Ileostomy Take-Down without Ileal Pouch
This surgery will close your ileostomy. The stoma and skin opening will be sewn shut. Stool
will now travel through the bowel and exit through the anus. Surgery takes about 2 hours.
A few days before, you need to buy 1-bottle of magnesium citrate (10 oz). It tastes best when
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 Juice without pulp (apple, grape)
o Hard candy
o Clear Jell-O (no fruit, etc. in it)
o Sparkling water or soda
o Coffee or tea, no creamer
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 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 to the hospital in case you need supplies. We may not have your
product in stock.
Your wound may not be tightly stitched closed. In this case, it may take 1-2 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. The gauze dressing needs to be changed 1-2 times per day.
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
Watch for signs of infection.
ξ Increased redness or warmth.
ξ Pus-like drainage.
ξ Excess swelling or bleeding.
ξ Temperature (by mouth) above 100.4 θF for two readings taken 4 hours apart.
Expect to have pain after surgery. You will have pain pills to ease the pain.
ξ Your diet will advance from clear to full liquids then to a soft diet. Expect to go home on
a low- residue, low-fiber diet.
ξ Eat 3 meals a day. Try not to eat between meals. This can help regulate bowel
ξ 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.
ξ 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.
ξ 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.
If you had a bowel resection when your ileostomy was placed, after the ileostomy takedown you
will have an increased number of bowel movements per day. They will initially be loose, this is
normal. As your body heals and you have more fiber in your diet you will have fewer and more
formed bowel movements. At first, avoid acidic foods like orange juice, lemonade, tomato
products and foods with vinegar. These can cause rectal skin problems.
If you have had radiotherapy because of cancer you will have small stools over several hours per
day. This can be managed with a high fiber diet and medications. 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
It is common to have one or more bowel movements at night. This may last for several months.
Two 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:
ξ Increased thirst
ξ Dry mouth and skin
ξ Weight loss of more than 3 pounds overnight
ξ 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:
ξ Tender and bloated stomach
ξ Nausea or vomiting
ξ Temperature of 99ºF by mouth or higher
ξ Unable to pass gas or stool
ξ Do not drive if you are taking narcotic pain pills.
ξ Do not lift more than 10 pounds for the first 2 weeks. Then, for the next month, do not lift
more than 20 pounds.
ξ Nothing more strenuous than walking until okayed by your doctor.
ξ Check with your doctor before going back to work.
ξ Sex may be resumed when you feel ready.
ξ Avoid all tobacco and second hand smoke.
When to Call the Doctor
ξ Nausea or vomiting
ξ Rectal skin problems
ξ Bowel movement problems
ξ Pain not controlled by pain pills
ξ 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
Digestive Health Center: (608) 890-5000 Monday – Friday, 8am – 5pm
After hours, weekends or holidays this number will be answered by the paging operator.
Ask for the doctor on call for Dr. ________________. 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.
Your health care team may have given you this information as part of your care. If so, please use it and call if 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 © 7/2015 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7806