Dealing with liquid ostomy output – OSTOMY TIPS (w/ video)

Dealing with liquid output
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I had previously written about dealing with thick ostomy output, but many ileostomates have the opposite problem: liquid output. In this post, I’d like to go over a few tips that you can use to thicken up your output. These tips apply to colostomates who have loose stools but are directed more towards ileostomates.

Video

https://youtu.be/M97eBxJpV2s

Why Worry About Liquid Or Loose Output?

For the most part, there’s nothing really wrong with having liquid or loose output, but it does come with a few challenges:

  • liquid output is more likely to cause leaks.
  • liquid output can shorten the life of your wafer by speeding up erosion.
  • liquid output can clog pouch filters and/or leak through them.
  • emptying a pouch full of liquid can be messy (especially if you have mobility issues).
  • liquid output could lead to dehydration more easily.
  • a high-output stoma could mean that nutrients don’t have time to be properly absorbed.
  • you may need to empty your pouch more often than you’d like.

Causes of Liquid Ostomy Output

Ostomates with Short Bowel Syndrome are more prone to having liquid output with fast transit of their food through their small intestine, but there are other reasons which can cause it too.

Here are a few of the more common causes:

Dietary

The following foods and beverages can cause a dramatic change in your output’s consistency. You’ll likely be able to identify the culprit within hours of consuming them:

  • Coffee or tea
  • Sport drinks
  • Soda/Pop/Soft drinks (both diet and regular )
  • Fruit juices
  • Chocolate
  • Certain fruits (for me it’s cherries)
  • Artificial sweeteners
  • Alcoholic beverages (especially wine)
  • Fried foods
  • Hot/spicy foods
  • Non-vegan foods like dairy (or other lactose-containing food, if lactose intolerant)

For the most part, very few of the items listed are needed (or desired) in a healthy diet, so if you can cut them out, you’ll find benefits in more than one way.

Drinking with meals or drinking too much at one time can loosen your output too.

Laxatives, Medication & Supplements

Some medication or supplements can cause our output to become loose. If you are taking a laxative, it may also cause loose stools.

Antibiotics can cause liquid output (diarrhea) that tends to pass within a few days.  You may be asked to take a probiotic while you are on antibiotics to help balance out your gut flora.  Keep in mind that you should never stop taking antibiotics until you’ve completed the full course.

Viral or Bacterial

There are many types of bacteria and viruses that can cause diarrhea or liquid output. If you’ve experienced an unusual change in your output, you may fall into this category.

Blockage

When you experience a blockage, your body will try to flush out the blockage, which can result in liquid output. I didn’t have this at all for my last blockage, but many ostomates report having liquid output while they were obstructed. This will usually be accompanied by other symptoms that are typical for a blockage like abdominal pain, pain with peristalsis (this comes in waves as your gut tries to move things along), nausea and possibly vomiting.

If you suspect a blockage, you’ll want to contact your GI or head to your local ER.

For tips on preventing and dealing with blockages see THIS article.

Tips for Dealing With Liquid Output

Talk to your doctor if you suspect food poisoning or another bacterial/viral cause of your liquid output. As suggested above, if you suspect a blockage, you’ll want to contact a medical professional.

For “normal” causes, you might want to try the following tips:

Dietary

One of the most effective ways to deal with liquid output is to make a few dietary changes or modify the way you eat. Keeping your meals and beverages separate, or drinking throughout the day (rather than in one sitting) can help.

The following foods are also known to thicken ostomy output:

  • Starchy foods like pasta, potatoes, rice, white bread
  • Crackers
  • Potato chips
  • Applesauce
  • Bananas (especially when underripe and without spots)
  • Nut butters (peanut, almond, sunflower seed, etc)
  • Oatmeal

Most of these foods can be considered healthy, although don’t depend too much on the white bread, white pasta or chips if you don’t need to. I remember one fellow I spent a hospital room with had to consume several bags of potato chips plus Imodium to slow his output down because of his short bowel.

Gelling agents

A popular choice among ostomates is to use gelling agents in their pouch. These can come in tablets, powder, capsules (usually made with animal ingredients) or sachets, but they all work in a very similar fashion: Add the gelling product to your pouch as directed and it will thicken up when it comes in contact with your output. Here’s a demo of how gelling products work:

I’ve reviewed the ConvaTec Diamonds sachets, but I’ve also tried other products and they generally work well. You should be able to get samples to try.

Here’s a video of the Diamonds sachets in action:

http://www.youtube.com/watch?v=pOALPqnrc_A&feature=youtu.be

Anti-Diarrheal Medication

Many ostomates will be told by their doctor or stoma nurse to take a product like Imodium to slow down their output. I would personally try this last if all other options failed, however, if you have a very high-output stoma which is causing ongoing nutritional problems or dehydration, this might be an option you’ll want to try until things get stabilized.

Fibre Supplements

This is not an option I’d recommend, nor is it something that your doctor is likely to recommend either. There are fibre supplements which can bulk up stool but they carry a risk of causing a bowel obstruction too. Do not try this unless explicitly told by your doctor.

