An ileostomy is a surgical procedure that is used to treat serious digestive complaints. It is also used to treat some types of cancer, where it is necessary to remove some or all the colon (large intestine) and, in some cases, the rectum and anus (where waste products are stored and passed out of the body).
If the colon is removed, another way of removing waste products from the body is needed. An ileostomy is a way of achieving this.
In order to understand why an ileostomy is required and how it works, it is useful to learn a little more about the digestive system.
The digestive system
The food that we eat passes down the oesophagus (gullet) and into the stomach where it is digested. The digested food passes into the small intestine where nutrients are absorbed. It then moves into the colon where more nutrients are absorbed.
Any waste products, or undigested food, are excreted (expelled) from the colon, as stools (faeces) through the rectum and anus.
In an ileostomy, the ileum, which is the end of the small intestine, is diverted from the colon and re-routed. The ileum can be re-routed through a hole that is made in the abdomen, which is known as a stoma. An external pouch (stoma pouch) is attached to the opening to collect waste products.
Alternatively, an artificial pouch can be created inside the body which can be periodically emptied, as and when required.
Conditions that are often treated using an ileostomy include:
For more information, see Ileostomy - why it is used.
Types of ileostomy
There are four main types of ileostomy:
- loop ileostomy
- end ileostomy
- ileo-anal pouch
- continent ileostomy
These are described in more detail below.
During a loop ileostomy, a loop of the small intestine is brought out through the stoma, but the colon and rectum are not removed. The procedure is usually only used as a temporary measure, when it is necessary to remove part of the colon. Once the remaining colon has healed, it can be reconnected to the small intestine, and the stoma can then be closed.
Loop ileostomies are often used to treat bowel cancer.
During an end ileostomy, the colon and rectum are removed and the end of the ileum is brought out through the stoma and attached to an external pouch. An end ileostomy is usually permanent.
An ileo-anal pouch (also known as a J pouch) is an internal pouch that is surgically constructed from the small intestine. Ileo-anal pouches are used in cases where the colon and rectum need to be removed. The pouch is connected to the sphincter muscle, which is the muscle that surrounds the anus.
Ileo-anal pouches are becoming an increasingly popular option because people who have them do not need to wear an external pouch. However, they are not a suitable option for everyone, and have some disadvantages, such as having to frequently empty the pouch.
A continent ileostomy is similar to an end ileostomy, but rather than having to wear an external pouch, an internal pouch is created inside the abdomen. A valve is implanted into the skin so that the pouch can be emptied using a catheter (thin tube).
Continent ileostomies are not used as much as they were in the past because most people prefer to have an ileo-anal pouch. However, they maybe a useful treatment option for people who cannot have an ileo-anal pouch due to health, or technical, reasons, or in cases where an ileo-anal pouch malfunctions and needs to be removed.
How common are ileostomies?
An ileostomy is a relatively common type of digestive surgery.
Ileostomies that are used to treat digestive conditions, such as Crohn’s disease, or ulcerative colitis, tend to be carried out in younger people who are 15-30 years of age. Ileostomies that are used to treat bowel cancer tend to be carried out in older people who are 60-70 years of age.
Adjusting to life with an ileostomy can be challenging, and many people will experience both physical and psychological problems in the short to medium term after the operation.
Problems can include:
- skin irritation around the stoma,
- leakage from the stoma or pouch
- feelings of anxiety and self-consciousness
Many people adjust well to life with an ileostomy and often report that their quality of life improves following surgery. This can be particularly true in cases where a person has been living with a painful digestive condition, such as Crohn’s disease, for many years.