Having any type of surgery, especially one which alters your body such as ostomy surgery does, is traumatic. It is ok to be upset, grieve, get angry, scared, feel as though you're the only person in the world with this type of surgery - I dare you to find an ostomate who has not had those feelings.   Yes, it will take time to adjust to your surgery, but from  experience, the more you lea about ostomies and ostomy surgery, and the more ostomates you can talk with before , during and after your surgery, the easier it becomes to accept your stoma. The best tools an ostomate can have are a sense of humour and willingness to laugh at themselves.  This will lead to a very positive outlook on life. Remember, people will always react to your emotions. If they sense that you are unhappy or uneasy with your surgery, then they are going to act the same way.   If, on the other hand, you have a positive and confident outlook on life and don't let your stoma bother you or control your life, then (in the majority of cases), other people are not going to worry about your stoma either. You own your stoma - not the other way round!  

What does an Ostomy/Ileostomy do 

An ileostomy is usually performed in the case of severe Ulcerative Colitis or Crohns Disease.  It involves removal of the colon, and in some cases, the rectum, which have been affected by the ulcers or inflammation.   It can also be a result of familial poyposis, hirschsprungs disease, a defect at birth or bowel cancer. You will have no control over when your ileostomy decides to "go" or pass gas.  You can't feel it happening normally.   The only way you know that your stoma is working is that your bag will feel start to feel full and you'll have to empty it. I usually empty mine approx 6 times a day but it varies from person to person. The gas can be a bit of a problem, I won't lie to you about that.  Altho, usually gas passes through my stoma without a sound, somehow Harriet, my stoma, just knows when I'm in a quiet meeting, etc and that is her signal to start singing out loud.  A hand pressed over the stoma can muffle the sound a bit - if that doesn't work, there's always the excuse that I'm hungry and my stomach's growling! Because of the shortened bowel length,food will pass through you much quicker than it does in "bowel intact" people. The time it takes could vary between 20 minutes to several hours following a meal depending on what you ate. It's always interesting to see what food gets digested during these times as food that is undigested can come out of you exactly the same way it looked when you ate it! Normal stool from an ileostomy is of a paste like consistency but there are times when your stool will be watery, if for instance, you haven't been eating much due to illness.  A lot of people like to thicken their stool up by eating bananas, etc.  This is fine.  Having a watery stool for a short time is fine too (as long as it doesn't go on for days! - in this case, see your doctor because it could indicate a blockage of some sort).  Just remember to drink lots of fluids at all times, because ostomates tend to dehydrate a lot quicker than "bowel intact" people because the large bowel which absorbs fluids is no longer there to do it's job. Don't be alarmed if straight after your op, your stool is watery and greenish in colour.  Apparently, this is bile and is perfectly normal. With time, as you start to introduce solid foods back into your diet, your stool will go to it's normal brownish, pasty consistency.

Choosing the right Appliance

Ok, first and foremost, there is no one appliance that is right for everybody.  It will be a matter of trial and error in most cases, before you eventually settle on the sort of appliance that you will use.   Some people prefer to use a one-piece appliance system and others swear by the two piece system.  It is simply a matter of choice and do not let anyone try and tell you that their system is better than yours. The majority of the appliances available today are odour-proof and light weight. Some are disposable and some are reusable depending on the system you choose to use. No one can tell that you are wearing an ostomy bag as it is not visible under your clothing (although I have noticed that some brands of bags tend to "rustle" a little).

