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Dealing with thick ileostomy output

Dukeis

Dynastic Overlord
When my output is real thick I drink grape juice. That will usually thin it up pretty quickly.
 
Hi UnXmas

I usually have thick stools when I eat carbs. The less carbs I eat, the more watery my output. Low residue diet usually thickens my output. In my case, it's not so much fibre that makes a difference as much as carbs.

I also swish water around in my bag when I'm emptying. I open my bag, use a small water bottle to add water to my bag, swish it around and then empty. I usually use a little bit more water and swish it a second time, and my bag gets empty and clean.

Hope this helps!

Kismet
 

UnXmas

Banned
Interesting, I found the opposite, on a low residue diet I was eating plenty of carbs - white bread, white rice, biscuits, lots of things like that, and my output was watery and easy to empty and clean. When I google for tips to loosen it, I keep finding advice to eat more fibre, and that's just not working for me.

I have tried washing out the bags, I find it icky. Maybe I have unrealistic expectations, I want to empty it and have it be completely clean, but that was how it used to be for me!

I will try grape juice. I read prune juice can help also. I'm thinking of trying laxatives though. I know with an ileostomy they can lead to dehydration, but that really doesn't look like it will be an issue for me. It's like the consistency of playdough.
 
Maybe increase your liquid intake ?.
I find mine gets really thick if I haven't drank enough.
The thing that really makes mine liquid is stout, so much so that I avoid it.
 

UnXmas

Banned
The other reason I've considered taking laxatives with my ileostomy before is that I get so full, not just my stomach due to eating, but my bowel seems full and uncomfortable all day, and I have no output, then in the evening I finally get output and get more comfortable, so I've thought about taking something to move things along and get comfortable earlier.

So yesterday evening I took a stool softener, docusate sodium (the only kind of laxative I had in the house). I didn't bother checking how long it takes to work as I know my digestive system doesn't follow guidelines. I felt as usual over night and this morning, with hardly any output this morning (as usual). Eating lunch I felt more full than usual, I finished lunch about half an hour ago, and my bag has now rapidly filled up with watery output. I guess that's a good result. I still feel full and uncomfortable, so I think there's more to come. I'm not sure if I'd say it's an improvement on the fullness, as I feel worse so it depends how long this lasts before it all gets out. But I definitely can't complain that it's too thick, so hope when I empty it in a minute it will wash out nicely. No dehydration or anything either, it's only a bag of output so far so I don't think it's too much fluid loss.

Of course I also know that this evening I could take the exact same dosage of the exact same stool softener and have something completely different happen from this time round.
 
Good luck with it, UnXmas. I hope all of the effects sort themselves out, and all you get is a loose output!

The other thing that gives me watery stool is wine. Goes right through like water. Fruits and vegetables are the foods that give me a watery output. By the way, did you try Metamucil at all? I'm not sure how that works with an ileostomy, but I'm wondering if it might loosen your output somewhat.

Fingers crossed that you can come up with a solution so you don't have to deal with an icky bag!

Kis
 

UnXmas

Banned
I don't drink alcohol - well I have literally one drink at Christmas, New Year's, etc., so I'm not sure my stomach would like wine or stout.

The docusate sodium did give me watery output, but I'm not sure it was worth the stomach discomfort it gave me. I might try it again though, or another laxative. I'm not sure about Metamucil as that's a fibre supplement, and eating fruits and vegetables and other fibre foods isn't loosening it so I'm not sure a fibre supplement would either.

I will keep experimenting though, thank you for the suggestions.
 

Dukeis

Dynastic Overlord
You do know that using laxatives with an Ileostomy can be dangerous. You can become dehydrated quickly and the with laxatives in your system you are most liking not able to catch up on fluids without an IV.
 
High sugar stuff, like grape juice, is good to thin out stuff. High fiber foods will definitely thicken up the output.

I would avoid laxatives. Sugar-free candy gives me super watery output really quickly and has caused me to be dehydrated more than once. Miralax is made from the same chemicals as sugar-free sweeteners.
 

UnXmas

Banned
So it's not just me who finds fibre thickens things? I keep reading guides that say fibre should loosen it.
 

