So, you’ve been told you need to have an ileostomy formed and the big day arrives for you to go down to theatre and have it formed. All the questions you were going to ask have flown through your ears and back out. You sit there sign the forms and get prepared for theatre and either walked down or wheeled down depending on a planned or emergency surgery.
What is an ileostomy?
An ileostomy is where your small bowel is pulled out through an opening in your tummy and stitched into place and that will have a stoma bag attached to it and that is now how your faecal matter will be exiting your body rather than its usual route.
“I am not a medical professional this is purely based from personal experience and several surgeries”
What happens after surgery?
You will awaken from your surgery in the recovery room and advised your stoma formation was successful and the surgery went well.
You will also be rather hazy and on the drug train that will help with the initial after surgery pain. Honestly it is going to hurt, I can’t lie about that. It will be painful, but the pain medication will take off the edge.
The following day
You have awoken to a new day and you are more lucid and the nurse will want to have you up and out of bed. The nurse is normally an enhanced recovery nurse and studies now show the quicker you are up and about then the quicker you will heal and get home (sounds sadistic) but it is a proven method and cuts discharge times for patients going home and recovering more quickly.
The aim on day one is to get you out of the bed and sitting up in a chair for at least half an hour and then back to bed.
Most patients have one of two options for pain relief. One is an epidural or the other is self-administered pump to top up should you be in any pain. I personally stay away from the epidural and it’s a longer recovery time and it normally numbs your abdomen and legs, so walking isn’t normally an option until it is removed. But please make your own choice depending on your pain tolerance. I prefer the pain relief pump and I am normally off of all Iv pain medication within 48 hrs and back to oral medication.
Now not everyone will wake up with one of these delightful tubes, but should your bowel be inactive and frozen then this is in until you start having normal bowel sounds and your bowel is active. If you do wake with one of these then it will be nil by mouth until normal action resumes and they will have other options of getting fluids and nutrition into your body. The Ng tube will be used to pull out any fluid collection’s and gas build up via a syringe they attach to an outlet on the tube.
Walk the line
Most gastro wards have a lovely yellow or red line that goes around the outer hub of the ward in a rectangle. The aim before discharge is to have you be able to walk that without getting breathless and experiencing pain. I have walked this many time with bits attached to me as I find I recover better at home and want to get out of the hospital.
You will have a catheter inserted when you are under anaesthetic and this will remain in place to catch your urine and measure the output until you are mobile and able to get to the toilet to pass urine as normal. Don’t be alarmed at this, you won’t feel it unless you catch the tube when moving on the bed.
You will wake up and have one or maybe two drains attached to you that have the tube stitched into your abdomen with a bottle or drainage pack attached to the bottom. This is purely to drain any fluid or excess blood from your abdomen caused by the initial surgery. Sometimes these are removed quickly or on the day of discharge as long as the drain isn’t draining. My advice for when having these removed is to have oral pain relief half hour prior to removal. The pain is a weird one having these removed, it’s like a pressure and then a pop and it’s all over and removed. The site is dressed and left to heal on its own.
All expelled bodily functions are monitored
So, you are thinking yes, the catheter has gone and that’s a step forward to going home “It’s a brilliant step”. However once removed you will still have to pee in a pot until they are happy with the tests run on that and your output is in conjunction with what you are taking in with fluids. No, you can’t cheat. This is essential and needs to be monitored to make sure it is deemed safe for you to be sent home.
Your ileostomy output Is monitored until the day of discharge. They will not discharge you until your output has reached a porridge like consistency and the output is in line with what you are in-taking. There is food to help with this and that will be on a following post.
First bag change
If this is your first stoma then apologies as this will be daunting for you. General consensus from my experience is that if you can’t change your bag then discharge won’t be possible until you have a handle on the change. The stoma nurse will sit with you and show you how to change the appliance. Should you not feel comfortable with changing it then they will do that for you. The stoma will not be hurt by you changing it. It has no feeling. It may take several attempts but once you have mastered changing it yourself then that will be a weight off of your mind.
It is normal to have the stitches removed from around the ileostomy site prior to discharge. This does not hurt and it’s better to have them removed as healing tissue can make them pull tight and cause discomfort. Please make sure you speak to your stoma nurse about this as some issues with leaking stomas and sore sites post-op are related to stitches not being removed and healthy tissue growing over the stitches.
Track suit bottoms, leggings or good old-fashioned pyjamas will be your friend as they are light and don’t impact the surgery sites and rub on healing wounds.
Due to the surgery and risk of blood clots due to bed rest then these are injected once a day to thin your blood and prevent the risk of blood clots. You will also have to wear teddy stockings both for your entire hospital stay and for a month after discharge at home. They will also send you home with a 4-week supply of these to inject daily with a waste disposal for the needles.
For you to be discharged you have to have a collective all clear from your consultant, surgeon and stoma nurse. Your stoma nurse has the final say and you won’t be discharged until she agrees that you are ok with your stoma and with its output and you are eating well.
I am hoping you found this informative and not to daunting.
Louise aka CrohnsFighting Xx