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Allen KamravaMD · MBA · FACS · FASCRS

Colon and Rectum

Ileostomy Care and Complications

An ileostomy is a surgically created opening in the abdomen that allows stool to pass out of the body, requiring specific care to manage output and prevent complications.

Reviewed by Allen Kamrava, MD, MBA, FACS, FASCRS · Last reviewed 2025-10-12

Overview

What is an ileostomy?

An ileostomy is a surgically created opening, called a stoma, that brings the end of the small intestine (the ileum) through the abdominal wall to the surface of the skin. This allows stool to exit the body and be collected in an external pouching system. An ileostomy is created when disease or surgery prevents stool from passing through the colon and rectum in the usual way. It can be temporary, to protect a downstream surgical connection, or permanent, as is often the case after the entire colon and rectum have been removed for conditions like ulcerative colitis or familial adenomatous polyposis.

There are two main types of ileostomies:

  • End Ileostomy: The end of the ileum is brought through the skin and everted (cuffed back on itself) to create a spout that protrudes from the skin.
  • Loop Ileostomy: A loop of the small intestine is brought through the skin, and an opening is made in it. This creates two openings: one that drains stool (the proximal limb) and one that leads to the inactive part of the bowel (the distal limb). Loop ileostomies are most often used for temporary fecal diversion.

When to see a doctor

When should I seek care?

You should contact your surgeon or WOC nurse if you are experiencing any of the following:

  • Signs of dehydration, such as dizziness, dark or infrequent urination, and extreme thirst.
  • Persistently high stoma output (>1500 mL per day for more than 24 hours).
  • No stoma output for more than 4-6 hours accompanied by abdominal pain, cramping, or nausea.
  • Severe skin irritation or breakdown around the stoma that does not improve with pouching adjustments.
  • A significant change in the size or appearance of your stoma, such as a large prolapse or retraction that makes pouching difficult.
  • Signs of a parastomal hernia, such as a large bulge around your stoma.

Treatment

How are ileostomy complications treated?

Treatment depends on the specific complication.

  • High Output and Dehydration: Initial management involves oral rehydration solutions and anti-diarrheal medications. For severe cases, hospitalization for intravenous fluids may be necessary.
  • Peristomal Skin Issues: Most skin problems can be managed with the help of a WOC nurse by adjusting the pouching system, using skin barrier products, and treating any underlying fungal infections.
  • Food Blockage: Most blockages resolve with a clear liquid diet, gentle massage of the abdomen, and warm baths. If the blockage persists, you should seek medical attention.
  • Stoma Retraction, Prolapse, and Parastomal Hernia: These structural problems may require surgical repair if they are causing significant symptoms, pouching difficulties, or risk of bowel strangulation.

Self-care

How do I care for my ileostomy?

Learning to care for an ileostomy is a key part of recovery and involves several components. This is usually taught by a specialized Wound, Ostomy, and Continence (WOC) nurse.

  • Pouching System: The pouching system consists of a skin barrier (flange or wafer) that sticks to the skin around the stoma and a collection bag that attaches to the barrier. The opening in the skin barrier should be cut to fit snugly around the stoma to protect the surrounding skin from the stool output. The pouch should be emptied when it is about one-third to one-half full. The entire system is typically changed every 3 to 5 days.
  • Peristomal Skin Care: Keeping the skin around the stoma (peristomal skin) clean and dry is the most important step in preventing irritation and skin breakdown. Clean the skin with warm water and pat it dry before applying a new skin barrier.
  • Diet and Hydration: Since an ileostomy bypasses the colon, which is where most water is absorbed, the stool output will be liquid or pasty. It is crucial to drink plenty of fluids (at least 2-3 liters per day) to prevent dehydration. Certain high-fiber foods, like raw vegetables, nuts, and seeds, can sometimes cause a blockage and should be introduced slowly and chewed well.
  • Monitoring Output: The normal output from an ileostomy is usually between 500 and 1200 mL per day. Persistently high output (>1500 mL/day) can lead to dehydration and electrolyte imbalances and should be discussed with your doctor.

Frequently asked questions

Can I live a normal life with an ileostomy?
Yes. After a period of adjustment, most people with an ileostomy return to their normal daily activities, including work, exercise, and social life. The pouching systems are discreet and odor-proof, and no one will know you have a stoma unless you choose to tell them.

What is the difference between an ileostomy and a colostomy?
An ileostomy is made from the small intestine, and the output is liquid and continuous. A colostomy is made from the large intestine (colon), and the output is more formed and less frequent, similar to a regular bowel movement.

When can a temporary ileostomy be reversed?
A temporary loop ileostomy is typically reversed 2 to 3 months after the initial surgery, once healing of the downstream anastomosis has been confirmed.

References

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