UnXmas

Banned
Sugar and artificial sweetners don't loosen my output, so I don't think grape juice is going to help either. I would be annoyed to have to go back on a low fibre diet, having been on it for years until quite recently, but it seems my options if I want thin output are either low fibre or laxatives.
 

UnXmas

Banned
I tried some lactulose - that's working! But I'm going to cut back on fibre, hopefully I'll be able to still have some fruit and whole grain crackers and things, but I'll probably start with hardly any at all (which I know how to do, since I spent so long having to avoid all fibre, I'm familiar with it) and assuming that thins the output, I'll then add it back in gradually until it begins getting thick again.

Or I'll just keep taking lactulose. And yes, if I read that anyone else with an ileostomy was taking that I'd tell them it was dangerous, but I honestly have no signs of dehydration. And given my stoma output is usually like cement, perhaps the amount of fluid I lose with the lactulose is actually closer to what most with ileostomies lose? Normally I go all day with no output, then get about one bagful in the evening and then another half-bag overnight. Today with the lactulose I've had one half-bag this morning and another after lunch. It's watery but I'm not loosing a huge amount of fluid. Though I'll also have to see how predictable it is. It's so easy to empty though! My stoma is prolapsed most of the time, 15cm last time I measured, and it actually curves round back up to the top of the bag again, so the output goes all over the stoma, which is not good when it's thick as it just sticks to it.
 
My stoma is prolapsed most of the time, 15cm last time I measured, and it actually curves round back up to the top of the bag again, so the output goes all over the stoma, which is not good when it's thick as it just sticks to it.
Output on your stoma, thick or thin, is not harmful to your stoma. It is harmful to skin, but not your stoma. I understand that you don't like it, but medically it is okay. A stoma is intestine and intestine is made to be in poo all day.

I'm glad you are happier with the lactulose!
 

UnXmas

Banned
I really am liking the lactulose - I'd forgotten what it's like to be able to just open the bag to empty rather than having to squeeze it all out and still be left with a bag coated in output! And it's not been out of control, I've only emptied three times today so far (it's now evening here). I know it's not bad for the stoma, but the rational side of me that knows that doesn't seem as strong as the irrational, OCD side that thinks it must all be clean.
 
I can appreciate that! My OCD side is the whole reason I thought I would absolutely HATE having a stoma in the first place. It is amazing how giving back even just a little bit of health can change your outlook.
 

UnXmas

Banned
I'm still pleased with the lactulose. I took none yesterday evening because I didn't want my bag filling too much during the night, but woke up this morning with a bag of really thick output so I will experiment more with doses and timings. I'm cutting back on fibre too, I don't want to stop eating it completely though.
 

UnXmas

Banned
I've taken a break from the laxatives because we're having a heat wave. I'm sure our temperatures here in England are not hot compared to where some forum members live, but I'm not good with heat and not risking dehydration.
 

UnXmas

Banned
Heat wave over (that's as long as they last here :p ) I'm hoping that taking lactulose again today will get things moving because I am so full and bloated and have had hardly any stoma output.
 

UnXmas

Banned
I'm concluding that lactulose solves my thick output problem without me having to give up fibre. So I just have to be certain it's not causing dehydration. Can it cause problems absorbing calories? With the lactulose I'm having to empty my bag about four times a day, and it's watery, sometimes with bits in, or it's semi-liquid. With no lactulose I emptied twice a day and it was practically solid.

I tried grape juice on the two days of heatwave when I didn't take any lactulose, and that seemed to have no effect at all. How much grape juice do people generally need to consume for it to work? Is having three or four glasses spread out over a day enough? Or do you have to down a litre in one sitting or something?
 
Two glasses of grape juice usually does it for me. I react pretty quick to high-sugar stuff like grape juice, maple syrup, corn syrup, etc., though.

Concerns over nutrition and calories comes in if your output is coming in high quantity and rapidly after you eat. In other words, after a meal, do you see that food coming out soon afterwards or is it several hours after? The longer it stays in your system, the more you are absorbing, so rather than thick or thin output being better for nutrition, its more about how much time your intestines are getting to absorb the food.
 

UnXmas

Banned
Thanks, that makes sense. The majority of my output still comes in the evening and overnight, the rest has been more randomly timed. Today I emptied after eating breakfast, but I've had no output since, even having eaten lunch a few hours ago. I'll see how it goes.

