High output loop ileostomy, any tips?

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IntestiFail
New Member


Date Joined Aug 2011
Total Posts : 6
   Posted 8/28/2011 5:47 AM (GMT -6)   
Hi all,

I had surgery for stricturing small bowel Crohn's on August 5th to give me a temporary loop ileostomy, with reversal set for 3 months time.

It's now been over 4 weeks since my surgery, and I'm still producing over 2 litres fluid daily from my stoma. I seem to be emptying it every five minutes - I have to set my alarm during the night for every hour or so to prevent a 'blow out'.

I've been advised about the danger of dehydration, so I've been drinking plenty of isotonic ORS mixture along with water and orange juice for potassium. The trouble is, everything just seems to flow straight through me. I'm not feeling dehydrated particularly, and don't have any of the signs of dehydration, except that my urine is quite dark and infrequent (2-3 times daily).

I'm taking 6mg of loperamide an hour before eating, up to 30mg a day, and I'm at a loss for what to do. I've tried pasta, bananas, toast, gelatin sweets etc to thicken things up but no real success. It might thicken and slow for an hour or so, but as soon as I have something to drink it whooshes on through again. I'm eating a lot at the moment as I'm trying to gain weight, example day below:

Morning snack - 2 cereal bars with packet of crisps
Breakfast - Bacon baguette or fried English breakfast or scrambled egg on toast
Mid morning snack - Crisps and small apple pie
Lunch - Pasta with tomato sauce
Afternoon snack - Ham sandwich on white bread with packet of crisps and portion of cheese
Dinner - Pepperoni and ham pizza

Drinks throughout day: ORS solution, water, orange juice, Ensure Plus drinks. Total of at least 2+ litres fluid daily.

Anyone got any ideas? I'm a bit stuck. Thanks in advance.

Bay Area Guy
Regular Member


Date Joined Jul 2010
Total Posts : 301
   Posted 8/28/2011 6:11 AM (GMT -6)   
The OJ may be doing something to you given the high sugar content and the pulp in it. I know when I had my ileo, if I drank juice straight, it would zip right through me and take everything else with it. You might want to try some yogurt along with the rest of what you're eating. I would have a yogurt first thing in the morning and another one last thing before bed. It seemed, along with the rest of the stuff I was eating, to slow me down and firm my output up.

Good luck.

Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3115
   Posted 8/28/2011 7:34 AM (GMT -6)   
It does take time to adjust, but you may actually be causing the high output with the amount you are drinking...sugar (or artificial sweetener) content of those drinks could be a culprit, to. There isn't a 'set' amount that a person with an ileostomy has to drink. It's very individual and may take some trial and error to figure your new system out.

We can also get the fluids we need through the foods we eat, which helps us absorb it better, since it's not shooting through us. Yogurt, canned fruit, pudding, ice cream or Popsicles can all help.

Welcome to the forum...keep us posted on how things are going.
formally known as OHIO76 ~ honoring my daughter's passion!
Crohn’s dx 1989
some terrible years before my temporary ileo in 2001
Proctocolectomy w/end ileo in 2008
...wish I knew then what I know NOW!

IntestiFail
New Member


Date Joined Aug 2011
Total Posts : 6
   Posted 8/28/2011 9:12 AM (GMT -6)   
Thanks for the responses everyone. I'll try cutting back on the orange juice and sugary drinks. I've always tended to drink quite a lot during the day, I suppose now I've got this stoma I'll have to try and cut back on my fluid intake.

One more question - my visiting stoma care nurse, and several articles I've read online, suggest that ileostomy output should be about 1 litre regardless of fluid intake, and increasing the amount drunk should just increase urine output. Is this accurate? Other than keeping my salt intake up, I'd there anything else I can do to aid absorption?

Thanks again. I've been lurking on this forum for a while reading posts, and it's good to hear from people with experience. First few weeks with this ileostomy have been very stressful, to put it mildly...

stripey
Veteran Member


Date Joined Feb 2011
Total Posts : 1059
   Posted 8/28/2011 3:12 PM (GMT -6)   
When an ileostomy is first performed the output tends to be high for anything up to the first 3 months. This is because the colon, which is the area that liquid is absorbed from waste, is no longer in use and so the small bowel has to learn to take over this work and this takes time.

Orange juice and any sugary fruit juice or drinks will speed things up and so produce more output, this is turn will dehydrate the system. Stick to water, sugarfree drinks, caffeine free tea/coffee and also be careful with fat intake as when I had my loop ileo it didn't like high fat content and would respond with high output. Also the tomato sauce on your pasta could cause things to whizz through, if I eat tomato pasts sauce or soup or drink tomato juice it comes straight out in 30 minutes.


So try to reduce your liquid intake, reduce fat intake (fried breakfast, pizza, cheese) and reduce sugar intake. Things will settle down but in first few weeks they can be a bit all over the place.

I produce over 2 lts a day as I have short bowel syndrome and high output. I've just got used to it but manage to go 8 hours most nights without needing to empty.
Crohn's dx 1989, loop ileo 1992, end ileo 1992. Arthritis developed 1990 Stoma abcess 1995. Azathioprine started 1995. Panprocolorectomy 1999. Stillbirth 2000, antiphospholipid syndrome dx 2000. Flare up 2004, stoma abcess and strictoplasty 2004. Low blood pressure dx with impaired kidney function 2006, fludrocortisone pres. flare up 2010, azathioprine, codeine, immodium, simethicone.
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