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Ileostomy - Complications of ileostomy

NHS Choices Medical Reference

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

Obstruction

Sometimes, the ileostomy does not function for short periods of time. This is not usually a problem. However, if your stoma is not active for more than six hours and you experience cramps or nausea, you may have an obstruction. In this situation contact your GP or stoma nurse.

A warm bath may help to relax your abdominal muscles. Do not take a laxative. Foods such as nuts, pineapple, coconut and corn are more likely to cause an obstruction.

Vitamin B12 anaemia

It is estimated that about a quarter of people who have had an ileostomy will experience a gradual decrease in their levels of vitamin B12. Vitamin B12 plays an important role in regulating the brain and nervous system.

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

In some people, the fall in vitamin B12 levels can trigger 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
  • faintness
  • irregular heart beats (palpitations)
  • headache
  • tinnitus (the perception of a noise, such as ringing in one or both ears or inside your head)
  • loss of appetite

If you have had an ileostomy and experience any of these symptoms, contact your GP, who 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 anaemia is left untreated, it can cause more serious problems with your nervous system, such as memory loss.

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

Read more information about vitamin B12 anaemia.

Pouchitis

Pouchitis is when an internal pouch becomes inflamed. It is a common complication in people with an ileo-anal or continent ileostomy. It is estimated that around one-in-three people with an internal pouch will experience at least one episode of pouchitis.

Symptoms of pouchitis are similar to digestive conditions such as Crohn's disease or ulcerative colitis and include:

  • diarrhoea, which is often bloody
  • abdominal pains
  • stomach cramps
  • dehydration 
  • high temperature (fever) of or above 38C (100.4F)

Pouchitis can usually be successfully treated with a two-week course of antibiotics.

Stoma problems

Some people with an ileostomy experience problems related to their stoma. These can include:

  • irritation and inflammation of the skin around the stoma, which can make it difficult to hold the bag in position
  • narrowing of the stoma (stoma stricture), which can make it difficult to fit the bag onto the stoma
  • widening of the stoma (stoma prolapse), which can make it difficult to hold the bag in place

If you experience any of these problems, you should contact your GP or stoma nurse for advice. Skin irritation can usually be treated with topical treatments, such as a spray.

You may need to have minor surgery to correct a stoma stricture or prolapse.

Valve malfunction

A common complication of a continent ileostomy is that the valve connected to the internal pouch can stop working due to the valve narrowing or being pulled out of position. In this circumstance, minor surgery is required either to repair or replace the valve.

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.

Medical Review: March 09, 2012
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