Ileostomy care nurses
The following guidelines will help make care of your ileostomy easier. Keep this information close by for quick reference.
- 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:
- Place all your equipment close at hand before removing your pouch.
- Wash your hands.
- 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.
- 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.
- 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.
- 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).
- 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.
- Optional: Apply a skin barrier powder to surrounding skin if it is irritated (bare or weeping), and dust off the excess.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Change your pouch every 5 to 7 days. Change it immediately if leakage occurs.
- 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.