The Ostomy Files: Empowering the Ileostomy Patient with a Mechanical Bowel Obstruction

    A frightened young woman with an ileostomy presents in the emergency room, writhing in pain. A friend who knows little to nothing about the ileostomy has accompanied her. In their panic and rush to seek medical attention, they left home without any ostomy supplies. An emergency room physician who knows nothing of the patient's medical history and has had little experience with ileostomy management or knowledge of ostomy supplies is assigned to evaluate her.

   Unfortunately, this scenario is all too common. A person simply has to visit the United Ostomy Association's (UOA) chat rooms (www.uoa.org) to read about the alarming and dangerous experiences ostomy patients have encountered when they have had a food blockage and went to the emergency room (ER). Most ERs do not stock a wide range of ostomy supplies, few physicians have been educated on ileostomy lavage, and the services of a wound, ostomy, continence nurse (WOCN) are not always available. Besides the associated pain, unresolved intestinal blockages can result in perforation and may require emergency surgical intervention. Patients suspected of having a bowel obstruction should be evaluated by a knowledgeable physician or WOCN in a timely fashion because imbalances in fluids and electrolytes must be corrected and the etiology of the obstruction determined.

   In an effort to reduce confusion and complications and to educate its membership and the emergency room personnel who care for them, the UOA has taken a proactive step by developing a two-sided, 5" x 8" laminated card titled "How to Treat Ileostomy Blockage." One side of the card lists steps the patient can take at home to try to relieve the blockage, signs and symptoms that indicate it is time to seek professional medical assistance, and suggested supplies to take to the emergency room.

    The other side of the card, "Emergency Room Staff: Ileostomy Obstruction," provides step-by-step instructions for emergency room personnel to alleviate pain, evaluate the patient, and perform ileostomy lavage should it be indicated. The card is designed for the patient to bring to the ER and present to the treating physician.

   Clinicians caring for new or established ileostomy patients have a responsibility to empower their patients by educating them about the potential for food blockage and appropriate steps they should take to resolve such problems. Our previous healthcare delivery system was viewed by most Americans as an entitlement. Today's healthcare delivery system demands more of the patient; therefore, clinicians must practice preventive medicine by paving the way for patients to play a more proactive role in their care.
Because most ERs stock a limited selection of ostomy supplies and each patient has adopted a management system that provides predictable, sustained wear time, it is the patient's responsibility to take a change of equipment to an office visit, hospitalization, or visit to the ER when seeking help for an ileostomy blockage or any other medical intervention, even if the problem is unrelated to the stoma. The ability to have a pouching system at hand that creates a sense of security and fits into the patient's lifestyle can help the patient maintain a sense of control over what can sometimes feel like an out-of-control situation. It also helps prevent leakage and subsequent peristomal skin problems. 

   This "emergency kit" for a person with an ileostomy should contain the following: a one- or two-piece system (skin barrier and pouch); skin barrier wipes or paste (if they are used); extra tail closures; and any other accessories the patient uses daily. Additionally, a packet of supplies needed to perform ileostomy lavage should contain a two-piece colostomy irrigation sleeve (if a two-piece system is used) or a one-piece colostomy irrigation sleeve (self-adhering or to be used with an ostomy appliance belt).

    The instant availability of the appropriate supplies needed to perform ileostomy lavage and a medically appropriate quick reference guide can help ensure speedy interventions, alleviate the patient's discomfort, and facilitate release of the mechanical bowel obstruction. Unnecessary ER visits may be avoided altogether if the patient knows appropriate steps to take at home.

    These laminated blockage cards are available for purchase in sets of 10 ($10.00 plus $4.00 shipping) through the UOA by emailing www.uoa.org or calling (800) 826-0826. 

The Ostomy Files is made possible through the support of ConvaTec, A Bristol-Myers Squibb Company, Princeton, NJ