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Ileo-Pouch Anal Anastomosis Guide
Following ileoanal reservoir surgery or ileostomy closure, you may experience an increase in bowel frequency. Irritation may occur from frequent wiping of the skin around the anus (perianal area). Additional irritation may occur from stool leakage and frequent contact with the perianal skin. You will therefore need to pay special attention to the skin around the anus.
Recommendations to Decrease Skin Irritation and Prevent Skin Breakdown:
- Cleanse the skin after each bowel movement using a periwash bottle or syringe filled with warm tap water and gently pat dry with soft toilet paper (Charmin Ultra).
- Apply a protective barrier cream after every bowel movement.
- Wear cotton underwear and a peri-pad (if needed) in order to absorb excess moisture and stool leakage.
- Perform Kegel exercises as instructed (refer to instructions provided).
- Your doctor may prescribe a stool bulking agent, such as Metamucil, to increase water absorption and increase stool bulk. You may also be prescribed Imodium, Lomotil or Tylenol with codeine to decrease bowel activity.
What to Avoid:
- Scratching or scrubbing perianal skin.
- Scented tissues and soaps.
- Foods that cause diarrhea or anal irritation (see Diet).
Protective Barriers for Perianal Skin:
- Bag Balm, Baza Cream (by Sween), Calmoseptine (by Calmoseptine), Citric Aid (by Sween), Double Guard (by Bard), Proshield Plus (by Health Point), Tripe Care EPB (by Smith Nephew), zinc oxide.
Try any one of these protective barriers for a minimum of seven
days before changing to a new one.
Treatment for Broken Perianal Skin:
- Mix Mycostatin powder (prescription needed) with Maalox.
- Using a cotton ball, apply mixture to broken skin and allow to dry. You may use a blow dryer on low setting.
- Apply protective barrier as listed above, or apply an incontinence spray such as Bard or Sween. Allow to dry.
- Reapply after each bowel movement. Continue protective barrier or spray until skin is healed.
- Discontinue Mycostatin and Maalox after three days.
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