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Relief for the intestine

© Ben Schonewille / istockphoto

To many patients, an ileostomy sounds like a huge hindrance. But with the right approach it can provide regularity and security.

Most people who have received an ileostomy (artificial bowel outlet or intestinal stoma) have colorectal cancer or are suffering from Crohn's disease. But ileostomies may also be necessary in severe acute inflammations of the intestinal mucosa. "An ileostomy is meant to relieve the intestine," says Dr. Philipp Manegold, senior physician in the Department of General and Visceral Surgery at the Medical Center – University of Freiburg. Generally speaking there are two different types of ileostomy: permanent and temporary. In the case of a permanent ileostomy, the patient will carry around a stoma pouch on his body for his whole life. In a temporary ileostomy, the outlet is positioned externally in order to preserve a segment of the intestine until after the disease is gone. This can be reinserted after healing.

In some colon cancer patients, the tumor is located in the rectum. The surgeon removes the affected intestinal section, along with the growth, in an operation. But if cancer attacks the sphincter, that cannot be preserved. "Then an ileostomy has to be created," says Dr. Manegold. For this purpose, the end of the intestine is guided outwards to the abdominal wall. "Surgically, an opening is made on the abdomen, into which the end of the intestine is sewn," explains Dr. Manegold. This intestinal stoma (ileostomy) leads the stool outwards and into a pouch, which is attached to the abdominal wall and collects the excretions. If on the other hand the sphincter can be retained during the operation, and the intestines can later be re-connected, it makes sense to protect the newly made intestinal connection (anastomosis) via a temporary ileostomy. When the intestine has healed, this so-called "protective stoma" is removed.

Before an operation, patients already receive detailed information on the topic. But still, questions often arise afterwards: How do I change the pouch? What kind of implements do I need to connect the pouch, and what do I have to be careful about while showering? A stoma therapist provides help and tips as to the right approach. At the Medical Center – University of Freiburg, stoma therapist Angelika Kohlrepp advises patients on all questions relating to the topic, and provides guidance on self-reliant stoma care.

A stoma pouch is no problem when showering. When swimming, you can wear a bathing suit for protection. In general, all sports are open to a stoma wearer. For various activities there are tools available that can give the patient more security.

There are also no major limitations to diet. Stoma carriers may continue to eat all the foods they like. "In order to avoid digestive problems, one should eat several small meals rather than a few large ones," says Dr. Manegold. Avoiding greasy fare and preparing your food carefully also helps. Often, the mere idea of having to live with an ileostomy is at first perceived as a huge limitation. However, with the right advice and support, especially in the initial phase, most fears and doubts can be eliminated. In some cases, the ileostomy even means improved quality of life.