Ileostomy

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Helpful hints

As you learn more, you may have questions. There is no one right answer, only suggestions and ideas for you to try. This section has many tips that come from others. But remember, no two people are alike.

Protecting the skin around the stoma

The skin around your stoma should always look the same as skin anywhere else on your abdomen. But ileostomy output can make this skin tender or sore. Use the following tips to help keep your skin healthy:

  • Use the right size pouch and skin barrier opening. An opening that is too small can cut or injure the stoma and may cause it to swell. If the opening is too large, output could get to and irritate the skin. In both cases, change the pouch or skin barrier and replace it with one that fits well.
  • Change the pouching system regularly to avoid leakage and skin irritation. Itching and burning are signs that the skin needs to be cleaned and the pouching system should be changed.
  • Do not rip the pouching system away from the skin or remove it more than once a day unless there is a problem. Remove the face plate gently by pushing your skin away from the sticky barrier rather than pulling the barrier away from the skin.
  • Clean the skin around the stoma with water. Use a mild soap and rinse well. Dry the skin completely before putting on the skin barrier or pouch.
  • Watch for sensitivities and allergies to the adhesive, skin barrier, paste, tape, or pouch material. They can develop after weeks, months, or even years of using a product because you can become sensitized over time. If your skin is irritated only where the plastic pouch touches it, you might try a pouch cover. These are available from supply manufacturers, or you can make your own.
  • You may have to test different products to see how your skin reacts to them. If you feel comfortable testing yourself, follow the directions under "Patch testing" that follow. If you are not comfortable doing this on your own and the problem continues, talk to your doctor or ostomy nurse.

Patch testing

Patch testing can be done to see if you are sensitive to or allergic to a product used as part of your ostomy care. Place a small piece of the material to be tested on the skin of your belly, far away from the colostomy. If the material is not self-sticking attach it with an adhesive tape that you know you are not allergic to (Figures 21 and 22). Leave it on for 48 hours.

Diagrams showing how to perform a patch test.

Gently remove the patch at the end of 48 hours and look for redness or spots under the patch. If there is no redness after 48 hours, it is generally safe to use the product. But, in a few cases, reactions that took longer than 48 hours to show up have been reported (Figure 23).

Itching or burning before 48 hours pass is a sign of sensitivity. Remove the material right away and wash your skin well with soap and water.

A reaction to the tape is also possible. If this is the case, the redness or other irritation will only be in the area outlined by the tape (Figure 24).

If you seem to be allergic to a certain product, try one made by another company and patch test it, too. It may take a few tries to find one that works for you. Keep in mind that allergies are not as common as is irritation caused by using a product the wrong way. For this reason, before using a product, always read the directions that come with it. When in doubt, check with your ostomy nurse or doctor.

Spots of blood on the stoma

Spots of blood are not a cause for alarm. Cleaning around the stoma as you change the pouch or skin barrier may cause slight bleeding. The blood vessels in the tissues of the stoma are very delicate at the surface and are easily disturbed. The bleeding will usually stop quickly. If it does not, call your ostomy nurse or your doctor.

Shaving hair under the pouch

Having a lot of hair around the stoma can make it hard to get the skin barrier to stick well and may cause pain when you remove it. Shaving with a razor or trimming hair with scissors is helpful. Extra care should always be taken when doing this. A mild soap or shaving cream may be used. Rinse well.

Bathing

You may take a bath or shower with or without your pouch in place. If you do not wear the pouch, keep in mind that the output may keep coming out. Soap cannot harm the stoma. Just rinse it well. Do not use bath oil around the stoma – it can make it hard to get the pouch to stick well. If you bathe with your pouch off, be sure your skin is dry and cool before you replace the pouch. Otherwise the heat from a hot bath or shower can cause sweating under the barrier, which makes it hard to get a secure seal. Pat dry and apply the pouch.

Gas (flatulence)

Right after surgery it may seem that you have a lot of gas almost all the time. Most abdominal surgery is followed by this uncomfortable, embarrassing, yet harmless symptom. As the tissue swelling goes down, you will have less gas. But certain foods may cause gas, such as eggs, cabbage, broccoli, onions, fish, beans, milk, cheese, and alcohol.

Eating regularly will help prevent gas. Skipping meals to avoid gas or output is not smart because it will make your small intestine more active and might cause more gas and watery output. Some people find it best to eat smaller amounts of food 4 to 5 times a day.

You may be worried about how others may respond to gassy noises. You will find that these noises sound louder to you than to others. They often only sound like stomach rumblings to those around you. If you are embarrassed by these rumblings when others are nearby, you can say, "Excuse me, my stomach’s growling." If you feel as though you are about to release gas when you are with people, casually fold your arms across your belly so that your forearm rests over your stoma. This will muffle most sounds. Check with your ostomy nurse about products you can take to help lessen gas.

Odor

Ileal output does not smell the same as normal stool. This is because the bacteria in the colon that break down food and cause odor are not found in the small intestine. Many factors, such as foods, normal bacteria in your intestine, illness, certain medicines, and vitamins can cause odor. Some foods can produce odor: eggs, cabbage, cheese, cucumber, onion, garlic, fish, dairy foods, and coffee are among them. If you find that certain foods bother you, avoid them. Learning by experience is the only solution to this problem. Here are some hints for odor control:

  • Use an odor-resistant pouch.
  • Check to see that the skin barrier is stuck securely to your skin.
  • Empty the pouch often.
  • Place special deodorant liquids and/or tablets in the pouch.
  • There are some medicines you can take that may help. Check with your doctor or ostomy nurse about these products and how to use them. Some things that many people have found help with odor are chlorophyll tablets, bismuth subgallate, and bismuth subcarbonate.
  • There are air deodorizers that control odor very well when you are emptying the pouch.

Medicines

Be aware that coated tablets or time-released capsules may come out whole in the pouch. In most cases, this means you did not get the medicine. If you notice this, talk with your health care provider or pharmacist. There may be other medicines you can use to make sure you are getting what you need. Liquid or liquid gel medicines tend to absorb faster and may work better for you.


Last Medical Review: 03/17/2011
Last Revised: 03/17/2011