Dealing with Thick Ostomy Output – OSTOMY TIPS (w/ video)

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Output from an ileostomy is generally liquid or loose, but some of us have thick ostomy output which can be difficult to manage.  Colostomates also tend to have thicker output, but it’s generally drier, formed and far less frequent.

Because I have an ileostomy, I’ll be focusing on ways in which I’ve handled thick output.  These may or may not work if you have a colostomy (or you may not have the same challenges).

Video

Causes of Thick Output

There can be several factors which can thicken your output.  Sometimes they are intended, but other times they may be a result of factors that you have little control over.  Some of the most common reasons are listed below:

Diet

It’s no surprise that the foods and beverages you consume will have an impact on your output.

Here are some foods that tend to thicken ileostomy output:

  • Starchy foods like white rice, potatoes, pasta.
  • Processed foods like white bread, potato chips, crackers.
  • Nut butter (peanut, almond, etc.).
  • Bananas (I find them to be especially more thickening when they are under-ripe).
  • Applesauce.
  • Non-vegan foods like milk, cheese, marshmallows.

It’s not only the type of food but also the quantity consumed that can make a difference.

Medication, Supplements, OTC drugs

Some medications we take can also affect the speed at which our food passes through our system.  Some ostomates use Imodium to intentionally slow down their output while others may use fiber supplements in the form of stool bulking agents like Metamucil. Be sure to let your doctor know if you’re taking anything like these.

Dehydration

When we don’t drink enough fluids, little water passes through our digestive system and the result can be thicker output. Some ostomates reduce their fluid intake on purpose, but this isn’t recommended and can increase the risk of dehydration.

I’ve written an article about maintaining adequate hydration HERE.

Problems Caused by Thick Output

Thick output may sometimes be desired by some ostomates, as it can reduce the risk of leaks or premature wafer erosion, but there are a few drawbacks as well:

  • can cause “pancaking“, which means stool gets stuck around your stoma and doesn’t drop down to the bottom of the pouch.
  • can put pressure on the pouch causing it to come off in some cases (more of a problem at night).
  • can increase the chance of blockages if things are too thick and slow.
  • can make it difficult to empty or clean your pouch.
  • can make wearing an ostomy wrap a bit uncomfortable.
  • can make some liquid pouch deodorants more difficult to work.

Ways of Dealing With Thick Output

Fortunately, there are several ways in which you can remedy thick output or at least make it more manageable. Here are several that I’ve found to work:

Dietary considerations

Some foods and beverages can help loosen up your output. You may have to experiment with a few to find one that works.  Here are a few that have been known to work in a majority of ostomates:

  • Fruit juices (especially prune, apple, and/or grape)
  • Coconut water
  • Sports drinks
  • Coffee/tea
  • Warm water
  • Fruits (canned, cooked or raw)
  • Artificially sweetened drinks.
  • Wine

Prune juice works really well for me, and it’s a great source of potassium.  If I only want to loosen my output, then I’ll have about a cup worth of prune juice; if I want to really flush out my system, then I’ll have about a liter worth and simply wait about an hour.  I’m not a coffee drinker, but coffee is often the culprit when an ostomate complains of loose output.  You don’t have to chug a bunch of these liquids at once; simply having 1/3 – 1/2 cup at a time and throughout the day is enough to keep things moving.

I don’t recommend the use of artificial sweeteners as they are known to cause more harm than good.

You can also reduce or eliminate the foods which that are known to thicken output (I posted a list earlier in the article).  I try not to limit healthy foods like bananas or potatoes, but if you drink cow’s milk or consume cheese, it might be worth eliminating them from your diet and replacing them with better plant-based alternatives (soy milk, almond milk, hemp milk, oat milk, coconut milk, etc.).

Also, try eating smaller meals more frequently throughout the day.  This may not be an option for you, but it’s something to consider if you’ve had trouble with thicker output.

Hydration

Ostomates need to pay particular attention to their hydration, especially if they have an ileostomy since the colon is what would normally reabsorb fluid back into the body.  Over time, the small intestine adapts and will compensate for some of the fluid loss, but it’s still important to drink enough water (and fluids in general) to keep hydrated.

Drinking throughout the day, or consuming water-rich foods like watermelon, tomatoes, or cucumber will help keep your hydration in check, but it will also aid in loosening your output. If you find that certain meals (i.e. starchy meals) cause your output to thicken too much, consider drinking water with your meal.

