NRSG258 Acute Care 1: Examining the Effects of Ileostomy on Patients

This presentation delves into the physical and psychological effects of ileostomies, surgical procedures involving the creation of a stoma for fecal diversion. It highlights the two main types of ileostomies, loop and end ileostomies, and addresses the common physical complications such as skin irritation, pouch leakage, and odor, as well as the inability to lift heavy objects. The presentation also examines the psychological impact, including social anxiety, reduced engagement in pleasurable activities, and potential depression stemming from embarrassment and social isolation. While acknowledging the challenges, it also notes that some patients experience an improved quality of life post-ileostomy, particularly those who previously suffered from debilitating conditions. The content references relevant studies and clinical practices to provide a comprehensive overview of the effects of ileostomies on patients' lives.

Ileostomy: physical and psychological effects.
A stoma is an opening in the abdominal wall whereby fecal diversion from the colon or
ileum is done for treatment of conditions such as cancer, ulcerative colitis, Crohn disease
diverticulosis or trauma (McGee, 2016). A stoma involving the colon is a colostomy while one
involving the small gut is ileostomy. The stoma is connected to an external bag device that
collects the fecal matter, is changeable and watertight.
Ileostomies can be temporary whereby a reversal can be done, or permanent if reversal is
not feasible. Two types of ileostomies include a loop ileostomy and end ileostomy (Bailey, Love,
Mann, & Russell, 2018). In loop ileostomy, a knuckle of ileum is pulled through the skin, the
distal knuckle is incised and the proximal one pulled over the distal one to form a spout (Patil,
Vijayakumar, Ajitha, & Kumar, 2012). This allows the distal portion to be in continuity and
allow for reversal later.
The interventions can treat the presenting complains and, in some cases, cure them,
however, stomas have many complications and have a large impact on the quality of life of the
patients. the care of patients with ileostomies includes education of care and cleaning,
recognition of complications and actions to take. However, physical and psychological effects of
ileostomies still abound from living with a stoma.
The physical effects of ileostomies involve the stoma and stoma care. Skin excoriations,
irritation and rash around the stoma site are the most common (Jayarajah, Samarasekara, &
Samarasekera, 2016). A study by Dabirian, Yaghmaei, Rassouli, & Tafreshi (2011), stratified the
physical problems associated with living with a stoma. The results showed skin irritation was the

most common at 76%, pouch leakage at 62%, and offensive odor at 59%. Another distressing
problem is the inability to lift heavy objects as ileostomy prolapse is a complication.
Psychological effects of living with a stoma include social anxiety, reduction in
pleasurable activities and in some cases depression (Silva, Santos, Rosado, Galvão, & Sonobe,
2017). The embarrassment of having an ileostomy bag, or the foul odor of a stoma leads to
avoidance of social contact. Activities such as sex and outdoor activities become a burden due to
anxiety and stigma. This separation can lead to depression and depressive symptoms like
insomnia.
However, not all patients report negative effects of ileostomies as some report an
improvement in the quality of life (McGee, 2016). Some patients may have had far worse
distressing symptoms from their individual diagnoses like the pain of cancer, or the morbidity
associated with inflammatory bowel syndromes. These do not compare to the relief an ileostomy
provides in such cases. Some report they can ambulate better, relate with their families and live a
relatively normal life (McGee, 2016).

References
Bailey, H., Love, R. J. M. N., Mann, C. V., & Russell, R. C. G. (2018). Bailey and Love's short
practice of surgery. (27th ed.). London: Chapman & Hall Medica
Dabirian, A., Yaghmaei, F., Rassouli, M., & Tafreshi, M. Z. (2011). Quality of life in ostomy
patients: a qualitative study. Patient Preference and Adherence, 5, 1–5.
Jayarajah, U., Samarasekara, A. M. P., & Samarasekera, D. N. (2016). A study of long-term
complications associated with enteral ostomy and their contributory factors. BMC
Research Notes, 9(1), 500.
McGee, M. F. (2016). Stomas. JAMA, 315(18), 2032-2032
Patil, V., Vijayakumar, A., Ajitha, M. B., & Kumar L, S. (2012). Comparison between Tube
Ileostomy and Loop Ileostomy as a Diversion Procedure. ISRN Surgery, 2012, 5.
Silva, N. M., Santos, M. A. d., Rosado, S. R., Galvão, C. M., & Sonobe, H. M. (2017).
Psychological aspects of patients with intestinal stoma: integrative review. Revista
Latino-Americana de Enfermagem, 25.