An ileostomy is a surgical procedure that creates an opening through the abdominal wall for waste to pass through, bypassing the large intestine, rectum, and anus. Digested food collects in an external pouch.

An ileostomy can also generally refer to living with a stoma from the ileum (the final, or lower, part of the small intestine).

Doctors recommend an ileostomy if substantial damage to certain parts of the digestive tract prevents it from functioning.

An ileostomy can be temporary or permanent, depending on the medical reason. If temporary, you can later have an ileostomy reversal surgery to reconnect your small intestine to your large intestine or rectum, depending on your circumstances.

Keep reading to learn more about the ileostomy procedure, what to expect during recovery, and lifestyle practices you may need to follow to care for your ileostomy.

An ileostomy creates a small surgical opening, known as a stoma, in the abdominal wall that allows the small intestine’s ileum to pass through.

During the procedure, the surgeon will stitch the end of the small intestine to the stoma to keep it in place.

They typically attach a pouch to your skin where digested food will collect. Doctors may refer to this digested food as ileostomy output, or succus.

Ileostomy output differs from waste because it has not passed through the large intestine. It can have a porridge-like consistency. Compared to stool, it contains more liquid and may also include partially digested food particles.

If your ileostomy is temporary, your intestinal tract can be reattached inside your body once healing occurs.

For a permanent ileostomy, your surgeon removes or bypasses your rectum, colon, and anus. In this case, you’ll have a pouch that permanently collects your output. It may be internal or external.

Types

Depending on your circumstances, you may be able to have either an external or internal pouch. These include:

  • Brooke ileostomy: This is the most common type of ileostomy that empties into an external pouch. Unlike with a bowel movement, you cannot control when the ileostomy output flows into the external bag, known as an ostomy bag. You empty the pouch when it fills, usually a few times daily.
  • Kock ileostomy, K-pouch, or continent ileostomy: With this type of ileostomy, a surgeon uses part of your small intestine to form an internal pouch with an external stoma that serves as a valve stitched into the abdominal wall. You insert a flexible tube through the stoma and into the pouch a few times per day. You expel output through this tube.

The procedure a doctor recommends for you can depend on your health history and whether or not your ileostomy is permanent.

You may need an ileostomy if certain parts of your digestive tract become damaged and can no longer function to digest food and eliminate waste from your body.

Health conditions that may require an ileostomy include:

  • Crohn’s disease, a type of IBD that can involve inflammation and scarring along any part of the digestive tract
  • ulcerative colitis, a type of IBD that causes inflammation, sores, and scarring in the large intestine and rectum
  • a tumor in the lower digestive tract, such as from rectal or colon cancer, but it can also result from cancer that has spread from another location in the body
  • an inherited condition called familial adenomatous polyposis, in which polyps form in the colon and can lead to cancer
  • congenital structural issues with the intestines, such as Hirschsprung’s disease
  • injuries or accidents with internal damage that involve the intestines

Surgeons recommend an ileostomy if damage to the digestive tract occurs in:

  • the top part of the large intestine
  • the end part of the small intestine
  • the entire large intestine

Otherwise, if the intestinal damage affects only a portion of the large intestine, they may recommend a colostomy instead. This procedure is similar to an ileostomy, except the stoma is created for the large intestine rather than the small intestine.

If your ileostomy is planned, your surgical team will provide instructions on preparing for your ileostomy surgery. Preparations may include:

  • following a clear liquid diet
  • not eating for 12 hours before surgery
  • using laxatives or enemas, if prescribed, to empty your intestines
  • showering or cleaning your body the day of your surgery
  • planning for a hospital stay

Your specific pre-surgical preparations may vary based on your situation and surgical team. If you have emergency ileostomy surgery, you may not have to follow all or any of these steps.

If your ileostomy is planned, you will likely also meet with an ostomy nurse, also known as an enterostomal therapy nurse (ET nurse), to learn what to expect in caring for your stoma.

They may also help the surgeon decide where to place the stoma for your comfort as well as ease in managing it yourself.

An ileostomy is performed in a hospital under general anesthesia.

The surgery can be open or laparoscopic, using smaller cuts and lighted instruments. You will know before the surgery which method is recommended for your condition.

If needed, your surgeon may also remove damaged portions of your digestive tract or your entire rectum and colon. This is known as a proctocostomy with an ileostomy.

For a standard ileostomy, the surgeon makes a small incision that will be the site of your ileostomy. They’ll pull a loop of your ileum through the incision. This part of your intestine is turned inside out, exposing the inner surface. It’s soft and pink, like the inside of a cheek. The part that sticks out is called a stoma. It may protrude up to 2 inches.

If you are having K-pouch surgery, your surgeon will use some of your small intestine to form a pouch for your output to collect.

Ileostomy surgery is a major surgery. You may be hospitalized for a few days, a week, or longer. This exact time can depend on how long it takes your digestive tract to begin digesting food again.

