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Post Operative Instructions for Ileostomy Closure

This resource will help you care for yourself after your ileostomy closure.

After Ileostomy Closure

For the first few weeks after your surgery, you may have a lot of irregular bowel movements. This is because the lower part of your colon (large intestine) has not been used in a while. It will take time for your body to recover. To help you heal, you will need to take pain medicine. You will also need to take stool softeners to help your stool (feces) move through your colon. Take these medicines as instructed by your doctor or nurse.

You will also have an open wound where your ileostomy used to be. Keeping the wound open helps prevent infection. Before you are discharged, you will be given supplies and instructions on how to care for it. If needed, a visiting nurse can come to your home to help you care for the wound. It should close within 4 to 6 weeks.

What to do during the first 4 weeks after surgery

  1. Eat a low-fiber, low-fat diet. A dietitian will go over this with you during your hospital stay.
  2. Try to maintain your weight. Eat 5 to 6 small meals throughout the day.
  3. Do not do any heavy lifting, pushing, or pulling. Also, do not do any abdominal exercises. This will help prevent a hernia.
  4. Clean your anal area with warm water only. Soap or wipes can make the skin more irritated. Apply a cream to your anus as needed to prevent the skin from breaking. This can happen from a lot of wiping. Examples of creams are Balmex® and Desitin®.

What to do 5 weeks after your surgery

  1. Slowly go back to a regular diet by adding foods with fiber back into your diet.
  2. Make sure to chew all your food thoroughly.
  3. Slowly start doing activities that you did before the surgery.
  4. Take 1 tablespoon of fiber supplement a day. You may take more of this as needed. Examples of fiber supplements are Metamucil® and Citrucel®.
  5. Drink at least 6 to 8 glasses of water each day.

Changes to Your Rectum

Your rectum is a storage tank for stool. You had surgery to remove part of it and now this tank is smaller. This means that it cannot hold as much stool. If you had radiation treatment, the rectum may have also become stiff. It will not be able to stretch and hold stool as well as before the surgery. After an ileostomy closure, many patients have “clustering” right after the surgery. This is when you have a lot of small bowel movements because your rectum cannot hold a lot of stool. When stool enters the small, stiff rectum, you will feel an urgent need to have a bowel movement. Over time, your rectum will stretch and increase the amount of stool it can hold. This process can take several months to years to happen.

Changes to Your Bowel Function

It is very important that you take fiber supplements for your bowel function. Fiber is a laxative, which means that it stops constipation (not being able to have a bowel movement). It works by soaking up water out of the stool. This will combine all the small pieces of stool together to create a larger bowel movement. The rectum squeezes better when it is full. These larger stools will also stretch out the rectum and you will be able to hold more stool. You will eventually have fewer and larger bowel movements.

Many patients need to make changes to their diet after this surgery. Certain foods may cause diarrhea (loose bowel movements). Every patient is different, so there is no way to know which foods make this happen. During the first few months after your surgery, it may be helpful to keep a food diary. This will help to find out which foods may have caused the diarrhea.

There are many ways to control and alter your bowel function. Your nurse or doctor can help you do this. If you need help or have any questions or concerns, please call your doctor's office.

Follow-up Care

Make an appointment to see your doctor 2 weeks after your surgery. At this visit, your doctor and nurse will check to see how you are doing. Your nurse will tell you how to make your bowel function better based on your symptoms.

Call your doctor or nurse if you have:

  • Diarrhea more than 8 times a day. If this happens, stop taking any stool softeners until you have talked to your doctor or nurse
  • Stomach cramps, nausea, and vomiting
  • Redness, swelling, or fluid coming out of your wound
  • A temperature of 101° F (38° C) or higher
  • Problems with your bowel function in between appointments
  • Any questions or concerns