stoma. If the pouch does not fit snugly around the stoma the skin can become exposed to the harmful effects of the faeces. Leakage, as well as the too frequest removal of the pouch and the use of harsh skin cleansers can also cause some irritation of the skin. Look at the skin around the stoma when changing the pouch, if you notice any swelling, rash or redness which does not go away after a couple of changes, please get in touch with your stoma care nurse.

Changing The Pouch

It is a good idea to try to establish a routine for changing the pouch. As you get used to your stoma you may find that at certain times of the day it is more active than at others, for example shortly after a meal. Try to choose a time when it is relatively inactive, perhaps first thing in the morning.

Before starting to change the pouch make sure you have everything to hand that you will need to complete the process.

Check you have everything you need: wipes, warm water, a new pouch, any accessories and a disposable bag.
If you are using a drainable pouch remember to empty it before removing it.
Remove the old pouch, working slowly and gently from the top to the bottom.
Wash the stoma and the surrounding skin with warm water and wipes.
Dry the area well with the wipes.
Fit the new pouch making sure it is secure all the way around.
Place the old pouch into the disposable bag, seal it and put in the dustbin. Do not try to flush it down the toilet as this will cause a blockage.
Remember to wash your hands after emptying or changing your pouch.

Types of pouch

Most people with an ileostomy wear a drainable pouch, which will need to be emptied approximately 4-6 times per day and can be left on for 2-3 days. It is agood idea to empty the pouch when it is about one third full. There are many different sorts of pouches available and your stoma care nurse will be able to help you choose the most suitable type for you.

There are two main types of pouches available. These are known as the a one-piece and the two piece systems. A one piece comprises of a single unit which is made up of the collection bag and the adhesive area which firmly attaches the pouch around the stoma.

The two-piece system has the collection bag separate from the adhesive area and the two halves are then connected together. This means that you do not have to remove the adhesive part from around the stoma every time you change the bag.

Obtaining Supplies

On leaving hospital your stoma care nurse will provide you with enough pouches and other necessary supplies to keep you going until your own supply is organised. The nurse will give you the necessary codes for your specific requirements and these should be given to your GP who can issue you with a prescription. This prescription should be taken to your local pharmacy who will then obtain the items for you. Stoma care supplies are covered by the Medical Card and by the Drug Payment Scheme.

Be careful not to store your equipment in direct sunlight or near heat as this may make them deteriorate.

Diet

Like everyone you should try to eat regular well-balanced meals, which can include your favourite foods.

However, for the first month it is advisable to avoid the following foods:

Breakfast cereal containing bran.
Green vegetables.
High fibre bran or wholegrain brown bread.
Nuts, pips, seed, skins and kernels of fruit or vegetables.
Curries or highly spiced dishes.

After the first month try new foods in small amounts. This helps you isolate any problems foods. You may find that certain foods produce more wind from your stoma or make the bowel motion more liquid. If this bothers you simply cut down on these foods. You will soon find a balances of food that is right for you. Alcohol is fine in moderation but beer and lager can produce wind and cause the output from the stoma to be more liquid.

As your digestive system is not as long as it was, foods that are normally difficult to digest can pose a problem. Blockages in the small bowel can be caused by certain foods and your specialist nurse will advise you of these.

You should also be aware that sometimes eating red food sch as beetroot, can cause the bowel motion to look as if it contains blood.

It is important to drink approximately 3-4 pints of water per day and you will require additional salt.

Do not try to alter the activity of your stoma by reducing fluid intake or missing meals. This will either make you dehydrated or make your stoma work more.

Your stoma will work best if you eat regularly. Remember it is still possible to get constipation and diarheao with an ileostomy.

Sex and Relationships

In most cases a normal loving relationship can be resumed, however there is a stronger risk of impotence when the rectum has been removed. It is very important to talk to your partner and to not feel self-conscious because of the operation. It is still possible for women to become pregnant after stoma surgery and for some men to father children. Your stoma care nurse will discuss any questions you may have with this delicate issue.

Ileostomy