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Ileostomy Care


Your Bowel & How it Works

The main function of the digestive system is to prepare and process food to be absorbed and used by the body. The mouth provides a mechanical breakdown of foods eaten. From here, the food passes through the esophagus into the stomach.


The food is stored in the stomach for a short while and eventually enters the bowel, also called the intestine or gut. The bowel or intestine is a tube-like structure that is divided into two major parts. The parts are called the small bowel and the large bowel. The small bowel starts below the stomach. This part is called the duodenum. The bowel continues on, loosely coiled in your abdomen. This section of the small bowel is called the jejunum. The last part of the small bowel, just before it becomes the large bowel is called the ileum. The entire small bowel is approximately 20 feet long. The small bowel does all the work to digest and absorb the food (nutrients) you have eaten.


The next part of the bowel is the large bowel or colon. This part is about 6 feet long and it frames the small bowel. It is divided into 6 sections: cecum, ascending, transverse descending, sigmoid, and rectum. The large bowel's function is to remove the water from your waste products (stool) and to store these products until you are ready to eliminate them.



Knowing Your Ileostomy

The aim of this site is to help you to become more familiar with your ileostomy. Your bowel disease has resulted in the need for your waste products to be rerouted through a surgically created opening in the abdomen called a Stoma (the Greek word for mouth).


No doubt you are experiencing a variety of feelings regarding your ileostomy. A sense of loss of self-esteem or control over your own body is not unusual. You may even feel that those whom you love will no longer love you in return. You are not alone in your reactions. More than one million North Americans live with ostomies and another one hundred thousand undergo this type of surgery every year. There will be many people upon whom your will be able to call. These will be discussed further on.


Most of the body's digestive activity takes place in the small bowel, while the large bowel or colon (six feet) functions to remove the water from your waste products or stool and store these products until you are ready to eliminate.


Even after the removal of your entire large bowel you will still have plenty of your small bowel to carry on the digestive process.


Ileostomies and Stomas

An ileostomy is a surgically created opening in the ileum to permit elimination of body wastes. The end of the ileum has been brought out through a surgically created opening to form a stoma. Stomas are wet, shiny and bright red in colour (similar to the tissue that lines your mouth). The stomas have no nerve endings and therefore are not sensitive to touch or pain. They are, however, very rich in blood vessels and may bleed slightly when rubbed. This is normal and should not be cause for alarm. Stomas may shrink a little in size during the first few months following surgery and therefore should be measured periodically by your Enterostomal Therapist – nurse in order to ensure an accurately fitting appliance.


Body waste (stool) will now be passed from the stoma into a collection device, or pouch, which is secured to your abdomen. Since the output of an ileostomy comes directly from the ileum, it tends to be “liquid-to-oatmeal” in consistency and still contains digestive enzymes that are very destructive to the skin. It is therefore imperative that your ostomy appliance is a proper fit. There will no longer be any urge to pass stool, nor will there be control as you had previously.


Caring for your Ileostomy

Caring for your ileostomy will soon become part of your daily routine requiring very little of your time if it is looked after properly. The frequency with which you change your appliance will depend upon the type of appliance your enterostomal therapist fits you for. Regardless of the differences between individual ileostomies, certain principles still remain the same.


1. Always us a skin barrier of some sort. Your skin will rapidly break down if it is exposed to ileostomy drainage.

 2. Most appliances nowadays are designed to stay 3-5 days but the appliance must be changed as soon as you feel any itching or burning beneath your skin barrier/flange. Similarly, redness of the skin, or irritation around the stoma is an indication for action.

a) Re-check the size of the stoma and adjust the opening in the flange accordingly (there should be only 1/16th to 1/8th of an inch of skin showing around the stomal base). You should try and cut the opening in the skin barrier as close to the same size as your stoma as possible without touching the stoma.

b) Avoid use of soap containing creams.

c) Use of Canada Care Medical's skin barrier paste by For Life on the skin side of the skin barrier is very helpful.

d) Call your enterostomal therapist or physician if problems persist.

3. Your ileostomy will be relatively inactive first thing in the morning and before meals. Take advantage of these "quiet times" for changing your appliance.

4. You may bathe or shower with your appliance on or off. However, if you choose to remove your appliance beforehand, you will be wise to use "quiet time." Wash surrounding skin with mild soap and water. Rinse and dry area well.

5. You may wish to take a shower with the appliance off - this not only feels good but also provides an excellent opportunity to bathe the skin around the stoma, which has been covered by the skin barrier and this will also allow an opportunity for shaving the skin.

Dietary Considerations

1. No special diet is necessary. As a matter of fact, you will probably be able to enjoy foods that you could not tolerate before your surgery. New foods should be introduced one at a time so that those causing problems can be identified. Any that are not tolerated should be tried again later on. Try smaller portions at the beginning and gradually increase the quantity.


2. Chew your food well, in a relaxed atmosphere.

 3. It is recommended 6-8 glasses of fluid be consumed daily. More fluids should be consumed in hot weather.

 4. Three regular meals per day are important to establish good bowel habits and ensure proper nutrition. Skipping meals increases gas production.

 5. Medications should not be taken without direction from your physician.

 6. In the presence of diarrhea, there will be an increased need for potassium. Good sources include: meat, fish, poultry, dried fruit, bananas, oranges, tomatoes, and their juices, sweet potatoes, potatoes, dried legumes and whole grain cereals. If diarrhea persists, consult your physician.

