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Ileo-Pouch Anal Anastomosis Guide
Managing a Temporary Stoma
When you are admitted to the hospital, there will be many new things
for you to learn about and do. An Entrastomal Therapy (ET) nurse
will introduce you to some of these and assist you as you learn.
The stoma will be created at or near the site mark. You will find
that the end of the intestine coming out from the stoma protrudes
slightly from the abdomen, about a half an inch.
The stool that is secreted from your bowels through the stoma is a loose liquid mixture of digested food. To collect the stool and protect the skin from its acidity, a specially made appliance bag is used. The bag may be designed in one or two pieces. There are other assistive devices that may also be used to enhance the bag's function.
After the surgery, the ET nurse will teach you how to care for your stoma. Your personal appliance bag size and additional material will also be determined.
When attaching the bag, first a barrier is applied to hold the bag to the skin. The barrier can be in the form of a spray or barrier wipes. The other important function of the barrier is to protect the skin from the enzymes and acidity of the stool. If the skin does come in contact with the stool, it will become red and painful and will eventually erode. Further skin protection is provided by pastes that are used as a type of caulking.
Because of the large volume of stool an ileostomy produces, the bag needs to be emptied several times a day. This large volume of stool also means that large amounts of fluid and electrolytes are lost. It is important to drink extra fluids each day, some of which are electrolyte rich. Other aspects of the diet are important in the function and care of an ileostomy as well. A list of foods and their varying effects are provided. It is important to become familiar with which foods can cause gas and odor or cause a change in stool thickness.
A few supplies will be provided upon your hospital release. Pharmacies as well as medical supply stores or mail order companies carry needed supplies. Some insurance companies will also assist with payment of these supplies. Names and addresses of these insurance companies will be provided to you.
J Pouch Irrigation
The purpose of pouch irrigation is to gradually expand the reservoir or pouch capacity, strengthen the anal sphincter muscles and cleanse mucus from the lower bowel. This irrigation should begin no sooner than 14 days after surgery and then performed daily until the ileostomy is closed by surgery.
The supplies needed for irrigation include an empty enema bottle, a water soluble lubricant, and warm water from the faucet.
The steps of irrigation are as follows:
- Fill the enema bottle with 50cc (1/4 cup) of water.
- Lubricate the tip of the enema bottle.
- Carefully insert the tip approximately two inches into the anus.
- Gently push the water from the bottle into the pouch. If the water drains at the tip, advance the tip a little more and continue to instill the water gently.
- Remove the enema bottle from your anus.
- Try to hold the water as long as you can, up to ten minutes if possible, while doing a pelvic floor muscle exercise, and then expel the water into the toilet.
- If you are able to hold the water easily, increase the amount by 50cc each week until you reach a maximum of 250cc. Do not instill more than 250cc into your pouch at a single time. Note that the water you expel may be only a small amount, since your body will absorb some of it.
Remember, each time you put water into the reservoir, keep it inside (up to ten minutes) by doing a pelvic floor muscle exercise. This will strengthen your sphincter muscle.
Also note that as the volume of water increases there will be a tendency for some of it to reach the stoma in your abdomen and be released through the stoma opening. Do not be alarmed, as this is normal.
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