Ileostomy and Colostomy | Emphasis on Diet/Nutrition

Summary

This video provides a comprehensive guide to understanding ileostomies and colostomies, including their functions, nutritional considerations, and post-surgery care. It covers essential topics such as the impact on digestion and absorption, the importance of managing fiber intake to avoid blockages, minimizing gas and odor from certain foods, and ensuring proper hydration. The video also discusses strategies for managing high output and maintaining a balanced diet to reduce complications. Key nutrition recommendations and the role of oral rehydration solutions are highlighted, along with tips for improving overall care and quality of life for ostomy patients.

Takeaways

• 😀 An ostomy is a surgical connection between the gastrointestinal tract and the skin, allowing waste to be expelled when normal elimination through the anus is not possible.
• 😀 An ileostomy involves the small intestine (the ilium), while a colostomy involves the colon (large intestine). Both have a stoma that allows waste to exit the body.
• 😀 The main purpose of an ileostomy or colostomy is to provide fecal diversion when passing waste through the anus is unsafe or not feasible due to conditions like cancer, inflammatory bowel disease, trauma, or other surgical needs.
• 😀 A loop ostomy allows easier reversal by keeping both ends of the bowel attached, while an end ostomy involves severing the bowel, making it more likely to be permanent.
• 😀 Ileostomy and colostomy patients may face nutrient absorption issues. The ileum is crucial for absorbing vitamin B12 and bile acids, and the colon is vital for fluid and electrolyte absorption and housing gut bacteria.
• 😀 Patients with an ileostomy may experience incomplete fluid and electrolyte absorption, vitamin B12 deficiencies, and faster gastrointestinal transit, depending on how much of the ileum remains.
• 😀 Colostomy patients may have varying fluid and electrolyte loss depending on the stoma's location, with more concern closer to the small intestine, as effluent tends to be more liquid.
• 😀 In the first few months post-surgery, there’s a high risk of dehydration and stoma blockages. The body adapts to the ostomy, and fluid and nutrient absorption generally improves over time.
• 😀 A low-fiber diet for the first 4-6 weeks after surgery is recommended to prevent blockages in the stoma, with foods to avoid including raw vegetables, whole grains, and nuts. After this period, fiber can be gradually reintroduced.
• 😀 Hydration is critical for ostomy patients. Dehydration is a leading cause of readmissions. Oral rehydration solutions (ORS), like those from Pedialyte or Gatorade, are key in managing high output and preventing dehydration.
• 😀 To manage gas and odor, ostomy patients should avoid certain foods like broccoli, cauliflower, onions, and apples, and minimize activities like smoking or drinking carbonated beverages. Products like odor eliminators can also help.

Q & A

What is the difference between an ileostomy and a colostomy?

An ileostomy is a surgical procedure where the ileum (the final section of the small intestine) is connected to the abdominal wall, whereas a colostomy involves connecting the colon (the longest part of the large intestine) to the abdominal wall. Both procedures create an opening called a stoma for the waste to exit.

What are some conditions that may require an ileostomy or colostomy?

Conditions that may require an ileostomy or colostomy include cancer, inflammatory bowel disease (such as ulcerative colitis and Crohn's disease), diverticular disease, injury or trauma, and infections close to the anus.

What are the key differences between loop and end ostomies?

A loop ostomy involves pulling a loop of the bowel through the abdominal wall and cutting it enough for waste to exit but not severing it, making it easier to reverse. An end ostomy involves severing the bowel, with only the proximal end pulled through the abdominal wall; this may be temporary or permanent and is more likely to be permanent than a loop ostomy.

How does the placement of an ileostomy or colostomy affect nutrient absorption?

An ileostomy can impair fluid and electrolyte absorption, vitamin B12 absorption, and bile acid reabsorption. A colostomy, depending on its location, may have less concern for fluid and electrolyte losses but still presents challenges depending on its proximity to the small intestine.

What is the importance of fluid and electrolyte management for patients with an ileostomy or colostomy?

Proper fluid and electrolyte management is crucial to prevent dehydration, especially in patients with an ileostomy, who may experience significant fluid loss. Dehydration is a leading cause of readmissions, and managing fluid balance through hydration strategies and monitoring is essential.

Why should patients with a new ostomy avoid high-fiber foods during the first 4-6 weeks after surgery?

High-fiber foods should be avoided in the initial 4-6 weeks because fiber is indigestible and can get lodged in the stoma, leading to blockages. This risk is especially high post-surgery due to inflammation and healing of the stoma.

What are some foods that patients with an ostomy should avoid to minimize the risk of blockage?

Foods to avoid include raw vegetables, fruits with skins, stringy vegetables like celery, whole grains, whole nuts and seeds, legumes, and fatty meats, as they can get lodged in the stoma and cause blockages.

How can patients manage gas and odor produced by ostomies?

To minimize gas production, patients should avoid gas-producing foods like broccoli, cauliflower, and onions, and also avoid carbonated drinks, chewing gum, and smoking. Odor can be minimized by avoiding specific foods like fish and eggs, and by using odor-eliminating products such as Hollister M9 drops or sprays.

What are oral rehydration solutions, and why are they important for patients with an ileostomy?

Oral rehydration solutions contain a balanced mix of water, sugar, sodium, and potassium to enhance absorption and prevent dehydration. They are crucial for patients with high ostomy output, as they help manage fluid and electrolyte loss more effectively than plain water.

Why is it recommended for patients with an ileostomy to have their vitamin B12 levels checked annually?

Since the ileum is responsible for vitamin B12 absorption, patients with an ileostomy may have difficulty absorbing it. Regular monitoring ensures that any deficiencies can be addressed, though supplementation may not always be necessary if the patient adapts or undergoes an ileostomy reversal.