Managing a high output stoma

What is a stoma

When a large amount of your bowel is surgically removed or it is not functioning correctly, a stoma may be formed. A stoma is an opening from the gut to the outside of the body, which allows waste products from the body to be removed. Stomas have different names according to where in the gut they are formed.

Types of stoma

Jejunostomy

A jejunostomy is an opening from the jejunum (the middle part of the small intestine).

Ileostomy

An ileostomy is an opening from the ileum (last part of the small intestine).

Colostomy

A colostomy is an opening from the large bowel or colon.

High output stoma

When the bowel is shortened, its ability to digest and absorb nutrients is affected and this can mean that undigested food and fluid can move quickly through it. This can result in a large amount of waste going into your stoma bag.

It is common to have a high output when the stoma is newly formed but this usually settles as your body adjusts. An output of over 1500mls per day is considered high and can lead to dehydration and electrolyte (salt) imbalance, so it is important to try and get this under control.

How to manage a high output stoma

Drink less fluid

It might sound strange but you may need to restrict the fluid that you are drinking to help to manage your stoma output. Your body cannot process fluid in the same way with a stoma so drinking too much can cause more to pass through your body into your bag. This leads to a feeling of thirst and encourages further drinking which makes the problem worse.

You can reduce your output by:

• Limiting the amount of ordinary fluids that you drink (for example fruit juice, squash, fizzy drinks, water, tea or coffee) to about 1 litre per day (about 6 cups)
• Drinking a rehydration solution like Dioralyte can help your bowel to absorb more of the fluid and reduce your stoma output. You should make up around 1 litre as per packet instructions and sip throughout the day

Rehydration solution tastes quite salty but most people find that they adjust to the taste in time and feel it’s worth it for the reduced stoma output and feeling more hydrated.

Tips for improving the taste of rehydration solution:

• Drink chilled from fridge or frozen as a slush
• Sip through a straw
• Add a small amount of squash or fruit juice (after making up the solution with the correct amount of water)
• Adding fresh lemon or lime juice (as above, added after solution is made up)

Diet

When some of your bowel has been removed, its ability to absorb nutrients reduces. This can be reduced further if your stoma output is high, as the nutrients are washed out through the stoma before it has a chance to be absorbed.

When you have a high stoma output the best kind of diet is one that is high in calories, protein and salt and low in fibre. As the stoma output reduces it may be possible to increase the amount of fibre in your diet to tolerance.

Reducing fibre intake

Fibrous foods are difficult to digest and can increase your stoma output.

Fibrous foods to avoid:

• Brown, wholegrain or granary versions of bread, rice, pasta and cereals.
• Nuts, seeds and dried fruit such as raisins, sultanas and prunes
• Pulses such as beans, chickpeas or lentils
• Beans, celery, coconut, mango, mushrooms, peas, pineapple and sweetcorn

Examples of fibrous foods that can be eaten:

• Opt instead for white versions and cereals such as rice crispies and corn flakes
• Eat small portions of well-cooked fruit and vegetables. Remove any skins, stalks, seeds or pips prior to eating
• Peeled and well-cooked carrots, root vegetables, potatoes without skins, broccoli or cauliflower florets (no stalks)
• Peeled apples, banana, tinned (skinned) peaches or pears

Increasing calories

Choose full fat dairy products.

Add extra butter, cream, oil and cheese to food where possible.

Include high calorie, low fibre snacks such as biscuits (not wholegrain), chocolate and crisps.

Add sauces such as mayonnaise, cream or cheese sauce to food.

Include pastries, pies and sausage rolls in your diet.

Increasing salt intake

It can be confusing to be told to increase your salt intake as often people are advised to reduce their salt intake for their health.

Salt is lost through stomas so it is important to try and replace these losses so that your body has enough.

Salty foods also help your body to absorb more fluid from the gut and so help to reduce the stoma output.

Use salt in cooking and add it to your meals.

Increase your intake of salty foods such as crisps, cheese, bacon, ham and tinned or smoked fish, marmite or Bovril.

Medications

Your doctor or nurse may prescribe medications like loperamide (Imodium) or codeine phosphate to help reduce your stoma output. These are best taken 30-60 minutes before food.