What is an ileostomy?
An ileostomy is where the small bowel (small intestine) is diverted through an opening in the abdomen (stomach). The opening is called a stoma. A special bag is placed over the stoma to collect waste products that usually pass through the colon (large intestine) and out of the body through the rectum and back passage (anus). This leaflet is for people with ileostomy’s which are producing large volumes of waste (we call this high output).
What is a normal ileostomy output?
A normal ileostomy output should be 400-600ml over 24 hours. Output should have the consistency of porridge or toothpaste.
What is classed as high output?
If you are losing more than 1500ml/24 hours. (You will notice the amount of bag changes you need to do will be increasing, dependant on your bag size).
Why does this happen?
One of the roles of the large bowel (colon) is to reabsorb fluid. When the large bowel has been removed the small bowel must adapt to absorb more fluid, which it is not as effective at doing (this will improve over time). This means output from your stoma can increase.
When does this happen?
High output stomas can occur when:
• A stoma is newly formed
• If your bowel is affected by disease or treatment
• If your bowel is shortened by formation of a temporary stoma
• If certain foods are consumed
• If excess fluid is consumed
What does this mean?
If your stoma output is loose and watery for more than 24 hours nutrients, electrolytes (eg. Salt) and fluid are not absorbed properly. This can lead to dehydration and increase your risk of malnutrition. If you are dehydrated you may get symptoms such as feeling thirsty, tired, light headed or you may get a headache. You may be passing less urine and it may be darker than normal. Try your best to follow advice from this leaflet. If you are unable to, seek advice from your doctor or dietitian.
Are there any foods I should avoid if I have a high stoma output?
The following foods may increase your stoma output:
• High fibre foods (opt for white bread, pasta, cereal, rice rather than wholemeal versions)
• Beetroot
• Mushrooms
• Spicy food
• Alcohol
• Fruit juice
• *Milk
*Milk is a good source of protein and calcium. If you feel milk is increasing your stoma output you could try using ‘lactose free milk’ to see if your symptoms improve eg. ‘Lactofree’ or supermarket own brand.
It is important you try to consume 2-3 portions of dairy a day such as:
• A matchbox size portion of cheddar
• 120g yoghurt or calcium enriched soya yoghurt
• ½ large tin rice pudding
• 200ml milk or calcium enriched soya, oat, nut or coconut milk
• ½ tin sardines (60g)
• 2 ½ tbsp spinach
• 6 dried apricots
• 80g curly kale
The following foods may cause excess gas from your stoma:
• Onions
• Peas
• Beans
• Carbonated drinks
• Spicy foods
• Beer
• Milk
The following foods may cause an offensive odour from your stoma:
• Fish
• Onions
• Leeks
• Garlic
• Eggs
There is no need to avoid the above foods if you are not getting any symptoms.
Are there any foods that will thicken my stoma output?
The following foods may help thicken your stoma output:
• Starchy carbohydrate foods such as: white bread, pasta, potatoes, rice
• Jelly cubes
• Marshmallows
• Bananas
• Jelly babies
• Biscuits
• Cakes
• Smooth peanut butter
• Apple sauce
Is there any other dietary advice I should be following?
If your stoma output is high add extra salt to meals and opt for salty food such as crisps, marmite, salted biscuits, smoked meat or fish, Bovril, stock cubes etc. this will help reabsorb some fluid.
• Try to avoid drinking before, with, or 60 minutes after a meal.
• Restrict fluid intake to 500-1000ml a day. Isotonic drinks are the best (eg Gatorade, Powerade, Accelerade). Avoid intake of hypotonic drinks such as tea, coffee, alcohol and fruit juices.
• Some people find that eating close to bed time can increase their output overnight. You may find not eating a couple of hours before you go to bed improves your symptoms.
• Once your stoma output has reduced to normal levels, try reintroducing any foods you have cut out. Not all food causing symptoms will needs to be cut out from your diet long term.
If stoma output remains high after following the above
A rehydration solution will be needed to help replace salt and sugar lost through your stoma and help you to rehydrate. Use the following as your only source of oral fluids (500-1000ml per day):
Dissolve:
Sodium chloride (salt) 3.5 g
And sodium bicarbonate 2.5 g
And glucose 20 g
Into 1 litre of tap water
As your stoma output begins to thicken you can wean yourself back onto ‘normal’ fluids.
Medications
As well as dietary changes some medication may help slow down and thicken your stoma output:
• Loperamide (Immodium)
This works by slowing the speed of your gut contents through your intestine. This allows more time for water and electrolytes to be reabsorbed back into the body. This results in a more formed output.
• Codeine phosphate
This works by slowing the muscular contractions of the intestine. This reduces the speed your gut contents moves through your intestine.
• Omeprazole
Reduces the amount acid your stomach produces.
Summary
If your stoma output is continually over 1500ml in 24 hours this is classed as a high output stoma. This can cause complications of dehydration, electrolyte imbalance and malnutrition. It is important you follow dietary advice above to prevent these complications. Medication may also be needed to reduce your output.
*If you have diabetes please consult your doctor or dietitian before following this advice*
For further information
NHS Choices website
Produced by Sirona dietitians, Sirona care & health
Sirona care & health
Yate Westgate Centre,
Yate, 21 West Walk,
Bristol BS37 4AX
Tel: 01454 315355 (option 2)
e: sirona.hello@nhs.net
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