Types of ostomies: Ileostomy

The ileum, a segment of small intestine most proximal to the large intestine, is used for both fecal and urinary diversions.

Characteristics of an ileostomy

Characteristics of an Ileostomy: Ielostomies are formed in the small intestine and as such patients may suffer from loose stools. These can have a watery to thicker oatmeal consistency. Pouches may need to be emptied 5-8 times per day. Patients should be instructed to watch for consistency not only in the amount of output, but for frequency. Should there be no output within a 4-hour period, patients should be instructed as to what to do and to call their caregiver. Caregivers should remind the patient's doctor and pharmacist that they have an ileostomy (requiring an adjustment to their medications) due to being more prone to blockages. Also, it should be noted, patients with an ileostomy are very prone to dehydration, which is the most common reason for re-hospitalization.

Formed in the small intestine May have watery to oatmeal consistency stool May need to empty pouch 5-8x/day Should be concerned if there is no output in a 4 hour period Should remind MD and pharmacist that they have an ileostomy (may need meds adjusted) More prone to Blockages Very prone to dehydration (number 1 reason for re-hospitalization)--need to drink 8-10 glasses of fluids/day

 

Ileal Conduit (Urostomy)

A small segment of the ileum may be used as a conduit for a urinary diversion when the bladder is removed.

There are several reasons for a patient to have a urostomy. These include the following:

Bladder cancer Neurogenic bladder Interstitial cystitis Congenital anomalies

bladder cancer, neurogenic bladder, interstitial cystitis and congenital anomalies. Looking at the diagram, the incontinent urostomy is created when the bladder has been removed and a portion of the ileum is used as a passageway (conduit) for the urine. This is not a storage area. The ureters are tunneled into the ileal segment and the distal segment is brought up to the outside of the abdomen to form a stoma. This is called an ileal conduit and is usually situated on the right lower quadrant of the abdomen. A pouch is worn at all times to collect the urine. It is important to teach the patient that it is normal to see mucous shreds in the urine. Instructions on how to maintain an acidic pH of the urine (to decrease the potential for urinary tract infections) includes the use of vitamin C and cranberry juice, and by pushing fluids.

Removal of bladder Ureters connected to segment of ileum Stoma created at one end, other end of segment is sutured

Let's take a look at some of the continent urinary diversion options.