High Stoma Output Guidelines for Enhanced Recovery Patients
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What is a normal ileostomy output? Output from an ileostomy in approximately 500-700ml per day. If you need to empty your pouch which is half full more than 5 times per day you must inform the stoma team as this is classed as a high output.
What should the output consistency be like? As a general rule your output should be a porridge/toothpastelike consistency.
Why is it important I maintain this consistency? Sometimes after surgery your stoma output can temporarily become loose and watery. If this happens for more than 24 hours it results in poor absorption of nutrients, salt and fluid from your diet. This can lead to you becoming dehydrated. It is important that you follow the instructions in this leaflet to prevent you from becoming unwell from dehydration if you have a high output from your ileostomy. If you are unable to follow these instructions then it may result in you being readmitted to hospital or needing further treatment.
How can I prevent this? nn Low fibre diet – this will reduce the amount of bulk moving through your bowel, helping to rest it. nn Add extra salt to your meals and try to increase your intake of salty foods. nn Try not to drink before, with meals or 60 minutes after meals. nn Restrict your fluid intake to no more than 1500ml per day as the more you drink, the more will come out of your stoma. nn Medications. 2
High Stoma Output
Medications that can be taken The following medications can help to slow down and thicken up your output: nn Loperamide (also known as Immodium) nn Codeine Phosphate
Loperamide Start with 1 capsule (2mg) up to 4 times per day – it should be taken 30-60 minutes before each of your meals. If necessary this dose can be increased to 2 capsules (4mg) up to 4 times per day. Please consult your enhanced recovery team or GP if you feel you need a larger dose. Loperamide does not need to be prescribed and can be brought over the counter.
Codeine Phosphate If your output is not responding to Loperamide alone, Codeine Phosphate can be added. This needs to be prescribed by a Doctor. Start with 1 x 30mg tablet up to 4 times per day – it should be taken 30-60 minutes before each of your meals. If necessary this dose can be increased to 60mg (2x30mg tablets) up to 4 times per day.
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How can I tell if I am still dehydrated? You may feel thirsty, tired, light headed and have a headache. You may be passing less urine and it may be darker than normal.
What should I do if I am still feeling dehydrated? nn Rehydration solutions will help replace salt and sugar lost through your stoma and help dehydration. A simple rehydration solution can be made at home using the following recipe mixed together: 6 level teaspoons of glucose (sugar) 1 level teaspoon of salt 1000ml water 2.5g sodium bicarbonate Some of the water can be replaced with concentrated fruit squash to improve the flavour. nn Restrict your oral fluid intake to 1000ml per day (you can also have 1000ml of the above rehydration solution additionally to this) nn Contact your stoma care nurse, ERP nurse or GP as you may need assessment
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High Stoma Output
Helpful Hints and Tips: Foods that may help thicken up the output: White bread Jelly cubes Marshmallows Pasta Bananas
Foods that contain extra salt: Crisps/Twiglets Bovril Marmite Stock cubes Salted biscuits/crackers Smoked fish Processed meats e.g. pork pie, bacon, salami Lower fibre foods: White bread/cereals/rice/pasta are better than wholemeal/ brown versions Avoid fruit and vegetables, especially those with skins, pips and seeds. Tinned fruit is okay. Plain cakes, biscuits & chocolate are suitable but avoid any containing dried fruit, nuts or coconut.
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