For tips on getting adequate hydration, check out THIS article.

Lubricating your pouch

This is an easy option that doesn’t require any modification of your diet.  It’s important to note that lubrication your pouch won’t loosen your output, but it will make emptying your pouch a little easier. I’ve reviewed several Lubricating pouch deodorants already, so feel free to check them out or try samples of a product that you have easy access to.  A bonus with these products is that they tend to also eliminate pouch odors!

Some people will opt for do-it-yourself solutions, rather than purchase ostomy pouch lubricants (likely because of costs).  I do caution on the use of some of these methods, as they may have unintended consequences to your pouches wear-time.  There’s also a risk of these products being absorbed into your body through your stoma.  If you are adventurous, here are few ideas that I’ve come across through various ostomy forums:

  • Cooking oil, including olive oil, vegetable oil, canola oil, etc. (add several drops to your pouch)
  • Pam cooking spray
  • KY-Jelly (or other personal lubricants)
  • Baby oil
  • Essential oils (be careful with this one, you may burn the lining of your stoma!)
  • Coconut oil (is solid at room temperature and liquefies in your pouch)

Just Add Water!

If pouch lubricants aren’t working well, you can try adding a bit of water to the inside of your pouch.

I’ve experimented with approximately 1 tablespoon worth of water, and it helps to losen up thicker stool, making it easier to manage.

Of course, you can add more or less water until you find a sweet spot that works for you!

An advantage of using water instead of a lubricating deodorant is that it’s cheaper, but also less viscous which means it will flow better and mix easier with your stool.

Talk to your doctor or pharmacist about medication or laxatives

If you are on medication or painkillers that are known to slow down and thicken your output, you might want to see if there are other alternatives that you could use instead.  Also, don’t use products like Imodium, laxatives or fiber supplements without your doctor’s knowledge.

Some people use laxatives or magnesium supplements (i.e. Natural Calm) to help with thick stools.  You shouldn’t be taking either without your doctor’s knowledge as they may cause electrolyte imbalance and other potential complications.

Tips

  • Wear an ostomy accessory belt overnight to give you a little extra support if your output has a tendency to push your pouch out.
  • Avoid wearing ostomy wraps or anything that might put pressure on your stoma if you have thick output. Wearing them increases the chance of pancaking and leaks.
  • Always try to seek guidance from your ostomy nurse.  While they may offer the same suggestions, they can also offer you a solution based on your personal circumstances.

Closing Thoughts

While there are many reasons why your output could be thick, there are just as many solutions you can try to make life a little easier.  Each one of us is unique, so experiment to see which suggestion works best for you.  Good luck!

QUESTION: How do you deal with thick output?
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Tony
1 year ago

k

LK
1 year ago

Eric,  THANK  YOU!  That was perfect. I was going to say in my entry to squeeze the life out of the remaining center, but because I get eczema and the OJ burns it when wet by OJ, I just take the cutting board I used, grab a fork, jab the remains and slide the back of a spoon across the rest to get all those great vitamins. Eric, your so awesome! Does anyone else think Eric is awesome?

LK
1 year ago

Yes, you can add me to the list of orange  partial blockage. I handled it from home only because I was not in that much pain. With short gut syndrome, I was aware how many meals and what should have been through to the bag. After two days of nothing, and eating lightly,  I new I was hooped. I also new immediately what had caused it. I had two small oranges the night before. After that if I wanted an orange, I made a point to take it out of  the skin. If you have ever watched a chef on TV you will know how to do this. Let me help. Cut the tops and the bottom off the fruit to make it sit to not roll. Then slice the peel off the fruit from top to bottom removing the softer part of the skin under the peel also, once done with a knife place the blade into the fruit as close to the skin as you can get. Do this on each side of each segment and then making the triangle towards the center, the fruit should release into  waiting bowl. Do this over a bowl or plate to catch the juice and be sure to enjoy that also. To get the remaining juice from the pieces of peel you just removed, take the back of a spoon and drag it along the peel over the  bowl. I am on a very tight budget, and at first thought this would be wasteful. Not any more. If you have a problem with doing this to your fruit, reason it out to one less hospital stay. Grape skin can be equally as bad for a blockage. I chew the grape down to the point where the skin is feeling tough and dry and then toss it. Not worth the risk.  Three days later, the blockage cleared. I will not make that mistake twice. I get eczema on my hands quickly from oranges, so I usually drink my OJ, but sometimes you just need a good chew! 

