Postoperative Management

After RP and IPAA with loop ileostomy, patients invariably have high ileostomy outputs of from 1,000 to a 2,000 cc per 24 hours. Effectively the "high" ileostomy bypasses a 20% or more of the distal SB and this sets the stage for dehydration. The following advice is given our patients:

• Be aware of added risk factors for dehydration (hot weather, exercise, air conditioning)

• Be aware of symptoms of dehydration (ie, lassitude, fatigue, headache, nausea)

• Maintain intake of adequate oral liquids, especially salty soups, electrolytes supplements. Minimize caffeine intake.

• Avoid high solid fiber/indigestible foods for 6 weeks (as with all new ileostomates)

• Use bulking agents (eg, Konsyl, Citrucel, Metamucil)

• Use liquid loperamide or atropine diphenoxylate dosed on a weight basis to thicken enteric output

• Be aware of the fact that external ileostomy pouches may stay on for only 2 days or so (compared with 5 to 7 days for end ileostomies). Loop ileostomies tend to be flush with the skin

• Follow the steroid-tapering schedule prescribed on discharge

• Recognize symptoms of post discharge bowel obstruction

• After the ileostomy is closed, a similar program is instituted.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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