Ileostomy Care

The following guidelines will help make care of your ileostomy easier. Keep this information close by for quick reference.

Helpful hints

  • Eat a well-balanced diet on a regular schedule. Drink at least 6 to 8 glasses of fluids daily.
  • To avoid feeling hungry, try eating 6 small meals a day instead of 3 large ones. Eat a light snack before bedtime.
  • To avoid gurgling sounds, eat solid foods first on an empty stomach before drinking liquids.
  • If you eat red beets, cherry gelatin, or cherry soft-drink mixes like Kool-Aid, the discharge from your stoma may be red. This is normal. These foods do not lose their color during digestion.
  • Foods like fish, onions, garlic, broccoli, asparagus, and cabbage produce odor. Although your pouch is odor-proof, if you eat these foods, you may notice a stronger odor when emptying your pouch. If this is a concern, you may want to limit these foods in your diet.
  • Eating parsley with meals may lessen the odor of the stoma discharge. Yogurt and buttermilk are also good natural food deodorizers.
  • Do not try to reduce discharge from your stoma by skipping meals. Your ileostomy will keep working whether you eat or not. An empty stomach can cause nausea and produce gas.
  • If you feel sick to your stomach, take a few sips of tea or water, then eat a soda cracker or saltine cracker immediately.
  • If you lose too much fluid through your stoma, sodium and potassium levels in your body can change. This may lead to problems. To keep sodium and potassium at the proper levels, eat foods that are high in sodium and potassium each day (see chart below).
  • Try drinking tea when you have an upset stomach, increased liquid, or cramps. Tea helps reduce spasms and soothes an upset stomach. It also contains potassium, which is often lost in increased liquid output.
  • Pretzels can help to decrease high liquid output and can replace lost sodium. Other foods that may help thicken the stool are peanut butter, baked potatoes, baked apples, applesauce, pudding, marshmallows, bread, rice, and tapioca.
  • If you lose too much fluid through a high liquid output, or if you don’t take in enough fluid, dehydration (dee-hy-DRAY-shun) may occur. Signs of dehydration include dry mouth, dry skin, thick stool, decreased urination, and light-headedness. If you have these symptoms, increase the amount of fluid you drink, especially water. If the symptoms are severe or last longer than 2 or 3 days, call your doctor.
  • To prevent dehydration, drink more fluids when you exercise and in hot weather.
  • To replace sodium and potassium quickly, keep an electrolyte drink (like Gatorade) on hand. The electrolyte drink can be frozen on sticks for a refreshing treat.
  • If you have cramps and think your ileostomy may be blocked, take a hot shower. Let the hot water run on your back for about 15 minutes. If the cramps continue, call your doctor.
  • Enteric-coated medication will enter your pouch undigested. Ask your doctor or pharmacist for medication that is not enteric-coated. Liquid medication is best.
  • Birth control pills also may enter your pouch undigested. Check with your doctor if you take birth control pills.

Applying the pouching system

To apply your pouch, follow these steps:

  1. Place all your equipment close at hand before removing your pouch.
  2. Wash your hands.
  3. Stand or sit in front of a mirror. Use the position that works best for you. Remember that you must keep the skin around the stoma wrinkle-free for a good seal.
  4. Gently remove the used pouch (1-piece system) or the pouch and old wafer (2-piece system). Empty the pouch into the toilet. Save the closure clip to use again.
  5. Wash the stoma itself and the skin around the stoma. Your stoma may bleed a little when being washed. This is normal. Rinse and pat dry. You may use a wash cloth or soft paper towels (like Bounty), mild soap (like Dial, Safeguard, or Ivory), and water. Avoid soaps that contain perfumes or lotions.
  6. For a new pouch (1-piece system) or a new wafer (2-piece system), measure your stoma using the stoma guide provided in each box of supplies (Fig. 1).
  7. Trace the shape of your stoma onto the back of the new pouch or the back of the new wafer (Fig. 2). Cut out the opening (Fig. 3). Remove the paper backing and set it aside.
  8. Optional: Apply a skin barrier powder to surrounding skin if it is irritated (bare or weeping), and dust off the excess.
  9. Optional: Apply a skin-prep wipe (such as Skin Prep or All-Kare) to the skin around the stoma, and let it dry. Do not apply this solution if the skin is irritated (red, tender, or broken) or if you have shaved around the stoma.
  10. Optional: Apply a skin barrier paste (such as Stomahesive, Coloplast, or Premium)
    around the opening cut in the back of the pouch or wafer. Allow it to dry for 30 to 60 seconds.
  11. Hold the pouch (1-piece system) or wafer (2-piece system) with the sticky side toward your body. Make sure the skin around the stoma is wrinkle-free. Center the opening on the stoma, then press firmly to your abdomen (Fig. 4). Look in the mirror to check if you are placing the pouch, or wafer, in the right position. For a 2-piece system, snap the pouch onto the wafer. Make sure it snaps into place securely.
  12. Place your hand over the stoma and the pouch or wafer for about 30 seconds. The heat from your hand can help the pouch or wafer stick to your skin better.
  13. Add deodorant (such as Super Banish or Nullo) to your pouch. Other options include food extracts such as vanilla oil and peppermint extract. Add approximately 10 drops of the deodorant to the pouch. Then apply closure clamp. Note: Do not use toxic chemicals or commercial cleaning agents in your pouch. These substances may harm the stoma.
  14. Optional: For extra seal, apply tape to all 4 sides around the pouch or wafer, as if you were framing a picture. You may use any brand of medical adhesive tape.
  15. Change your pouch every 5 to 7 days. Change it immediately if leakage occurs.
  16. Wash your hands. If you are wearing a 2-piece system, you may use 2 new pouches per week and alternate them. Rinse the pouch with mild soap and warm water and hang it to dry for the next day. Apply the fresh pouch. Alternate the 2 pouches like this for a week. After a week, change the wafer and begin with 2 new pouches. Place the old pouches in a plastic bag, and put them in the trash.

Tips for ileostomy care

Applying Your Pouch

  • You may stand or sit to apply your pouch.
  • Keep the skin where you apply the pouch wrinkle-free. If the skin around the pouch is wrinkled, the seal may break when your skin stretches.
  • If hair grows close to your stoma, you may trim off the hair with scissors, an electric razor, or a safety razor.
  • Always have a mirror nearby so you can get a better view of your stoma.
  • When you apply a new pouch, write the date on the adhesive tape. This will remind you of when you last changed your pouch.

Changing Your Pouch

  • The best time to change your pouch is in the morning, before eating or drinking anything. Your stoma can function at any time, but it will function more after eating or drinking.

Emptying Your Pouch

  • Empty your pouch when it is one-third full (of urine, stool, and/or gas). If you wait until your pouch is fuller than this, it will be more difficult to empty and more noticeable.
  • When you empty your pouch, either put toilet paper in the toilet bowl first, or flush the toilet while you empty the pouch. This will reduce splashing. You can empty the pouch between your legs or to one side while sitting, or while standing or stooping. If you have a 2-piece system, you can snap off the pouch to empty it. Remember that your stoma may function during this time.
  • If you wish to rinse your pouch after you empty it, a turkey baster can be helpful. When using a baster, squirt water up into the pouch through the opening at the bottom. With a 2-piece system, you can snap off the pouch to rinse it. After rinsing your pouch, empty it into the toilet.
  • When rinsing your pouch at home, put a few granules of Dreft soap in the rinse water. This helps to lubricate and freshen your pouch.
  • The inside of your pouch can be sprayed with non-stick cooking oil (Pam spray). This may help to reduce stool sticking to the inside of the pouch.

Bathing

  • You may shower or bathe with your pouch on or off. Remember that your stoma may function during this time.
  • The materials you use to wash your stoma and the skin around it should be clean, but they do not need to be sterile.

Wearing Your Pouch

  • During hot weather, or if you perspire a lot in general, wear a cover over your pouch. This may prevent a rash on your skin under the pouch. Pouch covers are sold at ostomy supply stores.
  • Wear the pouch inside your underwear for better support.
  • Watch your weight. Any gain or loss of 10 to 15 pounds or more can change the way your pouch fits.