Bill grandy
1 year ago
Reply to  VeganOstomy

Sorry you ran into the same problem Linda. Thanks for the tips. I won’t be eating oranges for awhile. I didn’t realize grapes did the same thing so goodbye to grapes also.
Bill grandy

Bill grandy
1 year ago

Beware of large oranges causing blockages. I had a blockage a couple of weeks ago. The doctor I saw said that was the second blockage he had seen from oranges in a month. Luckily I passed it all within a matter of a couple days.

Bill grandy
1 year ago

What do you suggest for itching under the pouch.

dd4741
dd4741
1 year ago
Reply to  VeganOstomy

could also be a fungal rash – try non powdered antifungal foot spray – if skin if irritated – the spray will sting like crazy, chnage your wafer every couple of days & spray with antifungal first, then do your usual skin prep routine. antifungal treatment usually takes 2-3 weeks to completely resolve.

LK
1 year ago
Reply to  dd4741

@dd4741, Hi there, no, no foot spray.  Stinging will inflame the skin further. Please see your doctor, a fungus can be dangerous and if it chooses to move inside of you, your could have much further trouble! Your GP OR Nurse Practitioner can prescribe a cream. Bring a new pouch with you when you go incase they swab the area. But please no foot sprays. 

john68
2 years ago

Hi Bill, Their can be many reasons and its narrowing it down, could the stoma changed size, when we gain weight after surgery it can mean a different tummy shape. without going through a list having a look at the article Eric has done on the possible causes. their is always an answer.

Bill grandy
2 years ago

I had an ileostomy operation approx. 3 years ago. I had several instances of leakage but for the past month I’ve averaged one leakage a day. Anybody else experience this problem.

Clair Rich
Clair Rich
2 years ago

I need to know if yogurt helps with thick stool or other things, thanks Clair

Clair Rich@icloud.com
Clair Rich@icloud.com
2 years ago

That is interesting, thank you for that. Clair. Do you know if yogurt helps?clairrich@

Anna Rappaport
2 years ago

Help! I’ve tried EVERYTHING to deal with pancaking/thick output and nothing seems to work:( I have a loop ileostomy and am a little more than 6 weeks post-op. No matter what I eat/how much I drink/stop eating etc I have very little output from around 6am until 4pm, and then it accelerates like crazy by 8 or 9 and lasts until 1AM if I’m lucky. I haven’t been able to tolerate fiber so I’m stuck with the horrible low residue diet still (except I seem to be ok with baked souffles with spinach and squash.) I tried juicing (with a masticating juicer!) and 3 hours later had a mini obstruction I was able to pass but with pain and my nurses said no go for juicing for now. Protein smoothies (I seem to be ok with peaches) accelerate my output. I’m a lactose intolerant vegetarian (so the only animal product I eat is eggs) so I’m eating all the thickening output foods:( It seems to work to drink pear juice but I can’t stand having all that sugar…I wake up every hour or 2 at night because I have to push the stuff out from the wafer or I’m afraid it’ll leak underneath. I have to wear a deep convex due to a surgeon error on my stoma (it empties from the underside loop below skin level even though my stoma is protruding.) Lubricants don’t help-I’ve tried adapt, brava, safe n simple etc… Not willing to try baby oil and jeopardize the bag. Any other ideas?

TravelAddict14
2 years ago
Reply to  VeganOstomy

Hey Eric,

I maybe empty 1 or twice for the majority of the day no matter whether I eat first at 8am or at 11 am (this has happened a few times when I’ve had to see the ostomy nurse). Then by 4 it’s every hour and by around 9 or 10 it’s every half hour until maybe 1am (give or take an hour for all of these). It’s like I’m switched-all the food I eat during the day comes out at night rather than immediately following the meal. I’ve tried to do the small meals throughout the day and just can’t pull it off. I wouldn’t say my 3 meals are BIG (breakfast is usually eggs on toast for example, lunch a peanut butter sandwich) and try to snack but my appetite just isn’t there to keep eating every 2 hours and when I do it makes me feel sick because I’m not hungry. It’s always done this:( I’ve been in hell barely sleeping.
Immodium just made it thicker and more impossible to get out. They gave me lomotil and I tried it at bedtime-interestingly when I woke up after 2 hours I had even MORE than usual and it was more liquidy.

I don’t know if it was an obstruction, it for once stayed in me (I struggle with protein shakes and this) but then 3 hours later I had cramping and it all came out in one large solid amount which my nurse said sounds like I passed a smaller obstruction?