On average, it takes about 6 to 8 weeks to recover fully from the surgery. During this time, you may have restrictions on lifting and physical activity, but depending on your specific work and the amount of physical activity it requires, you may be able to go back to work with accommodations.

Right after surgery

When you wake up from surgery, you may have a tube extending down your nose and into your stomach, known as a nasogastric tube (NG). It can help drain the contents of your stomach and stimulate digestion.

Your surgical team typically restricts food and liquid right after surgery to allow your digestive tract to heal. During this time, you may receive pain medications and any other medications you typically take through an intravenous (IV) line.

In the days after surgery

After surgery, your team may recommend a slow transition to an adjusted diet:

  • When you are cleared to eat clear liquids, you can usually begin to take medications by mouth.
  • Slowly, you’ll be able to eat a full liquid diet.
  • If you tolerate a liquid diet, they may clear you for eating solid, low fiber foods as your bowels adjust to the changes.

Your care team may recommend smaller, more frequent meals as your body adjusts, and you may also still receive IV fluids during your hospital stay.

You may also notice excessive intestinal gas, especially if you had laparoscopic surgery. Depending on the type of bag you are wearing, it may build up inside. You can usually release gas by opening the bag slightly. You may also have gas pain in your abdomen, particularly if your digestive tract isn’t yet passing gas into the bag.

Your care team typically monitors and measures your ileostomy output. Once your output (of both liquid and gas) is normal, you may be able to leave the hospital. However, it can sometimes take a few days for your bowels to adjust to passing gas and output after surgery.

Some practices that may help stimulate your digestive tract include:

  • Walking: Moving around after surgery can help stimulate your digestive tract, help move gas and output through your body, and support your recovery.
  • Chewing gum: Chewing gum stimulates the gastrointestinal reflex, which promotes the muscle contractions that move food through the digestive tract.

Wound care and ostomy management

You typically receive education on caring for your stoma and the skin around it. Digestive enzymes in your ileostomy output can irritate your skin, so you must keep the area clean and dry. Beginning while you’re in the hospital, an ET nurse can help you learn to take care of your stoma.

This may include:

  • changing your ostomy bag with or without help every few days
  • using specific medical supplies to clean the skin around your stoma
  • learning to check the skin around your stoma for irritation or sores
  • using specific medical supplies to help heal any sores that may develop on your skin
  • learning who to contact if you experience any issues, once discharged from the hospital
  • wearing clothing that doesn’t constrict your stoma, such as loose, high-waisted bottoms

Depending on your insurance plan, you may have continued appointments with an ostomy nurse or receive limited home care services as you learn to take care of your stoma.

Some people develop post-operative ileus in the days after abdominal surgery. An ileus occurs when the movement of your digestive tract is interrupted, even though no physical blockage is present. It can have symptoms that may include:

  • nausea
  • vomiting
  • not passing gas
  • abdominal bloating, pain, or tenderness

If you develop ileus, your care team may:

  • stop food and water
  • give you anti-emetic medication to reduce nausea
  • put in an NG tube to drain your stomach contents
  • address electrolyte imbalances, which may contribute to ileus
  • reduce opiate pain medications, which may contribute to ileus
  • treat any infection, if applicable

There isn’t a cure for ileus, but research suggests that chewing gum may help stimulate the digestive tract.

For many people, an ileostomy can be lifesaving or give remission from IBD symptoms.

However, there are some ileostomy-specific health complications that it’s important to be aware of:

Irritated skin around the stoma

If your output comes into too much contact with the skin around your stoma, it can cause irritation. This can happen if you cut the opening on your bag too wide or if there isn’t a good seal.

Your doctor or ostomy nurse can recommend a medicated topical spray or powder to heal this irritated skin. You can also try different types of wafers, as well as ostomy pastes or rings, to help strengthen the seal and prevent irritation.

Leaks

Skin irritation can also make getting a good seal around your bag more difficult. If this happens, some of the contents of your bag may leak, especially if it is very full. If you often have leaks, it may mean you need to change your bag earlier. It’s best to talk with your ostomy nurse about frequent leaks.

To prevent leaks, it’s also usually recommended to avoid eating before bed to limit output and to empty your bag right before you go to sleep.

Sometimes, trying a different ostomy paste or bag may help you find one that works better for your body. You can usually contact ostomy product manufacturers for free product samples. Your ostomy nurse may also request these for you.

Pressure ulcers

If you use an ostomy belt to hold your bag in place and wear it too tightly, you can develop pressure ulcers. If this happens, it’s best to talk with your ostomy nurse.

In addition to treating ulcers, they may recommend alternatives to an ostomy belt, such as an ostomy wrap. However, wraps are usually sold by third-party retailers and are not covered by insurance.

