For those who have a high output stoma life can be a bit of a juggling act between slowing the output down, so it is manageable and also keeping well hydrated. It is so important to reach out for help if you are experiencing a high output from your stoma, as it doesn’t take long to become dehydrated and feel unwell.
Drinking alcohol when you have a high output stoma is a tricky combination. Life is hard enough with a high output and by adding in alcohol, it can often make the situation worse. Alcohol is a diuretic (it promotes the production of urine) and can start to dehydrate you quickly which can cause havoc when you are already trying to control a high output. Some alcohols can also create a laxative effect and hiding in the toilet with more diarrhoea will be a miserable experience many ostomates have experienced and will not want to re-visit!
Making changes to the types of foods you eat and fluids you drink, and when you eat and drink can be helpful in controlling your output. Often many people with a stoma feel that their output can be managed by eating a starchier diet before they embark on the odd glass of alcohol…. this is completely dependent on the person. We are all different and slowly re-introducing different foods and liquids is the best way to see what affects you, so start very slowly with alcohol if you are desperate to join in the festivities and celebrations. Remember you will have your own limits and it is important to stick to this.
What is a high output stoma and why does it happen?
A high output stoma is due to the type of bowel surgery you have had. If your large bowel (colon) is removed, the small bowel (ileum) is not as efficient at absorbing fluid so you may experience a high output from your stoma. If your stoma output is more than 1500mls per day, you are at greater risk of becoming dehydrated. However, over time your small bowel can adapt to maintain hydration.
A high output tends to happen with newly formed stomas. It can happen if your bowel is affected by disease or treatment or when your stoma has been shortened by the formation of a temporary stoma such as following pouch formation.
What does a high output mean?
A high output stoma is when you have more than 2 litres (8 cups) of fluid from your ostomy in a 24hour period. The output is usually very watery, and your pouch needs to be emptied 8 to 10 times or more per day. Due to the very loose consistency of your stool, it can lead to issues with leaks and move quickly on to sore skin.
If your output is not controlled with diet and medications, then you can become very unwell with severe dehydration and need admitting to hospital for intravenous fluids and monitoring.
Management of high output stomas:
You may be prescribed medications such as loperamide or codeine phosphate to try and reduce your stoma output and these are best taken 30-60mins before food. You may also be prescribed anti-secretory medication such as omeprazole or ranitidine to reduce the amount of acid produced by your stomach. Medications are another reason to avoid alcohol with a high output stoma.
Foods which thicken up your output are helpful:
- Eat plenty of low fibre carbohydrate foods which will help thicken up your output, such as white bread, rice, pasta
- Food consisting of gelatine for example: jelly babies, marshmallows and Haribo (do not eat sweets if you are diabetic)
- Stewed apple
- Bananas and smooth peanut butter
- Avoid high fibre foods such as large amounts of fruit and vegetables
- Add extra salt to your meals to replace the salts you are losing.
- Reduce your fibre intake
Often medications pass through the bowel without dissolving, if this happens, speak with your Stoma Care Nurse or GP as some can be sprinkled onto food to help with their absorption.
What to drink with a high output stoma?
- When you have a high output ostomy, your ability to absorb fluids is reduced. Drinking too much fluid can increase the output from your ostomy and cause you to become dehydrated. To help you absorb fluids: limit the amount you drink and change the types of fluids you are drinking.
- There are special drinks available called rehydration solutions – such as Dioralyte or St Marks Solution. These contain electrolytes such as sodium and potassium. These should be made up and sipped regularly throughout the day.
- Many ostomates prefer sport drinks…. dilute these down with water.
- Caffeine can increase the speed at which foods and fluids pass through your bowel, so try and change to decaffeinated versions or herbal teas. Sweeteners such as sorbitol, xylitol or mannitol or foods which contain them as they can also increase your stoma output and can also cause wind and bloating.
- Avoids other drinks high in sugar such as squashes, fruit juices, fizzy drinks as they make symptoms of diarrhoea worse.
- It is a good idea to separate fluids and solids. It may even be better to wait 30mins before or after a meal before drinking fluids. Try to limit fluids with meals to sips and have no more than 125mls (1/2 cup) in total. This will help the solid food pass more slowly through your intestines which helps your body absorb the nutrients.
- Try to avoid alcohol until you have the hight output under control. Bear in mind other factors such as what medications you are taking and how these will react together.
How would I know if I was dehydrated?
It is good to be able recognise the signs of dehydration. Often by checking the colour of your urine each day, it can be a guide to tell you how hydrated you are. A pale-yellow colour suggests you are well hydrated, however a dark yellow/brown colour can indicate you are dehydrated. Other signs of dehydration are listed below. If you experience these remember to contact your Stoma Care Nurse or GP for guidance.
Signs of dehydration:
- High liquid output from your stoma
- Dry, sticky mouth and increased thirst
- Light-headed or fainting
- Tiredness and headaches
- Passing urine less often, which may be dark or strong-smelling
- Muscle cramps
- Increased heartbeat