Chaging your Appliance

 Here are some tips on changing your appliances.   This is taken from the "Inflammatory Bowel Disease Centre". Once again, remember, this is only a guide and whether you follow the steps to the letter is up to you.  In time, you will find your own routine which you will become comfortable with. A. 2-Piece Appliance Equipment Needed:
 

• flange
• pouch with clip
• paste (optional)
• powder(optional)
• wet/dry cloths
• measuring guide
• scissors / pen
• plastic garbage bag

1. Assemble all equipment.
2. Gently remove the appliance. Remove the flange and pouch as one piece. Save the closure clip. Dispose of the soiled appliance.
3. Remove the excess stool or mucus from around the stoma with a dry cloth. Gently cleanse the stoma and surrounding skin with a wet, warm cloth. A mild soap may be used as long as the skin is rinsed well. Pat skin dry.
4. Use a mirror to observe the stoma and skin. Apply protective powder to any sore or irritated skin areas. Remove excess powder with tissue.
5. Use the measuring guide to determine stoma size. You need to leave a small amount of space, 1/8 inch, between the opening and the stoma. Once the swelling of the stoma has subsided, measurement is generally not required.
6. Trace the measurement on the back of the flange.
7. Cut opening and remove centre white backing paper.
8. Apply a ring of paste around cut opening on the back of flange (optional) and set aside or apply the paste directly to skin around the stoma.
9. While in either a sitting or standing position, centre the flange over the stoma.  Remove the remaining white backing paper and smooth out adhesive.
10. Secure the pouch to the flange. Apply closure clip.

• pouch with clip
• paste (optional)
• powder (optional)
• wet/dry cloths
• measuring guide
• scissors / pen
• plastic garbage bag

1. Assemble all equipment.
2. Gently remove the appliance. Save closure clip if using an open-ended drainable appliance. Dispose of the soiled appliance.
3. Remove any excess stool or mucus from around the stoma with a dry cloth. Gently cleanse the stoma and surrounding skin with a wet, warm cloth. A mild soap may be used as long as the skin is rinsed well. Pat skin dry.
4. Use a mirror to observe the stoma and skin. Apply protective powder to any sore or irritated skin areas. Remove excess powder with tissue.
5. Use the measuring guide to determine stoma size. You need to leave a small amount of space, 1/8 inch, between the opening and the stoma. Once the swelling of the stoma has subsided, measurement is generally not required.
6. Trace the measurement on the back of the appliance.
7. Cut opening and remove centre white backing paper.
8. Apply a ring of paste around cut opening on the back of appliance (optional) and set aside or apply the paste directly to skin around the stoma.
9. While in either a sitting or standing position, centre the appliance over the stoma. Remove the remaining white backing paper and smooth out adhesive.
10. Apply closure clip if using all open-ended drainable appliance.

• Your stoma should be pinkish red in colour - I've heard it described as a "rose bud".  If it changes colour at all, report it to your doctor or ET nurse.
• Some people change their appliance once a week, some twice a week, some more frequently.  The average wear time is approx 3 - 5 days. However, if you don't fit this patte, DON'T WORRY. It's the usual story - everyone's different.
• If your skin under the appliance becomes itchy or sore, change your appliance immediately. It usually means that you are leaking under the appliance If, however,  the problem persists, see your ET nurse. It could be as simple a problem as you are allergic to the adhesive you're using or it could be something more.

• Enteric coated medications are one of the biggest problems for ileostomates.  The coating is designed so that the medication doesn't get absorbed until it reaches your intestines.  Subsequently, this can be a problem for ostomates in that the medication won't get absorbed and quite frequently can come out into your bag fully intact.  Always check with your doctor if he is going to prescribe this sort of medication for you.
• Some antibiotics can cause yeast infections on the skin around the stoma.
• If using diuretics, you may need to take in additional high potassium foods  as dehydration can occur due to their use.
• There will be no need for you to take laxatives. People with ileostomies rarely get constipated.
• Some people prefer to use stool thickening medications such as Lomotil or Imodium if they have a high ostomy output.  These are fine but be careful not to overuse them.

