Ileostomy output – what to expect You may find that after your operation the output may be increased and it may be a fluid consistency. This will thicken to become a thick paste (toothpaste/ porridge consistency) in the following weeks as the rest of the bowel starts to take up more fluid than it used to.
Average ileostomy output ranges from 800 - 1,200 milliliters (mL) or 3 - 5 cups per day. Right after surgery, output may be watery. During the first few weeks after surgery the output should thicken to the consistency of applesauce. It is normal to empty your ileostomy bag 6-8 times per day when it is half full.
Ostomy pancaking is when stool overflows from the stoma. It leaves a thick, pancake-like mass of stool at the top of the bag. This can be unexpected and unpleasant, but there are a few things you can do to help prevent this from happening.
Use a lubricant: Insert lubricating gel, baby oil or olive oil into the top of the pouch – avoiding the filter. This helps the output slide down into the bag. Cover the filter: If your problem seems to be because your filter is too effective, you can use the stickers that come in your box of bags to cover the filter.
What is pancaking? Pancaking occurs if the internal layers of the stoma bag stick together causing a vacuum which prevents the contents from dropping to the bottom. The stool remains at the top of the stoma bag which can potentially block the filter. The bag can also be forced off the body.
If your stoma output is continually over 1500ml in 24 hours this is classed as a high output stoma. This can cause complications of dehydration, electrolyte imbalance and malnutrition. It is important you follow dietary advice above to prevent these complications. Medication may also be needed to reduce your output.
Some common complications of stoma include poor siting, parastomal hernia (PH), prolapse, retraction, ischemia/necrosis, peristomal dermatologic problems, mucocutaneous separation, and pyoderma gangrenosum. Each will be discussed separately in further detail.
The normal amount of output from an ileostomy in a 24 hour period is between 500mls – 1 litre. Depending on your stoma bag size, this may be the same as emptying the bag when it is 1/3 – 1/2 full 4-6 times a day. Anything above 1 litre in 24 hours is considered a high output.
Foods and drinks that can increase the wind passed by your stoma include beans, beer, broccoli, brussel sprouts, cabbage, carbonated drinks, cauliflower, cucumber, eggs, fruit, green vegetables, mushrooms, nuts, onions, peas, spinach, sweet corn, fatty foods (pan- fried or deep-fried foods) and rich creamy foods.
Most stoma pouches have charcoal filters built into the bag. These allow the wind to be released. However, if the filter capacity cannot handle the amount of wind produced, or if the filter has become wet or blocked by the stoma output, ballooning can occur.
Try to include a low fibre starchy food (bread, potatoes, pasta, rice) and protein food (peanut butter, eggs, meat, fish, cheese) at each meal and snack. This will help to slow down the digestion of food through the bowel allowing more time for your body to digest and absorb.
❒ Making changes to the types of foods you eat and fluids you drink, and when you eat and drink will help control your stool output.
You may become dehydrated (your body does not get enough water) if you have too much output. Your body may not absorb fluids well when you have a high output ostomy.
Signs of Stoma Problems
The stoma is no longer beefy red or pink but pale in appearance. The stoma is no longer moist in appearance but seems dry. Your stoma turns dark red, purple, or even black in color. Your stool from the stoma is always watery or diarrhea.
The first sign of a stoma infection may be a pus-like discharge, unusual swelling, increasing redness, or color changes. Some may notice an abscess or an ulcer. A Wound, Ostomy, and Continence Nurse (WOCN) or your doctor will be the best source for medical advice on this issue.
A partial blockage usually displays itself through cramping abdominal pain, watery output with a foul odour, and possible abdominal distension and swelling of the stoma followed by nausea and vomiting.
The average daily output of a colostomy is about 500 ml per day, with a range of about 200-700ml. You should learn to monitor the amount and consistency of your bowel movements.
A prolapsed stoma occurs when the stoma becomes longer than normal If your stoma has prolapsed it will look longer than normal and stick out further from the body. A stoma can prolapse if the muscles supporting it are weak or it may happen as a result of straining the abdominal muscles i.e. through lifting.
A Parastomal Hernia (Stoma Hernia) is a weakness or protrusion in the muscle wall of the abdomen at the site of a Stoma which allows the abdominal contents to bulge out. The bulge often protrudes more when coughing or undertaking physical activity.
Issues or problems with the skin around the stoma is probably the most common complication for ostomates. Not only is having sore skin extremely uncomfortable for the patient but it can also compromise the attachment of the bag to the skin causing leaks and leading to further skin damage.
Ballooning occurs when your stoma bag blows up with wind. This is usually due to the filter becoming wet or blocked from stoma output. This can cause the bag to come away from the body. Please note: Stoma ballooning can happen with a colostomy or occasionally with an ileostomy.
Losing weight can be difficult when you have a stoma. Many people gain unwanted weight following stoma surgery due to changes made to their diet in an effort to control their output.