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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Digestive Health Center (DHC)

Ileostomy Take-Down with Ileal Pouch (7133)

Ileostomy Take-Down with Ileal Pouch (7133) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Digestive Health Center (DHC)

7133



Ileostomy Take-Down with Ileal Pouch


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.

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
ξ 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.
ξ Drink only clear liquids (no sediment or
pulp) after breakfast/lunch until 4 hours
before your surgery starts.

o Water
o Broth
o Juice without pulp (apple, grape)
o Popsicles
o Hard candy
o Clear Jello-O (no fruit, etc, in it)
o Sparkling water or soda
o Coffee or tea, no creamer
o Gatorade
o Gatorade 03 Recover (16g. protein)
o
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
½ 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 to the hospital in case
you need supplies. We may not have your
product in stock.

Wound Care

Your wound may not be tightly stitched
closed. In this case, it may take 1-3 weeks
to heal. If the wound is closed, expect the
incision to heal in 10-14 days. It may be
swollen, pink, sore, numb, and bruised with
clear pink drainage. You may have more
drainage than from your other incisions.
This is normal. Be sure to change the
bandage if it is damp or wet and 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 θF 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 #3. You will start a
multivitamin with iron that you will take
for the rest of your life.
 At your 2-week follow-up expect the
fiber in your diet to be increased. This
will help to decrease the number of
stools each day. You may be asked to
try a bulk fiber such as Benefiber ,
Metamucil or their generic equals. You
may be asked to try Imodium or
Lomotil to help slow stools. This can
make travel easier.
 Be patient with yourself. By trial and
error you will 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 the process lasts. It can take
months to more than a year.

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. Be sure 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 99º F by mouth or
higher.
 Unable to pass gas or stool.


Pouchitis is inflammation of the ileal
pouch. The inside of the ileal pouch
becomes reddened, swollen and painful.

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
o Bleeding
o Urgency
o Feeling of pressure in the
pouch area
o Fever
o Liquid stools

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 and you may have
symptoms of pouchitis. Stretching the scar
tissue treats the stricture. This procedure is
done in outpatient surgery under anesthesia
or at GI procedures.




Symptoms of an anal pouch suture line
stricture are:

 More frequent small bowel
movements even at night (spitting of
stool)
 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.
 Do not lift more than 10 pounds for
the first 2 weeks. Then, for the next
month, do not lift more than 20
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:
o Increased redness or warmth.
o Pus-like drainage.
o Excess swelling or bleeding.
o Temperature greater than
100.4°F by mouth, for 2
readings taken 4 hours apart.



Phone Numbers

Digestive Health Center: (608) 890-5000.

After hours, weekends and holidays ask for the doctor on call for
_____________________________ (surgeon name). Leave your name and phone number with
area code. We will call you back.

Toll Free: (855) 342-9900.















Your health care team may have given you this information as part of your care. If so, please use it and call i f you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 11/2016 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7133.