Dehydration and electrolyte imbalances

Because your large intestine is not working to reabsorb liquid from your waste, you may lose water more quickly and need to drink more fluids to compensate. It’s best to drink 8 to 10 (8-ounce) glasses (about 2 liters) of fluids every day.

The risk of dehydration increases if you lose additional fluids through vomiting, sweating, or diarrhea. With an ileostomy, diarrhea typically involves having much more output than usual.

You’ll need to replenish lost water, potassium, and sodium and seek medical attention for severe dehydration or electrolyte imbalances. You may need to receive these electrolytes through an IV line.

Blockage

It’s possible to develop a full or partial blockage of your stoma. Symptoms can include:

  • only passing small amounts of output and gas into your ostomy bag
  • not passing any output or gas into your ostomy bag
  • nausea and vomiting
  • abdominal pain

A complete blockage usually requires urgent medical attention to clear the blockage. It’s best to contact your stoma nurse for advice.

If the protruding part of your small intestine is swollen, try cutting a bigger opening in the seal around it to give extra space.

If you think you may have a partial blockage from something you’ve eaten and you don’t have nausea or vomiting, you could try:

  • switching to a liquid diet
  • walking
  • applying a heating pad or sitting in a warm bath
  • massaging the area around your stoma

While there isn’t any scientific research to support it, some people report that drinking a small amount of carbonated cola may help pass a partial blockage. However, carbonated beverages may increase gas, and it’s usually recommended to avoid them with an ileostomy.

Extended-release medications

Extended-release medications may not fully absorb if you have an ileostomy. This is because your digestive tract is shorter than it was before.

If you take an extended-release medication, talk with a doctor about an alternate formulation.

Odor

Some people may experience odor with their ostomy bag or output. Some things that may help include:

  • using bag deodorizer products (which are usually covered by insurance), including drops or tablets you place in the bag to neutralize odor
  • avoiding foods with a strong odor, like eggs, fish, garlic, and onions
  • eating foods that help reduce odor, such as yogurt, buttermilk, and cranberry juice
  • not chewing gum or using a straw, which can both increase gas
  • avoiding alcohol and tobacco, which can increase odor
  • eating slowly and not skipping meals

You may need to adjust your lifestyle and diet if you have an ileostomy.

Lifestyle changes

Getting used to living with an ileostomy can be an adjustment both physically and mentally.

Still, it’s important to note that you can do most things with an ileostomy that you could do before you had one. This includes:

  • dating
  • having sex
  • going swimming
  • taking baths
  • playing sports
  • eating in restaurants
  • traveling

Some people seek help from an ostomy support group. Meeting other people who’ve returned to regular activities after surgery can help ease any anxieties. Others may talk with a mental health specialist about their concerns.

While not essential, you might consider adaptive clothing or products designed for people with ostomies. These may minimize the appearance of your ostomy bag through your clothing or provide additional support for certain activities, like swimming. Options can include:

  • an ostomy wrap or belt that you can wear under your clothing to hold the bag securely to your body
  • ostomy adaptive clothing with pockets for the ostomy bag
  • undergarments with pockets to hold your ostomy bag
  • swimwear designed for people with ostomy bags

Your ostomy nurse is also a good resource.

Diet

Your care team may recommend avoiding or limiting high fiber foods that can contribute to a blockage. These may include:

  • nuts and seeds
  • corn
  • beans and legumes
  • berries
  • fibrous skin from fruits and vegetables (for example, grape, apple, zucchini, and cucumber skin)

Some people may develop blockages from these foods, while others may be able to eat them safely in small amounts if they chew them well or blend them. If you’re trying a fibrous food, it’s best to eat a small amount, chew it well, and see how you tolerate it.

The J-pouch procedure is an alternative to an ileostomy that may be performed if you’ve had your entire colon and rectum removed. In this procedure, the doctor creates an internal pouch from the ileum that is then connected to the anal canal, allowing you to expel your waste through the usual route with no need for a stoma.

An ileostomy will not change how you urinate. Your urinary system is separate. However, with an ileostomy, you will not have bowel movements.

Instead, ostomy output collects in an external or internal pouch, which you must empty a few times a day.

Having an ileostomy does not affect your life expectancy. However, the underlying health condition that required an ileostomy may affect your life expectancy.

After a permanent ileostomy, you usually do not need additional surgeries. However, this may vary depending on the reason for your ileostomy.

However, people with a temporary ileostomy may choose to have their ileostomy surgically reversed at a later date, usually 6 to 8 months after their initial ileostomy surgery.

Ileostomy surgery brings a portion of the small intestine out through an opening in the abdominal wall to bypass the large intestine and rectum. It’s a major surgery that requires staying in the hospital for at least a few days.

An ileostomy can be temporary or permanent.

You may need to change your eating habits to prevent complications.

Resources and support are available to help you live well with an ileostomy and care for your stoma.

After you recover from surgery, you can usually go back to your typical activities from before surgery.