Constipation can become a worrying and uncomfortable problem for many ostomates. Some may experience it more than others. So, trying to understand why it happens and how to manage it when it does happen, can really help relieve some concerns you may have. Blockages with a stoma can happen quickly and can become painful, so learning how to prevent this from happening can be really empowering for all ostomates.
Read on to find out more about managing constipation with a stoma. Learn more about how the right combination of proper hydration, nutrition, activity, and routine can really help your bowels and keep things moving.
What can cause constipation with a stoma?
Insufficient fluid intake
Drinking plenty of fluids to keep well hydrated is important for all of us, but for those with a stoma it is even more important. Make sure you drink about 8 glasses of fluid a day (unless you have been told otherwise by your surgeon or stoma care nurse). Try to avoid alcohol or caffeinated drinks where possible as they are de-hydrating. Introduce herbal teas which are a nice change.
Low fibre diet
Increasing the amount of fibre to your diet can be useful to combat constipation Introduce high fibre foods such as wheat bran or oats to your diet. Eating wholemeal foods, such as wholegrain bread, or wholegrain pasta can help. Vegetables are also high fibre and help as a prevention to constipation. Increase the number of fruits such as bananas, make smoothies with them introducing other fruits such as berries for a smoother meal.
Be aware of the type of stoma you have before introducing too many fibre rich foods. The last thing you want is to experience diarrhoea because of too much fibre. This can happen very quickly with an ileostomy, and you may find introducing a smaller amount of fibre is more beneficial. Finding the right balance for you, is important.
Reduced physical activity
Never underestimate the importance of exercise for preventing constipation. Being active can really help everything keep moving. Even if its walking or pottering around the garden, try to keep as mobile as possible as this stimulates bowel function
Medications such as painkillers and certain anti-diarrheal drugs
Check any medications you are taking as very often their side effects can be the cause constipation. Painkillers such as codeine or morphine are well known to be constipating as they slow down the movement of stool through your bowel, this gives your bowel more time to take the water out of your stool making it hard, dry and difficult to pass. So, make sure you talk to your GP about what you can do to prevent any issues. Often, they will prescribe a laxative to take with the painkillers.
Anti-diarrhoea medications such as Imodium (loperamide) is well used for those with an ileostomy. This is to prevent loose stools and slow down your output. Keep an eye on your output to check it is not making your output too solid, which could then lead to constipation.
Changes in routine or stress
A change of scenery, such as going away for the weekend or holiday can break your routine and be a cause of constipation. Your routine is disrupted and you haven’t got your home comforts around you. Your diet may also be different which can have an impact.
Often physical and mental stress can contribute to digestive upset, including constipation. When your body is in fight or flight mode your adrenal glands release hormones like cortisol and epinephrine, which slow the digestion and intestinal movement causing constipation. If you are experiencing difficult thoughts, emotions or situations give yourself space and although self-care might be at the bottom of your list, try to look at ways of relaxing and being kind to yourself.
Certain medical conditions –
- Underactive thyroid (hypothyroidism)
- Diabetes
- Irritable bowel syndrome.
- Colorectal cancers.
- Multiple Sclerosis.
- Parkinson’s disease.
- Nerve dysfunction or damage
What are the signs and symptoms of constipation?
Infrequent or difficult stool output
You may notice your stoma has been quieter with less output than usual. Try and monitor when you last emptied your stoma bag.
Hard, dry stool
Often the stool will slowly become thicker in consistency, or it may even look and feel harder than usual. The stool will then become a dry and maybe difficult and painful to pass. The stoma may even stop functioning by this point.
Abdominal discomfort or bloating
You may find that your abdomen (stomach) becomes bloated or distended because of the constipation. It will also start to feel uncomfortable as a result and you may start to have a “full” sensation.
Loss of appetite
If you have a blockage or severe constipation, you will start to feel sick, have a loss of appetite in addition to the abdominal cramping/pain and bloating.
Vomiting
With a bowel blockage, known as a bowel obstruction, you will start to vomit. This is caused by the obstruction causing the material inside to back up to the stomach. If not treated a blockage can cause a rupture which can leaks harmful intestinal contents and bacteria into your abdominal cavity.
How to manage your constipation?
Increase water intake and consider drinks with electrolytes.
Add fibre gradually to avoid bloating and discomfort.
Gentle abdominal massage may encourage movement.
Warm fluids, such as herbal tea, can help stimulate bowel function.
Consult a healthcare professional before making major dietary changes.
Laxatives prescribed by your GP
When to seek help?
- It is important to move swiftly when you are experiencing constipation with a stoma.
- See your GP or speak to your stoma care nurse if you experience persistent constipation lasting more than a few days.
- If you are experiencing severe abdominal cramps, nausea, or vomiting
- Or you have signs of stoma blockage, such as no output for extended periods
FAQs:
Q: Can I use laxatives with a stoma?
A: Yes you can, speak with your stoma care nurse so they can guide you to which ones are best for you and how to take them
Q: I heard prune juices can help, is that right?
A: Yes any fruit juices can help with constipation
Q: Should I reach out for help if there is nothing in my stoma bag after 24hours
A: Yes let your stoma care nurse know especially if you have abdominal pain/cramps. They will be able to guide you to over the counter laxatives which you could get started with
Q: If I have an episode of constipation, will I be more likely to have another?
A: Not necessarily, if you look at hydration, diet and exercise, you should be able to prevent another episode
Q: Does my stoma get bigger when I’m constipated?
A: Yes your stoma make look a little swollen and slightly bigger, this will reduce again once your stoma start functioning again