Going Away From Home

  • A collapsible cup (like those that come in travel kits) or a soft plastic squirt bottle with a pull-up top (like a travel bottle for shampoo) can be used for rinsing your pouch when you are away from home. Tilt the opening of the pouch at an upward angle when using a cup to rinse.
  • Carry wet wipes or extra tissues to use in public bathrooms.
  • Carry an extra pouching system with you at all times.
  • Never keep ostomy supplies in the glove compartment of your car. Extreme heat or cold can damage the skin barriers and adhesive wafers on the pouch.
  • When you travel, carry your ostomy supplies with you at all times. Keep them within easy reach. Do not pack ostomy supplies in baggage that will be checked or otherwise separated from you, because your baggage might be lost. If you’re traveling out of the country, it is helpful to have a letter stating that you are carrying ostomy supplies as a medical necessity.
  • If you need ostomy supplies while traveling, look in the yellow pages of the telephone book under “Surgical Supplies.” Or call the local ostomy organization to find out where supplies are available.
  • Do not let your ostomy supplies get low. Always order new pouches before you use the last one.

Reducing Odor

  • Limit foods such as broccoli, cabbage, onions, fish, and garlic in your diet to help reduce odor.
  • Each time you empty your pouch,carefully clean the opening of the pouch, both inside and outside, with toilet paper.
  • Rinse your pouch 1 or 2 times daily after you empty it (see directions for emptying your pouch and going away from home).
  • Add deodorant (such as Super Banish or Nullo) to your pouch.
  • Use air deodorizers in your bathroom.
  • Do not add aspirin or mouthwash to your pouch. Even though these products can help prevent odor, they could cause ulcers on your stoma.

When to call the doctor

Call the doctor if you have any of the following symptoms:

  • Severe cramping, nausea, and/or vomiting lasting more than 2 hours
  • Swelling of your stoma to more than 1/2-inch larger than ususal
  • Pulling inward of your stoma below skin level
  • Excess bleeding from the stoma
  • Severe watery discharge from the stoma that has a bad odor and lasts more than 5 to 6 hours
  • Unusual, strong odor from the stoma that lasts more than 1 week
  • Purple, black, or white stoma
  • Severe skin irritation or deep ulcers
  • Bulging or other changes in your abdomen

My doctor’s name:


_____________________________________________________________________

My doctor’s telephone number:


_____________________________________________________________________


When to call your ostomy nurse

Call your ostomy/enterostomal therapy (ET) nurse if any of the following occurs:

  • Frequent leaking of your pouching system
  • Change in size or appearance of your stoma, causing discomfort or problems with your pouch
  • Skin rash or rawness
  • Weight gain or loss that causes problems with your pouch

My ET/ostomy nurse’s name:

__________________________________________________________________

My ET/ostomy nurse’s telephone number:

__________________________________________________________________

 
Foods rich in sodium and potassium

 

​Types of Food Foods Rich in Sodium ​Foods Rich in Potassium
Meat and Seafood
  • Smoked, cured, corned, pickled, pressed, dried, canned
  • ​Goose, sardines, scallops, trout (most meats, poultry, and fish)
​Vegetables
  • Beets, Swiss chard, lima beans, spinach, white turnips, sauerkraut
  • Potatoes, tomatoes, peas, raw carrots, pumpkins, bamboo shoots, cooked spinach, Chinese cabbage
​Fruits
  • ​Dried fruits (raisins, figs, apricots, and prunes)
  • Caution: be sure to chew these foods well because they are hard to digest
  • ​Dried fruits, fresh apricots, and bananas
​Cheese
  • ​Ally types
​Beverages
  • ​Milk, orange drink, cider, Gatorade, Sports Aid
​Snack Foods
  • ​Pretzels, potato chips, crackers, popcorn, coconut, nuts
  • Caution: popcorn, coconut, and nuts must be chewed very well and eat in small amounts
​Miscellaneous
  • ​Meat extracts, meat tenderizers, bouillon, broth powders, soups, gravies, sauces, ketchup, soy sauce, olives, pickles, relish, brown sugar, sweetened condensed milk
  • ​Chocolate, molasses, nuts, tea
  • Caution: nuts must be chewed very well and eaten in small amounts.

 

Your pouching system

Equipment (check one) ____ 1-piece ____ 2-piece

Wafer ______________________________________________________________________________

Pouch ______________________________________________________________________________

Paste (optional) ______________________________________________________________________________

Powder (optional)______________________________________________________________________________

Skin prep (optional) ______________________________________________________________________________

Deodorant ______________________________________________________________________________

Closure clip ______________________________________________________________________________

Tape (optional) ______________________________________________________________________________

Other ______________________________________________________________________________

Suppliers

UPMC Home Medical Equipment 1-800-247-6333

Other ___________________________________________________________________________

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