I know I only have 19 days but I’m so thin and sleep deprived and I’m worried about my health going into my reversal:(

TravelAddict14
2 years ago
Reply to  VeganOstomy

I see what you’re saying and understand that my output at night is likely from breakfast/lunch and ‘dinner’ (dinner being before 5pm)-I’m trying with the smaller meals but my schedule is such a mess right now it’s hard to snack. I’m having such horrible issues with the ostomy (I changed FIVE times on Friday) that I end up not eating trying to change it and then it’s gotten until late in the afternoon and I’m starving.) Problem with the output happening at night is I’m up every 1-2 hours to empty it because it’s so thick it pancakes and no matter how I sleep gravity doesn’t do the job and if I don’t get up to empty it it burrows it’s way through the wafer. I was hoping if I thinned it out overnight maybe it would drop better in the bag and I could sleep for longer than an hour or a 2 at a time:(

Amy Dormann
Amy Dormann
11 months ago
Reply to  TravelAddict14

My reversal is in 10 days and I’m having the same problems, had my stoma got 6 months with no troubles at all,the last three days have been hell,the cramps and hard stools and haven’t changed my diet,and of course tomorrow I have to go for my first presurgery tests and I’m feel blocked,my doctor told me to try colace ,so I am but it’s not helping much and makes my cramps worse, I’ll let you know tomorrow what they say,and maybe it wii help you,good luck!

Lia Elena
3 years ago

Hi everyone, I checked with Eric also on an issue that came about recently. Am 77 year old an have an iliestomy since 12/2015. Iliestomy was the result of nothing else but contracting the C difficil virus after a batch of antibiotics for a bladder infection an having a very simple elective procedure. My output has been always in the thick side, but was able to work work with it. Since a month or so, without reual changes on my boring diet, my output cIanged to gummy, sticky. The output sticks to the walls of the pouch( one piece) going down or just staying half way. Am able to rinse it out dome using Eric method of irrigating via the ez vent. Drinking grape would it make it worse? Is not the thickning of the output is the gummy sticky.. any one could suggest any foods to avoid or what to eat to help emptying my bag, which has me very stressed. Thanks for any tips you wonderful ostomates💕Lia

Cheryl McGuire
Cheryl McGuire
4 years ago

I have had an ileostomy for many years. My output is naturally very watery, and I am also allergic to adhesives. Because of my allergy, it has been difficult to find a pouch that didn’t make me break out in hives. After years of trial and error, I found a one piece, however it has the least amount of adhesive so I needed to empty often and change my pouch every 2 days, or it would leak. Rings and paste have never worked for me. They just cost a lot of money, and make things messy. I tried gel tabs and capsules from ostomy supply companies, but I had to use several to make any difference in the consistency, and in 4 days I would go through a $20 bottle. Recently, I made a few discoveries that have helped prolong my pouch life, help prevent leaks, and cut my costs back. First of all, I put corn starch in my pouch. (It thickens gravy…doesn’t it! ) A 500g box (no name brand) costs $2.00 and last about a week. I use a couple of small heaping teaspoons after every pouch empty. It also seems to help with odor. Secondly, I use “ThickenUp”, an instant food thickener by Nestles that cost $7.50 for a 227g can that lasts me a week. I put some in a smoothie that I drink twice a day. I eat unsweetened applesauce in the morning before I drink my coffee. I have one coffee a day and enjoy it very much, and coffee makes output watery. (I remember that I gave my son applesauce when he had diarrhea as a baby.) I have a banana, another healthy thickener, and snack on salted pretzels. If you have watery output, you are probably prone to sodium depletion and the pretzels help with that, as well as thickening the output. As far as deodorant goes, I have tried toothpaste and mouthwash and many other things, but I found they made everything smell worse. So I do invest in a good ostomy deodorant. For me, SG3 by Ostomy Essentials is the best. It will cost about $17.00 for a 240ml bottle, (It seems that the “copper complexes” in the ingredients does the trick!), but I use much less since I started using cornstarch with it. I also use a good ostomy skin barrier wipe, which is essential for my sensitive skin. So there it is; a one piece pouch, deodorant, corn starch, food thickener, and skin barrier. Oh, and because I have big thighs, I cannot empty my pouch while sitting on the toilet, so I invested in a small stool and sit it front of the toilet…makes for no splashing! Hope this helps at least one person. Good luck!