What is high ileostomy output?

High ileostomy output is a health condition that can happen after an ileostomy.

An ileostomy is surgery that allows waste to leave your body through an opening (stoma) in your belly and collect in a special pouch. During an ileostomy, the doctor attaches the end of the small intestine to the stoma. The pouch attaches to the skin around the stoma. Stools collect in the pouch. You must empty the pouch several times each day.

After an ileostomy, your stool may be more watery than it was before. This is common.

High ileostomy output happens when you lose too much fluid in your stool and become dehydrated. In most cases, this means needing to empty your pouch every 2 hours, losing more than 1.5 to 2 L of fluid per day.

What causes it?

If your remaining small intestine is very short, that could cause too much fluid loss in your stool. This fluid loss can also happen if something is blocking your small intestine. The small intestine may be blocked because it is too narrow. Or it may be blocked by other problems, like a fistula or a hernia.

Sometimes losing too much fluid in your stool is related to medicine use. Taking medicines that help food move through the digestive tract may cause it. Or it may happen if you stop taking some medicines, like opiates or steroids.

Certain types of drinks can also lead to losing too much fluid. These drinks include plain water and other low-salt fluids like tea, coffee, and alcohol. Other causes are having an infection or other health condition. These include Crohn’s disease, celiac disease, and hyperthyroidism.

What are the symptoms?

You may have high ileostomy output if:

• Your stoma pouch refills quickly.
• You often have thin and watery stool.
• The skin around your stoma is red and irritated.
• You have symptoms of dehydration, such as:
  • Dry eyes and dry mouth.
  • Thirst.
  • Less urine than usual.
  • Feeling dizzy, weak, or very tired.
  • Muscle cramps.

What other health problems can it cause?

High ileostomy output may lead to other health problems that require medical care right away. These include:

• Dehydration. This happens when your body loses too much fluid.
• Electrolyte imbalance. Electrolytes are minerals found naturally in the body. They include sodium, potassium, calcium, and magnesium. When they are not at the right levels, you can feel very ill.
• Kidney problems, including acute kidney injury and end stage renal disease.
• Malnutrition and weight loss.

How is it treated?

Treatment for high ileostomy output often includes treating dehydration, making changes to your diet, and taking medicines. If you have an underlying cause, like a small intestine blockage, that will also be treated. Some people may be treated in the hospital.

If you have high ileostomy output or are showing signs of dehydration, your doctor will likely have you drink oral rehydration solutions. Oral rehydration solutions hydrate better than other fluids when you have high ileostomy output. They replace both fluid and electrolytes. You can buy oral rehydration solutions in stores or make your own.

Insoluble fibre can increase your ileostomy output, so your doctor may put you on a low-insoluble fibre diet until the fluid output is managed. Insoluble fibre is found in higher amounts in legumes, dried fruit, nuts, seeds, whole grains, and skins or peels on fruits and vegetables.
Foods higher in soluble fibre may help thicken stool and absorb liquid in your gut. Foods with soluble fibre include applesauce, bananas, barley, black beans, cooked carrots, oat bran and oatmeal, and peeled fruits like apples and pears. If advised by your doctor, take soluble fibre supplements, such as psyllium husk. This can help thicken stool and reduce watery output.

If you are malnourished, nutrition supplement drinks may help. Some nutrition supplement drinks are higher in sugar and may make your ileostomy output worse. Choose options with less sugar, like Boost Carb Smart or Glucerna.
If your ileostomy output doesn’t thicken, or if it gets worse (thinner, more watery, and refilling your stoma pouch more quickly than before), contact your doctor.

How can you help prevent it?

While some causes may not be easily identified, there are tips you can try to help reduce your risk for higher ileostomy output, or to help manage your output before it gets worse.

• Drink plenty of fluids to avoid becoming dehydrated, unless your doctor tells you not to. Choose fluids with low or no sugar, such as water, oral rehydration solutions, broth, milk, and fortified soy beverage.
• Watch for symptoms of dehydration. Contact your healthcare team if you have any symptoms.
• Take your medicines exactly as prescribed. Contact your doctor if you are having problems with your medicines. Talk to your doctor before taking any new medicines, including medicines for diarrhea.
• Limit foods that can make your stool loose or watery. These include raw fruits and vegetables, garlic, onion, and milk. They also include alcohol and sugary foods, like candy, cake, and cookies.
• Talk to your doctor, dietitian, or ostomy nurse if you need help with your diet.
• Keep a record of your stoma output and your urine output as directed by your doctor or nurse. Contact your doctor if you have a high output of stool or a low output of urine.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

• You are very weak and have cool or clammy skin that looks blue or grey in colour.
• You have trouble breathing or chest pain.
• You passed out or you feel faint or dizzy.

Contact your doctor now or seek immediate medical care if you have symptoms such as:

• Dry eyes and a dry mouth.
• Passing no urine or only a little urine in 8 hours.
• Dark urine.
• Feeling thirstier than usual.
• Muscle cramps.
• Severe stomach pain.
• New or worsening symptoms.