An ileostomy is an opening made into the small bowel, the ileum. The resulting opening is called a stoma from the Greek word meaning "mouth". Initially after surgery, the stoma tends to be quite swollen due to the handling of the bowel. The size may decrease, however, this will occur over a period of time often taking up to six weeks. The bowel is not unlike the inside of our mouths. The stoma is red, soft, and moist. The stool from an ileostomy stoma contains many harsh enzymes. If stool should come in contact with skin, irritation can occur. To avoid this problem, the surgeon will construct the stoma so that it protrudes approximately 2.5 mm from the skin and well into the opening of the appliance.

The stoma can be either a loop or an end portion of the ileum. Through the opening, the bowel is turned back on itself almost like a cuff and stitched to the skin. The loop ileostomy will have two openings - the top opening called the proximal opening where stool is passed and the distal opening or bottom opening that is connected to the resting portion of bowel. An ileostomy may be temporary or it may be permanent. Ileostomies are usually located in the right lower quadrant of the abdomen.

End Ileostomy
Loop Ileostomy
End Ileostomy
Loop Ileostomy

The person with an ileostomy has no voluntary control over the passage of stool or gas because, unike the anus, the stoma has no sphincter muscle. As a result, an external appliance must be worn at all times.

The stool from an ileostomy is initially quite loose. It may take 24-48 hours before the ileostomy will start to function. Prior to that, there may be bloody drainage present in the appliance. Once the ileostomy starts to function, the contents may be loose, thin, watery and greenish looking. This is know as bile. Ileostomy stool will always be loose because the colon, large bowel, has either been removed or bypassed with the surgery and less water and salt is absorbed. As the small bowel adapts to this change (which takes several weeks), the stool should gradually thicken to a porridge or toothpaste consistency. The stool from an ileostomy should never be formed. Changes in the consistency of the stool will vary during the course of a day depending upon the types and quantities of fluids and foods consumed. You might find that stool will pass into your appliance anywhere from 1 ½ to 4 hours after eating and drinking.

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