Ileostomy - Complications of an ileostomy

As with any surgery, complications can develop during or soon after an ileostomy operation. Discuss the risks with your surgeon before the procedure.

Some of the main problems that can occur after an ileostomy or ileo-anal pouch procedure are described below.

Obstruction

Sometimes, the ileostomy does not function for short periods of time after surgery. This is not usually a problem, but if your stoma is not active for more than six hours and you experience cramps or nausea, you may have an obstruction.

If you think you may have an obstruction, contact your GP or stoma nurse for advice. They may recommend:

• avoiding solid foods for the time being
• drinking plenty of fluids
• massaging your tummy and the area around your stoma
• lying on your back, pulling your knees up to your chest and rolling from side to side for a few minutes
• taking a hot bath for 15-20 minutes (to help relax the muscles in your tummy)

In persistent or severe cases, you may be advised to go to your nearest accident and emergency (A&E) department because there is a risk your bowel could burst (rupture).

Dehydration

You are at an increased risk of becoming dehydrated if you have an ileostomy because the large intestine, which is either removed or unused if you have an ileostomy, plays an important role in helping absorb water from food waste.

Therefore, it is important to make sure you drink enough fluids to keep your urine a pale yellow colour to prevent complications of dehydration such as kidney stones and even kidney failure.

Rectal discharge

People who have an ileostomy but have an intact large intestine often experience a discharge of mucus from their rectum.

Mucus is a liquid produced by the lining of the bowel that acts as a lubricant, helping the passage of stools, and it is still produced even though it no longer serves any purpose.

The mucus can vary from a clear "egg white" to a sticky, glue-like consistency. If there is blood or pus in the discharge, contact your GP because it may be a sign of infection or tissue damage.

Many people find the most effective method of managing rectal discharge is to sit on the toilet each day and push down as if passing a stool. This should help remove any mucus located in the rectum and prevent it building up.

If you find this hard to do, or if it is not helping, contact your GP because you may need further treatment.

Vitamin B12 deficiency

Some people who have had an ileostomy will experience a gradual decrease in their levels of vitamin B12. Vitamin B12 plays an important role in keeping the brain and nervous system healthy.

This decrease is thought to occur because the part of the intestine removed during the procedure is responsible for absorbing some vitamin B12 from the food you eat.

In some people, the fall in vitamin B12 levels can cause a condition called vitamin B12 anaemia, which is also sometimes known as pernicious anaemia.

Symptoms of vitamin B12 anaemia include:

• unexplained fatigue (extreme tiredness) and lethargy (lack of energy)
• breathlessness
• feeling faint
• irregular heartbeats (palpitations)
• headache
• tinnitus (hearing sounds coming from inside the body rather than from an outside source)
• loss of appetite

If you have had an ileostomy and experience any of these symptoms, contact your GP. They will be able to arrange a blood test to check your vitamin B12 levels.

It is important not to ignore these types of symptoms because if vitamin B12 deficiency is left untreated, it can cause more serious problems with your nervous system, such as memory loss and damage to the spinal cord.

If a diagnosis of vitamin B12 deficiency or anaemia is confirmed, treating the condition is relatively straightforward and involves taking regular vitamin B12 supplements in the form of injections or tablets.

Stoma problems

Some people with an ileostomy experience problems related to their stoma, such as:

• irritation and inflammation of the skin around the stoma
• narrowing of the stoma (stoma stricture)
• widening of the stoma (stoma prolapse)
• an internal part of the body, such as an organ, pushing through a weakness in the muscle or surrounding tissue wall (parastomal hernia)
• the stoma sinking below the level of the skin after the initial swelling goes down (stoma retraction) 

If you think you may have a problem with your stoma, you should contact your GP or stoma nurse for advice.

Skin irritation can usually be treated with topical treatments, such as a spray, but you may need to have further surgery to correct physical problems related to your stoma.

Phantom rectum

Phantom rectum is a complication that can affect people with ileostomies. The condition is similar to a 'phantom limb', where people who have had a limb amputated feel that it is still there.

People with phantom rectum feel like they need to go to the toilet, even though they do not have a working rectum. This feeling can continue many years after surgery. Some people have found sitting on a toilet can help to relieve this feeling.

Pouchitis

Pouchitis is when an internal pouch becomes inflamed. It is a common complication in people with an ileo-anal pouch or continent ileostomy.

Symptoms of pouchitis include:

• diarrhoea, which is often bloody
• abdominal pains
• stomach cramps
• a high temperature (fever)

Speak to your GP if you think you may have pouchitis. The condition can usually be successfully treated with a course of antibiotics.