Food

Oh yes, here comes the good part.  If your ileostomy is due to UC, you will be pleased to know that however restricted your diet was before, you should now be able to eat almost anything you want to.  It is for this reason, that some ileostomates tend to put on weight after their op - I know it happened in my case.  If your ileostomy is due to CD, however, there may still be some of the same restrictions on you as there was before your operation unfortunately. When first introducing new foods into your diet, it might be best to introduce them one at a time.  Some foods can cause problems such as blockages in some people.   Common problem foods seem to be : co (esp popco), peas, nuts, fruit skins and seeds.  Other people, on the other hand, find they have no problems at all with any foods. Always remember to chew your food really well - this will minimise the chance of a blockage in most cases.As an ostomate, remember you will need extra salt in your diet to compensate for that which doesn't get absorbed by the large bowel anymore.  I have known some ostomates who literally craved salt to the point where they would sprinkle some on their hand and lick it up. Well, now we know why.As we ostomates tend to become dehydrated a lot easier than "bowel intact" people, it is very important that you drink at least 2 litres of water a day. For a quick dehydration fix, try Gatorade, Powerade or any of the "thirst quenching" drinks - they replace fluids and electolytes really quickly. GasNow, the problem with all that food that you're now allowed to eat is that some of it can and will cause gas - quite a bit of gas in fact - and where does it end up? In the bag of course!  The main problem I have with gas it at night time.  I usually wake up in the moing with the Good Year blimp on my belly!  Over time you will be able to work out for yourself which foods cause the most gas in you but for now, here's some starters:

• carbonated drinks
• chewing gum
• onions
• spicy foods
• cabbage
• cauliflower
• broccoli
• pizzas tend to do me in especially!

 Also smoking and drinking through straws can cause you to swallow huge amounts of air and in tu cause gas. Sometimes, if I have been over indulgent on the gassy foods just before bedtime the night before, there is so much gas that it causes the bag to burst and I end up in a nice mess! Hint: if that happens, the easiest thing is to have a shower to clean yourself off, put on a clean bag and change the bedsheets - a real fun activity at 4.00am in the moing when you're still half asleep! Moral of the story: DO NOT have gassy foods or drinks just before bedtime - you will probably pay for it. The good news is that most ostomates seem to be able to "train" themselves into waking up at night before the leak gets too messy. OdourOk, everybody, and I mean EVERYBODY's stool and gas smells.  But we ostomates' outputs  tend to smell worse than other people's.  I don't mean in everyday living - today's bags and appliances are odourproof so as long as there are no leaks, there is no smell, BUT it's when you empty your bag that the ostomate's anxieties tend to start, esp if you are at a friend's place or at work!  Yes, it does smell really bad but thankfully, there are some things you can do to combat it.  There are any number of deodorisers, ones that you take orally, ones that you put in the toilet or ones that you put in your bag, available to us from ostomy suppliers.  Take advantage of them.Also try to avoid foods which are known to produce odour such as: fish, onions, eggs and beans.  Capsicum and yoghurt can help reduce odour. Remember, if all else fails, just use the age old trick of striking a match in the toilet Food BlockageA food blockage means literally that. Some people are lucky enough to have never have even one but then again, I know some people who have had several. Some bits of food have become stuck in your small intestine and are unable to make their way down through the intestine and out into your bag. Signs that you may have a blockage include: watery stools, fever and/or nausea, pain and/or cramps in the stomach area, your ileostomy has stopped working or it could work almost continuously. Some home-remedies include:  Relax (if you can through the pain!) - if you can tolerate wine, have a glass - it helps relax the intestinal muscles, massage your stomach, take a hot bath or shower - this will also help relax the muscles, take a dose of Milk of Magnesia, drink some hot tea.  Some people find it beneficial to go down on all fours and position your self so that your bottom is stuck up in the air (an undignified position but apparently it does work ). If none of the above work, then seek medical attention.  Go to the doctor or to the ER department. A food blockage can become serious if left untreated. HeiasHeias around the stoma area can be a problem for some people. The reason being that your stomach muscles have now been compromised - there is literally a hole right through the stomach wall and they are therefore weaker than usual. A heia usually presents itself as a bulge at the side of your stoma and are quite painful to touch.  The skin is often red over the area too.  See your doctor immediately if you suspect you have one. So, if you are into weight lifting or have to lift heavy items at work - do it carefully!  A limit of 50 pounds is considered to be the norm for ostomates.  When playing sports, etc, there are "Heia belts" you can purchase from certain ostomy suppliers which can help minimise the risk of heias.Colostomy, Ileostomy, Rectal Pouch Diets

