Learning About 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 is losing more than 1.5 to 2 L of fluid per day.

High ileostomy output may occur within the first 3 weeks of an ileostomy. This is called early high-output stoma (HOS). If it lasts longer than 3 weeks or if it starts after 3 weeks, it’s called chronic or late HOS.

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.

Hypotonic drinks can also lead to losing too much fluid. Hypotonic 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.

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.

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.

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 are dehydrated, your doctor will likely have you drink rehydration solution. You may need to limit other drinks, including water, tea, coffee, and alcohol. You will also need to avoid high-sugar liquids, like soda and fruit juice. You may get fluids through an intravenous (I.V.) line in a vein in your arm.

Your doctor may put you on a low-fiber diet until the fluid output is managed. If advised by your doctor, take soluble fiber supplements, such as psyllium husk. This can help thicken stool and reduce watery output. You may take other medicines, including an antidiarrheal medicine or proton pump inhibitors.

If you are malnourished, you may get liquid supplements by mouth. Or you may get them through a feeding tube or by I.V. Sometimes treatment includes surgery, but this is rare.

Here are some things you can do to help prevent high ileostomy output:

• 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, broth, and vegetable juice. Avoid sugary liquids. They can increase stool volume. These include fruit juice, soda, ice cream, and sweetened gelatin.
• Watch for symptoms of dehydration. Contact your doctor 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.