A stoma is a surgically created opening that diverts bowel contents onto the abdominal wall. Understanding the physiological differences between ileostomies and colostomies is essential for preventing dehydration, skin injury, and medication failure. In UK practice, early education and specialist stoma nurse input significantly reduce readmissions and long-term complications.

🔍 Feature	🟢 Ileostomy	🔵 Colostomy
📍 Typical Site	Right lower quadrant (ileum)	Left lower quadrant (descending/sigmoid)
👀 Stoma Appearance	Spouted, protrudes 2–3 cm (protects skin from enzymes)	Flush or mildly protruding
💩 Effluent Character	Liquid → paste; bile/enzyme-rich; highly irritant	Formed → semi-formed; less corrosive
⏱️ Volume / Frequency	High output: 600–1200 mL/day typical ⚠️ High-output >1.5 L/day	Lower output: 200–600 mL/day Usually 1–3 empties/day
💧 Fluid & Electrolyte Risk	⚠️ High risk: dehydration, hyponatraemia, hypomagnesaemia, AKI	✅ Near-normal balance in most patients
👃 Odour	Milder odour (liquid stool)	More noticeable odour
🍽️ Diet Advice	Extra salt + ORS Chew thoroughly Avoid high-fibre/stringy foods initially	Balanced diet Fewer long-term restrictions
👜 Appliance Type	Drainable pouch (emptied frequently)	Closed or drainable pouch (often daily change)
🚿 Irrigation Suitability	❌ Not suitable	✅ Possible (left-sided colostomy)
💊 Medication Issues	⚠️ Poor MR/EC absorption Prefer immediate-release/liquid Avoid sorbitol in high output	Usually normal absorption Review if rapid transit
🩹 Skin Complications	Common dermatitis from enzymes Leakage → excoriation	Less frequent Still risk with poor seal
🏥 Common Indications	IBD, FAP, subtotal colectomy, diverting stoma	Colorectal cancer, diverticular disease, obstruction, trauma
🔁 Loop vs End	Loop = often temporary End = post-colectomy	Loop (diversion) End (Hartmann’s)
⚠️ Long-Term Risks	High-output stoma Renal stones, gallstones B12 deficiency (ileal loss)	Parastomal hernia Constipation, prolapse

🧠 Teaching Tip
Ileostomy patients lose sodium-rich fluid continuously. In high-output states, advise oral rehydration solutions (e.g. St Mark’s solution) rather than plain water, which worsens hyponatraemia. Always review modified-release and enteric-coated medications — “ghost tablets” in stoma bags indicate therapeutic failure.

📚 Clinical Pearls

✅ Sudden increase in ileostomy output = think sepsis, obstruction, medication change, or infection.
✅ AKI in stoma patients is usually volume-related until proven otherwise.
✅ Early stoma nurse review reduces complications by >30%.
✅ Persistent skin problems usually indicate appliance mismatch, not poor hygiene.

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Ileostomy vs Colostomy

🧻🩺 Ileostomy vs Colostomy — Clinical Comparison Guide

📚 Clinical Pearls

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