Ileostomy closure: One month out
Well. It's been a month. Putting the details below the cut.
If you're expecting your closure to be easier than the initial operation, get ready because no. First, you are still going to have a HOLE IN YOUR BODY. The ileostomy opening has to heal from the bottom up, That takes six to eight weeks for it to properly close. In that time, it's going to f*cking hurt. If you don't have a wound care nurse, here's what you need to do.
Shower with a waterproof dressing cover in place.
Remove the tape with adhesive remover pads and clean the area around the hole. You can use the same peristoma cleaning wipes that I used before and after closure.
Rinse the hole with sterile saline wound wash.
Place a 2x2 gauze pad over the wound and use surgical tape to keep it in place.
Infection doesn't always smell or look oozy and gross. Mine started with worsening pain at the site, hardness, and heat. If your wound starts to feel worse instead of better, get to the ER.
Now, the reversal isn't the only thing you're going to have to deal with. Your intestines have been offline, and I also had a resection which was then closed off to heal. I did not poop in the conventional manner for three months.
Get ready for the smell. It's fucking horrible.
You'll also have a gastrograffin xray before your surgery. It's beyond horrible and punted me back into CPTSD therapy - flashbacks are no fun.
You will not be discharged until you poop. You'll be on liquids, then soft foods, and if they have to help it along, they will. Conversely, if you're having diarrhea, they're not going to intervene too much. Constipation is what they're afraid of, and the strain on the surgical site. Getting home is going to be stressful.
For me, since I am missing intestines and rectum, it's been challenging. First, I have to rebuild my gut biome. Secondly, pooping feels very different. With the resection, there's urgency but I am learning the signals that I'd better get to the loo. Constipation has been on and off, and I've learned to handle it with docusate sodium, Citrucel, and prune juice. Your doc might have you on a low-residue diet for the first two weeks, so get that prune juice.
Yes, it does really work.
Getting your shit together can be painful because of reconfigured innards. You no longer have a capacious rectal cavity to hold the output, so you could find yourself pooping not two or three times a day, but eight to ten times per day. Your new resection has to stretch to be able to reduce the number of times you'll go. You'll need to rebuild motility and your gut biome.
Stay hydrated. Not just water and juice, but something like Ultima Replenisher will help. Soups and broths, too.
Prebiotics - you can add inulin powder to kefir, yogurt, skyr, or whatever probiotic rich food you're eating. Fermented foods can also be on the list.
DO NOT ADD FIBER UNTIL YOUR DOC SAYS OKAY.
Walk as much as you can, it keeps things moving.
So far, I have not had any continence issues, urgency is pretty common, but I have been doing pelvic floor exercises pretty faithfully, and that can help.
More when I can think of it.
