The Health of Subjects Living with a Permanent Ileostomy

Abstract

The alms of the present study were to survey the general state of health of a group of fleostomists, including social, psychological and sexual aspects, and to investigate a range of metabolic functions in the same patients. The subjects studied were taken at random from patients who had been treated by proctocolectomy and ileostomy in Oxford. There were 39 subjects whose operation had been performed for ulcerative colitis and 12 subjects who had had the operation for Crohn's disease involving the colon. A control group consisting of 39 healthy volunteers, matched for age and sex with the 39 patients who had had ulcerative colitis were also studied. The general health of the ileostomists, as judged by their medical history, the findings on complete physical examination and the results of standard biochemical and haematological investigations was good or excellent Virtually all were pursuing their normal occupations. Most of them enjoyed their normal recreations but several had given up swimming. An appreciable number considered that they had received inadequate explanation and guidance before and after the institution of the ileostomy. Psychological abnormalities, as judged by responses to standard inventories, were minor. There was little evidence of physical impairment of sexual activity but psychological problems were not unusual . The dietary habits of the ileostomists were essentially normal but they consumed more fluid and more salt than the control subjects. In spite of this, the ileostomists showed evidence of mild dehydration and aldosteronism. It is recommended that an Qeostomist should consume 15 ml/Kg body weight of additional fluid and 100 mg/Kg body weight of additional salt each day. There was a mild degree of iron deficiency which was correctible by oral supplements. Vitamin B12 absorption was enhanced in the ileostomists who had had ulcerative colitis. There was no evidence of folate depletion. The ileostomists had increased retention of calcium. This suggests that they were probably deficient in calcium at the time of operation and were slowly correcting the deficit. Male ileostomists had a high incidence of urinary stones, possibly related to a low pH and volume of the urine and a high level of plasma uric acid. The ileostomists had a high incidence of gallstones. The gastrointestinal hormone profile in the fleostomists showed significant differences from normal in the values of motflin, en-teroglucagon and neurotensin.