Purpose
Surgery is often needed to treat certain conditions of the colon (large bowel). Sometimes the surgeon must make an opening on the abdominal wall through which intestinal waste (feces) can pass. This surgery is medically known as colostomy and ileostomy. The opening itself is called a stoma. A lightweight, disposable bag is then wo over the stoma. This condition is often permanent. However, in certain cases it is a temporary detour that can be reversed at a later time. There are two forms of this surgery where a bag may not be needed. Sometimes a rectal pouch can be created from the small intestine, forming a reservoir for the stool behind the stoma. A tube is put in place so the reservoir can be emptied when needed, usually once a day. In another procedure, all of the colon is removed except for the last part of the rectum. A pouch is created from the small intestine and it is attached to the rectum so liquid stool can pass normally through the anus (opening to the outside of the body) about 3 to 7 times a day. After all of these surgeries, the stool consistency, amount, and frequency will depend on the type and amount of foods eaten. So, this diet is to help patients gain adequate control of their bowel movements. Nutrition Facts
Generally, colostomy and ileostomy patients can easily maintain a balanced diet to provide all the vitamins, minerals and calories needed for good health. In those cases where certain foods have to be restricted to control stool pattes or stool consistency, the physician may prescribe a vitamin-mineral supplementSpecial Considerations

1. Because each patient and type of surgery are different, no standard recommendations can be given for everyone. Most patients retu to a fairly normal diet. Still, a trial and error patte of eating is often necessary to identify those foods that may have an undesirable effect on the patient's stool. Then it is simply a matter of changing how much of these foods are eaten. The lists that follow are a guideline.
2. Eat foods at a regular time each day. Eating 4 to 6 smaller meals may help to promote a regular bowel patte.
3. Try eating the main dinner meal at noon and a smaller meal in the evening. This helps to reduce the stool output at night.
4. Introduce one type of food at a time to test how it affects bowel function. If it does not produce a good result, stop eating it. However, as the body heals and adjusts, the offending food may become easier to
5. tolerate, so try adding it to the diet again on several occasions before giving up on it.
6. Chew foods completely to help the digestive process. Especially avoid swallowing large pieces of leafy vegetables since they can block the stoma opening on the abdominal wall.
7. Fresh fruit may cause loose stool.
8. Drink 2 to 3 quarts of water a day. This helps to keep the stool fluid, and it also prevents dehydration. Normally, the colon absorbs water and electrolytes (substances such as sodium and potassium) from the stool, so people who have all or part of the colon removed will lose more water. Because electrolytes are also lost, do not restrict salt in the diet.
9. Maintain an ideal body weight. Extra fat in the abdominal wall can make it difficult for the stoma to function properly.
10. Colostomy patients may find that foods which caused problems before surgery continue to do so afterward.
11. During the first 4 to 6 weeks after surgery, ileostomy patients should limit foods that caused problems prior to surgery. This will reduce the chance of stoma blockage and lower the amount of gas.
12. Certain substances can change the appearance of the stool. Bile that cannot be reabsorbed in the intestine can cause a yellow or green stool color, especially when diarrhea or rapid bowel action occurs. Beets make the stool appear red; it is not blood! Broccoli, asparagus, spinach, and Pepto-Bismol can darken, even blacken, the stool.
13. Certain medications such as Imodium, Lomotil, Levsin, and Bentyl can help to slow the bowel when diarrhea is a problem.
14. Foods containing large amounts of fiber and bran should be avoided for 6 to 8 weeks after surgery. After that time, certain bulking agents such as psyllium (Metamucil), methylcellulose (Citrucel), and calcium polycarbophil (FiberCon) may help firm the stool. Only certain patients need to have a firmer stool, so do not use these agents without the physician's instructions.