Guar Gum

Guar gum is made from guar beans, but it’s been used as a thickening agent in various products for quite some time. There are claims that it has eight times the water-thickening effect compared to cornstarch, which is pretty impressive!

As a supplement, this often comes in tablets, but you should consult with your doctor to see if it’s a good option for you. Like fibre supplements, there’s a risk of slowing things down too much.

Closing Thoughts

Some ostomates don’t mind liquid or loose output, like my IBD blogger friend and ostomate, Marisa from the blog JournalingIBD (a.k.a Keeping Things Inside is Bad for My Health). But if you’re one of the people who find liquid output to be problematic, then I hope the suggestions listed will come in handy.  In addition to the tips included above, you may also want to try using barrier rings or moldable wafers to help prevent liquid output from leaking under your appliance.

QUESTION: What do you do to thicken your output?
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14 thoughts on “Dealing with liquid ostomy output – OSTOMY TIPS (w/ video)

  1. I was operated on just two weeks ago and I have to empty my bag every hour except at night and then when I wake it is nearly bursting full. I have an ileostomy with crohns. I am taking two imodium in the morning and two at night and one before each large meal. Can you tell me what I may be doing wrong? I feel like a prisoner in my home as I have to drain bag every hour. My output is well over 1,000 per day.

    • Hi Ed,

      Frequency and consistency of our output is really inconsistent in the first month or two. Usually, our output will be about equal to the volume of food and beverages we consume.

      A few things to consider :

      – your diet likely isn’t back to normal yet (you should get the OK at about the 4-6 week mark. Things will become more predictable after that point.
      – keeping a food diary could help you identify foods that increase your output.
      – check in your surgeon or stoma nurse about those hourly bathroom trips. Most ileostomates will empty their back 5-9 times a day, but there are many factors that can change this number.
      – starchy foods should help to slow your output down a bit more.

  2. I was diverted from my j-pouch to a permanent ileostomy 4 months ago. I won’t be going back to my j-pouch in the future. I wasn’t mentally prepared for that big surgery. Now I wish I’d had it removed. I have been wrestling with my output from day one. In the beginning it was nice and thick but I think that was due to the 3 hours my surgeon spent lysing my adhesions during the surgery. I think they were sluggish or something because as I recovered my output increased. I have had a problem staying hydrated ever since I got the j-pouch 5 years ago and it’s worse now. Plus I have an uneven, flabby, abdomen from abdominal surgeries and getting a wafer to last longer than 2 days has happened once. My stoma nurse told me to start taking Loperamide, prescription Imodium, again. I added capsules of Metamucil into the mix too. I have had several obstruction/partial obstructions and appreciate your warning about Metamucil. I have not been taking the max dose of 8 Loperamide daily but really need it. I have to empty my bag too many times daily. I have continued using electrolyte tabs, no sugar, like NUUN or similar powders as well as highly concentrated electrolyte liquids to add to water. They help with dehydration but not as well as they did before my stoma. Do you or anyone else here know if they are affecting my output? This topic was what I really needed to read tonight. Thank you for all you share with us.

    • Hi Paulette,

      I’m so sorry that you’ve been having so many problems, and I know how frustrating a high-output stoma can be.

      I haven’t used the product that you’ve mentioned, but if it has no added sugar (and no artificial sweeteners), then it’s likely not increasing your output. If you go a few days without it, does the frequency of your output change?

      It may help to find a support group (online or off) that focuses on people with short bowel syndrome, as they’d be dealing with very similar issues (high-output stoma), and may be able to offer you more tips.

      Good luck!

      Eric

      • Thank you Eric,
        I’m in many online support groups and they have been fantastic. I’ve even watched many u-tubes on things such as how to empty our bags while sitting on the toilet and how to keep everything dry or not to wet when showering and bathing – etc. I appreciate your help here as nowhere did I find such specific helpful information.

        I went off of Metamucil caplets and ate oatmeal for 2 days – like substituting. Today I am back to adding a 3 vs the 6 serving size caplets. It is easier for me to swallow the caplets and as we are to take in less water than people with colon’s, it is easier for me to take them. I am going to continue with oatmeal and try adding the generic metamucil caplets until I figure how many. I was just doing it willy nilly so am more deliberate.

        Thank you for responding and I will try groups with short bowel syndrome.

  3. Hi, thanks for you r videos, they are very helpful. I have high output ileostomy. My stoma is quite low to the skin. My nurse recommended a moldable convex insert. I am trying it, but what happens is after a day and a half, since it designed to “swell” up around the stoma to prevent leaks, it seams to swell up so good as to make the opening in the insert and wafer smaller. Then, the output must go somewhere, so it starts seeping through the wafer.Any suggestions? Perhaps mold the opening larger when I apply it? But then it may not cover close enough to the stoma to protect the skin. Any answers to my issue?

  4. I have a very high output yet I also suffer with my kidneys so I have to drink lots but this is affecting my liquid stoma output.

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