Slowing Down Ileostomy Output

When people ask me how to slow down output, I ask myself: Do they mean reduce the amount of output? Or slow down the transit time? Or thicken their stool?

Here are some causes and treatment options that cover all bases:

1. If this is a sudden onset – get a stool culture and rule out Clostridium difficile (“C.Diff.”)
2. Are you drinking too much fluid? Especially hypertonic fluids (Ex: fruit juices, Ensure®, sodas) or hypotonic fluids (Ex: water, sugar free tea, black coffee). Contrary to popular belief, water is not the best choice for hydrating with an ileostomy. It is best to drink fluids with electrolytes such as sodium and potassium that are also low in sugar. Dilute sports drinks with water to decrease the sugar concentration. Check out the new Ostomy Nutrition Guide from the UOAA at ostomy.org and the Short Bowel Syndrome website for more info on oral rehydration fluids and recipes.
3. Are you drinking with meals? Do you guzzle your drinks? Best choices are to drink fluids after meals, and to sip fluids all day long. This will improve your absorption of both nutrients and fluids.
4. If you ingest foods that have Sorbitol, such as diet candies or liquid medications, you may also see increased output. You might want to choose different candies or ask your doctor for different medications.
5. Certain medications such as Loperamide, Diamode, Ultra A-D, Imodium® A-D, and Questran can slow down output; check with your physician on dosage and frequency.
6. Soluble fiber additives slow down output. Examples include Metamucil®, Citracel®, and Benefiber®. These products also come in a biscuit form, which has the same effect.
7. Products with Magnesium can sometimes cause diarrhea; talk to your physician.

High Output: Dehydration and Other Concerns

High output from a stoma puts a person at risk for dehydration and serious electrolyte disorders. Watch for these symptoms of dehydration:

• Extreme thirst
• Feeling weak
• Dry mouth and skin
• Shortness of breath
• Decreased urine output or dark-colored urine
• Nausea or abdominal cramping
• Feeling light-headed or having headaches.

If you experience these symptoms, seek medical attention right away.

If your output is greater than 1200 mL, or 5 cups, in 24 hours, you may have Short Bowel Syndrome (SBS).  If you have had several resections of the small intestine, the shortened length of the small intestine can create problems with digestion and absorption. Speak to your doctor if you think you might have this condition. Also, the Short Bowel Syndrome website is a great resource,and their free book is excellent.

Slowing Output for Pouching Changes
If you are simply asking how to slow down your output so you can change your pouching system more easily, many ostomates do this by eating marshmallows or peanut butter about 30 minutes before the task.  Some people will take an Imodium® A-D 30 to 60 minutes beforehand.  Other foods that will thicken stool include:

• Applesauce
• Boiled rice or noodles
• Creamy peanut butter
• Tapioca pudding
• Bananas
• Peeled potatoes
• Toast
• Yogurt

My last desperate measure is to put some ice in a baggy and a washcloth and hold over stoma for a few minutes. If you frequently have trouble changing your pouch from continual output, consider trying the Stomagenie® by Stomagenics to contain your effluent while you clean and dry your skin for a new pouch.

As a masters prepared registered nurse with two decades of Certification in Wound, Ostomy and Continence Nursing, Anita Prinz, RN, MSN, CWOCN, WCC has hands on, down and dirty experience in acute care and home care. Anita has served on several committees for the WOCN Society and is the lead author of their Best Practice Guideline for Ostomy Discharge Planning. Anita has presented professional sessions at conferences, researched and created innovative posters. Her down to earth writing and teaching skills have helped her advocate for her patients. As a member of the American Holistic Nurses Association, and a healing touch practitioner, she strives to provide a holistic approach to her practice. Anita offers private home care consulting services, legal nurse consulting, writes and speaks to both health care clinicians and the community.

This article is not meant to replace the need for personalized medical advice, diagnosis or treatment. Please contact your doctor immediately with any concerns or in case of a medical emergency.

For more articles related to ostomies:

Top 10 Ostomy FAQs

Living with an Ostomy

Educate Yourself About Ostomies