 To relieve diarrhea:

Avoid naturally laxative foods such as prunes, figs, flax and licorice. Restrict fiber in diet and emphasize foods like peanut butter, cheese, applesauce, rice, bananas, tapioca and boiled milk.


7. Care must be taken to prevent blockage. Be cautious of seeds, pits, nuts and fibrous foods such as celery, coconut, pineapple, coleslaw and tough meats. Foods that tend to absorb water such as popcorn, corn and dried fruits may also contribute to this problem. Take special care to chew food well for at least six weeks after surgery.

Symptoms of blockage include:

a) an increase in quantity, watery, foul smelling stool or decrease/absence of stool.

b) Stomal swelling.

c) Nausea and/or vomiting.

d) Cramps

e) Feeling of pressure behind the stoma.

f) Distention of the stomach.

 Never take a laxative! Try drinking lots of fluid while refraining from solid food. If the problem persists after 12 hours, seek help from your physician or enterostomal therapist.

8. A general rule; any food that agreed with you prior to your illness should also agree after surgery.


9. To control gas:

Flatus (or gas), is often caused by swallowing air. Carbonated beverages, beer and chewing gum may also contribute to the problem. Sleeping on your back also causes gas – after abdominal surgery you will spend upwards of 18 hours a day on your back so you will experience more gas in the post-operative recovery period. When you are back to the regular 24-hour routine, the gas will diminish. The following gas-producing foods may not be tolerated:


Beans-dried (navy, lima, and kidney), broccoli, cabbage, cantaloupe, cauliflower, chives, corn, cucumber, leeks, onions (bulb and green), peas (dried), radishes, peppers (red and green), sauerkraut, and/or turnips (yellow and white).


It is important to remember to eat slowly and to chew your food thoroughly. It is not necessary to avoid gas-producing foods completely. Rather, try them in small amounts to see which, if any, cause problems.


10. To control odour:

The following foods may cause odour: asparagus, beer, cabbage family, cheese, eggs, fish, legumes, and onions.


Certain drugs and vitamin preparations may also cause odour. Parsley, yogourt and buttermilk may help to control odour.


It should also be noted that the food that is eaten will affect the colour of the ileal discharge. Example: cream de menthe causes green discharge – beets, red discharge.


If you are concerned with odour – there are a number of preparations available that control and eliminate odour. Consult the Ostomy Care Centre at (613) 234-1222 for more information.


11. Bowel upsets can be caused by conditions not related to your diet such as emotional pressure and the effects of travel. Foods, which cause problems, should be re-introduced after a period of time.

12. It is important to achieve and maintain your ideal body weight.

 Suggested Meal Pattern


Breakfast      Fruit or juice

                       Whole grain cereal and/or bread

                       Egg, cheese, meat or meat alternative




Lunch             Egg, cheese*, meat or meat alternative

                       Whole grain bread and/or potato

                       Fruit and/or vegetable




Dinner           Egg, cheese*, meat or meat alternative

                       Whole grain bread and/or potato

                       Fruit and/or vegetable





Between meal nourishments may be taken as directed. *An additional iron source must be chosen when cheese is substituted for egg, meat or meat alternative.



Many women have conceived and delivered normal, healthy children. A good rule is to stay in close touch with your physician through the duration of the pregnancy. You may also have to alter the opening in the face plate skin barrier as the pregnancy progresses. This is normal.



You own attitude toward your ostomy will be the most important one. If you have a healthy attitude others will adopt it as well.


Very few people will be aware of your ostomy and it is up to you, and you alone, to decide who you want to tell and when.


Resumption of sexual relations often takes time. Much pressure regarding returning to a previous sexual activity level is self-imposed and should be disregarded. Give yourself time to recover fully from your surgery and even then keep in mind that there may be physical factors that may delay resumption.


In certain instances, particularly in men who undergo extensive surgery, it may be difficult or impossible to achieve and/or sustain and erection. Problems such as these are not common but they are possible. If there is a problem with the sexual response cycle your enterostomal therapist or physician will be able to discuss various alternatives with you.


Sexual concerns are very common between all partners, whether ostomy surgery is involved or not and the most important factor in finding or returning to a satisfying sexual relationship is honest and open communication. If time is taken and feelings are discussed openly you'll be surprised at how quickly a return to physical intimacy is established.



An ileostomy is in no way a restriction on your previous lifestyle. Rough contact sports (without special stomal protection) might result in stomal injury and perhaps should be avoided without your doctor's permission. Otherwise, you are free to enjoy all the activities that were enjoyed prior to your surgery.



Because your colon has been removed, and the purpose of the colon is to absorb the fluids from the digested food you will have to be aware of fluid loss. Fluids such as sodium, potassium, magnesium, etc are lost through everyday living, more so during strenuous exercise and perspiration. I find good sources of these electrolytes are found in tomato juice, bananas, coke, beer, apple juice and Gatorade.



Traveling to certain countries might dictate caution when drinking the water. Your safest bet in countries where the water is questionable is to buy bottled water.


Remember to always bring along adequate supplies with you when traveling abroad. When traveling by air, it is important to keep them with you in your hand luggage in order to avoid the risk of losing them should your checked luggage be sent elsewhere.


Financial Resources


Some financial assistance may be available from the following:


  1. Extended health care plans
  2. Provincial medical plans
  3. Disability pension recipients
  4. Veterans – DVA
  5. Canadian Cancer Society may offer financial assistance if the ostomy is a result of cancer.

      6. Some local United Ostomy Association Chapters.