Ileostomy Take-Down with Ileal Pouch HF#7133

This surgery will close your ileostomy.  The stoma and skin opening will be sewn shut.  Stool will now travel into your new ileal pouch and exit through the anus.  Surgery takes about 2 hours.

 

The Day before Surgery Bowel Prep

 

A few days before you need to buy 1-bottle of magnesium citrate (10 oz).  It tastes best when chilled.  

 

The Day before Surgery

• Eat a light breakfast and you may eat lunch if you know your system will clear over the next 6 hours by drinking more fluids. 
• Drink only clear liquids (no sediment or pulp) after breakfast/lunch until 4 hours before your surgery starts.

 

•  
  • Water
  • Broth
  • Juice without pulp (apple, grape)
  • Popsicles
  • Hard candy
  • Clear Jell-O^® (no fruit, etc. in it)
  • Sparkling water or soda
  • Coffee or tea, no creamer
  • Gatorade^®
  • Crystal Light^®

 

At 6 p.m.  (It is okay to do this earlier.)

 

______   If you are passing fluid with sediment/particles into your pouching system, then drink 1/2 bottle of magnesium citrate; 5 oz.

 

______   If you are passing clear fluid (no sediment or particles) into your pouching system, no magnesium citrate is needed.

 

Shower before bed and in the morning as usual.  After each shower use the Hibiclens^® soap given to you in the clinic to gently wash your abdomen and around your pouching system.  Gently wash for 2-3 minutes, rinse well, and pat dry.  If you can shower twice and maintain a pouch seal you are comfortable with, there is no need to change your pouching system.  Bring your ostomy kit with you the hospital in case you need supplies.  We may not have your product in stock.

 

Wound Care

 

It will take at least 10-14 days for your incision to heal.  You can expect that it will be swollen, pink, sore, and may be numb and bruised with some clear pink drainage.  You may have more drainage than you had from your other incisions.  Make sure to change the bandage at least once a day and as needed.

 

When it is okay to shower, gently wash it with a mild soap and water, pat dry.  Do not soak in a bathtub, hot tub, or swim until it is healed.  Do not put lotion, powder, or ointments on the wound.

 

Watch for signs of infection.

 

• Increased redness or warmth.
• Pus-like drainage.
• Excess swelling or bleeding.
• Temperature (by mouth) above 100.4°F for two readings taken 4 hours apart.

 

Pain Relief

 

Expect to have pain after surgery.  You will have pain pills to ease the pain.

 

Diet

 

• Your diet will advance from clear to full liquids then to a soft diet.  Expect to go home on a low- residue, low-fiber, ileal pouch diet. 
• Eat 3 meals a day.  Try not to eat between meals.  This can help regulate bowel movements.
• Eating after an early evening meal produces more bowel movements at night.  Many people choose to eat a larger midday meal and a smaller early evening meal to decrease bowel movements at night.
• After 2 weeks you will start a probiotic in pill form, such as; Florajen^® #3, Culturelle^®, or VSL^®#3DS.  You will start a multivitamin with iron that you will take for the rest of your life.
• At your 2-week doctor visit your diet will be adjusted to include more fiber, this helps to decrease the number of stools each day.  Fiber bulking agents you may be asked to try are Benefiber^®, Metamucil^®, Konsyl^® or their generic equals.  You may be asked to try Imodium^® or Lomotil^® to help slow stools, especially if you are traveling or will not be near toilets.
• As you know, it will be by trial and error that you find foods that work best for you to firm up your stools.  Remember this is a learning process. It varies from person to person on how long this process lasts.  It may take several months to well over a year.  Be patient with yourself.

Bowel Movements

 

After the takedown you will have many loose stools and maybe some urgency for the first few months.  After 2 weeks, you should be down to 8-12 liquid to pasty stools a day.  The number of stools you have will slowly decrease as foods are added to your diet and the pouch grows and stretches.  At first, avoid acidic foods like orange juice, lemonade, tomato products and foods with vinegar.  These can cause rectal skin problems.

 

You will need to protect the skin around your anus before you have problems.  Keep this area clean and dry.  Use a protective skin ointment such as Vaseline Constant Care^®, Desitin^®, Proshield Plus^®, Vaseline^®, A&D ointment^®, zinc oxide, or Calmoseptine^® on the rectal skin area after each stool to prevent skin problems.

 

It is common to have one or more bowel movements at night.  This may last for several months.

 

Four Things to Watch for After an Ileostomy Takedown

 

Dehydration is a concern when you have frequent loose stools.  It is important to drink extra water and fluids (14-15 8 oz. glasses) until your stool output decreases.  Sip on fluids.  Do not drink too much too fast, this causes them to move through your system even faster.

Symptoms of dehydration are

 

• Increased thirst.
• Dry mouth and skin.
• Weight loss of more than 3 pounds overnight.
• Fatigue.
• Feel dizzy when you stand or sit up.

 

Bowel Obstruction can be caused by food, bands of scar tissue across sections of bowel, a hernia, and a twisted or kinked bowel.  This problem can occur even if you are passing liquid stool or mucus.

Symptoms of obstruction are

 

• Tender and bloated stomach.
• Cramping.
• Nausea or vomiting.
• Temperature of 99ºF by mouth or higher.
• Unable to pass gas or stool.

 

Pouchitis is redness and swelling of the pouch.  If you have ulcerative colitis you can develop pouchitis.  People with familial polyposis rarely do.  Treatment for pouchitis is antibiotics (Ciprofloxacin or Flagyl).  Probiotics can help to prevent pouchitis.

Symptoms of Pouchitis are

 

• More frequent bowel movements even at night.
• Feeling like you have colitis again such as
  • Bleeding.
  • Urgency.
  • Feeling of pressure in the pouch area.
  • Fever.

 

Anal Pouch Suture Line Stricture is a narrowing caused by scar tissue where the pouch connects to the anal canal.  Stool backs up in the pouch.  Stretching the scar tissue treats the stricture.  This procedure is done in outpatient surgery under anesthesia.

Symptoms of an anal pouch suture line stricture are

 

• More frequent small bowel movements even at night.
• Feeling the pouch is not emptying after a bowel movement.
• Straining to empty the pouch.

 

Activity

 

• Do not drive if you are taking narcotic pain pills.
• For the first 4 weeks, do not lift things that weigh more than 10 pounds. 
• Nothing more strenuous than walking until okayed by your doctor.
• Check with your doctor before going back to work.
• Sex may be resumed when you feel ready.
• Avoid all tobacco and second hand smoke.

 

When to Call the Doctor

 

• Bloating.
• Nausea or vomiting.
• Dizziness.
• Rectal skin problems.
• Bowel movement problems.
• Pain not controlled by pain pills.
• Signs of a wound infection are
  • Increased redness or warmth.
  • Pus-like drainage.
  • Excess swelling or bleeding.
  • Temperature greater than 100.4°F by mouth, for 2 readings taken 4 hours apart.

 

Phone Number

 

Digestive Health Center: (608) 890-5000.

 

After hours, weekends or holidays this number will be answered by the paging operator.  Ask for the doctor on call or ask for Dr. Harms, Heise, Kennedy, or Foley.  Leave your name and phone number with area code. The doctor will call you back.

 

If you live out of the area, call (855) 342-9900.
 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 04/24/2013

Copyright © 12/21/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7133

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