An ileostomy is used when the colon becomes extensively damaged, inflamed, or loses function.

Common uses

The most common uses of an ileostomy are described below.

Crohn’s disease

Crohn’s disease is a condition where for reasons that are uncertain, the immune system causes inflammation (swelling) of the small intestine and colon (large intestine), causing a range of symptoms such as:

• diarrhoea
• abdominal pain
• fatigue

An ileostomy is usually recommended if the symptoms of Crohn’s disease cannot be controlled using medication, or if a serious complication occurs, such as a blockage in the intestine.

The preferred surgical option for treating Crohn’s disease is a permanent end ileostomy. A continent ileostomy, or ileo-anal pouch, is not usually recommended because there is a risk that these types of internal pouches may be affected by Crohn’s disease and will need to be removed at a future date.

However, if you and are willing to accept the risk that an internal pouch may need to be removed after several years, a continent ileostomy or ileo-anal pouch may provide a medium-term solution.

Ulcerative colitis

Ulcerative colitis is similar to Crohn’s disease in that it is a poorly understood condition that causes inflammation (swelling) of the colon,  leading to symptoms such as:

• abdominal pain
• bloody diarrhoea with mucus

In most cases, the symptoms of ulcerative colitis can be controlled with medication. However, in a small number of cases, all types of treatment prove to be ineffective. In such circumstances, permanently removing the colon is recommended. An ileo-anal pouch or, less commonly, an end ileostomy can then usually be created.

Bowel cancer

Bowel cancer is a general term that describes cancer that develops inside the colon or rectum (where waste material is stored and passed from the body).  The use of chemotherapy, radiotherapy (or both) is recommended for bowel cancer in order to shrink the cancer. It is then usually necessary to remove the section of the bowel or rectum that contains the cancerous cells.

If only a small section of the colon is removed, a temporary loop ileostomy is carried out, which is attached to an external pouch. Once the colon has recovered from the affects of the surgery, the remainder of the colon can be reattached and the loop ileostomy can be removed.

If most of the colon is removed, it may be necessary to perform a permanent end ileostomy. If the middle part of the rectum needs to be removed, it is usually necessary to create an ileo-anal pouch. If the upper part of the rectum is removed, the remainder of the rectum can be connected to the colon.

In cases where the lower part of the rectum is removed, an alternative procedure, called a colostomy will need to be carried out.

Less common uses

Less common uses of an ileostomy are described below.

Familial Adenomatous Polyposis

Familial Adenomatous Polyposis (FAP) is a rare condition that affects one in every 10,000 people, and triggers the growth of non-cancerous lumps of tissue inside the colon.

Even though the lumps are non-cancerous, there is a very high risk that, over time, at least one will turn cancerous. More than 99% of people with FAP will have bowel cancer by the time they are 50 years of age.

Due to the high risk of developing cancerous lumps, as a precaution it is usually recommended that a person who is diagnosed with FAP has their colon  removed. It is usually replaced with an ileo-anal pouch or, less commonly, an end ileostomy.

Bowel obstruction

A bowel obstruction occurs when part of the digestive system becomes blocked by food, fluids, or waste products. This can occur if part of the digestive system is scarred, or inflamed, or if the digestive system is unusually narrow.

If the colon becomes completely blocked, it is usually necessary to remove the colon and perform an ileostomy. This can either be temporary or permanent depending on the underlying cause of the obstruction.

Injury

A significant injury to the colon, such as a puncture, or an impact injury, can result in the colon becoming permanently damaged. In this case, it may be necessary to remove the colon and carry out an ileostomy. Whether this is a temporary or permanent ileostomy will depend on the type and extent of the injury.

Related Articles:

1. Ileostomy
2. Com­plic­a­tions of ileostomy
3. Recov­er­ing from ileostomy
4. Colostomy
5. Digest­ive dis­order: Irrit­able bowel syn­drome
6. Glu­ten intol­er­ance — Coeliac dis­ease
7. Inflam­ma­tion of the gall­blad­der — Acute cholecyst­itis
8. What is a digest­ive dis­order?
9. Appen­di­citis – the causes and symp­toms

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1. Ileostomy
2. Who requires a colostomy?
3. How a colostomy is performed
4. Colostomy
5. Living with a colostomy