I guess sugar just doesn't have that effect for me.
 

UnXmas

Banned
So apparently it is possible to quickly become tolerant to lactulose, or at least it is for me. Maybe it would still work ok if I increased the dose, but I don't want to end up drinking a litre of lactulose syrup a day. So, today I'm back on stewed apples and mashed up vegetables, hopefully this will help, though I am wondering if it's the amount of food as well as the amount of fibre that makes the difference.
 

fuzzy butterfly

Well-known member
Hi unxmas. Im mandy and new here. I had a loop ileostomy just over 12 mths ago (now reversed). I found fresh orange loosened mine a bit. But eating bananas , potatoes, jelly, marshmellows , peanut butter made it thicker. If you look up crohns low residue diet, it should tell you which foods etc thicken and loosen output. Hope this helps. Best wishes
 

UnXmas

Banned
Thank you mandy, I've looked at some guides online, but my stoma output doesn't seem to always react to foods the way most people's do, so I think I just have to keep experimenting.
 

fuzzy butterfly

Well-known member
Your welcome , unfortunately it is somewhat a guessing/trial and error thing this Crohn's. Ye just keep trying different things im sure the right thing for you will come along. It's just no fun while trying to find it though. Fingers crossed for you and if i can find anything that may help il let you know. Best wishes.
 

UnXmas

Banned
I've cut down my fibre intake a lot but the output is still thick (I've not been taking the lactulose) so that can't be the problem. Maybe something else changed when I had the new stoma? I can't think why changing to an end ileostomy or having a bit of small bowel removed would result in much thicker output though. Another thing that's changed is that I'm eating a lot more food now than I had done for the first six months of having a stoma, but the increase in food began with my hospitalisation for weight gain at the start of July last year, and the thick output didn't begin for a while after that. But the extra food may be having a long-term, delayed effect on my digestion, I don't know how that would work, but eating a lot over a long period (weeks and months) has had delayed, long-term effects on my digestive system many times before.

So my options are put up with it; see if increasing the lactulose works; or try another laxative. I'm putting up with it at the moment but I'll think about the laxatives some more.

At least I can go back to eating raw fruit again.
 
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UnXmas

Banned
I'm not having much luck. :( No matter what I eat or drink it's thick. Even with some lactulose it's thick, and I don't want to keep increasing that. A couple of my meds are constipating but I was taking them when I got my ileostomy, and it's only been thick since my last surgery/when I started eating more. I'm not really sure if there's a cause - maybe I've just randomly become constipated? Are there any laxatives that are strong (stool softeners didn't have much of an effect) that you can't become tolerant to? Or anyone know of a way to clean thick output from the bag without getting in a mess?
 

fuzzy butterfly

Well-known member
Hi unxmas. Can i ask do you eat large portions at each meal say 3 times a day ? . I tended and still do to eat little and more often. My out was mainly watery but did thinken when i ate larger amounts. Even with the reversal done i eat little n often and stools still very softly formed or watery now. Maybe a change of eating pattern might help ?. As for cleaning bag i used baby oil to help it not stick too much when it was thick. Do you use a pouch cover, if not try one then a least you dont have to see it in the bag so often. Its not the nicest thing to have to see every few hours is it !!! Best wishes. Mandy
 

UnXmas

Banned
Thanks mandy. I do eat spread out during the day. I think eating more may be what's causing this. But I am so underweight, last year I was hospitalised because of my weight, so if I go back to eating not so much, I'll be very ill and back in hospital again.

I tried baby oil and a lubricant from the company I get my other stoma supplies from but they didn't work and I ended up making the outside of the bag all sticky. :(

Today I'm trying senna, see what this does. I'm making an appointment wiyh my stoma nurses too.
 

UnXmas

Banned
I'm thinking of getting these a little shower head that you attach to a bathroom tap, to use to clean the output from the bag.
 
I usually just pour some water in my bag, close it up, give it a bit of a shake and drain it, works just fine at cleaning my bag when things are a bit thick.
 

UnXmas

Banned
Hi Thistle, thank you! I've tried doing that but it didn't go well, I have problems with motor skills and my right hand was paralysed last year and didn't fully recover, so things tend to get a bit messy. I've been looking on line at various types of water-spraying device. Hopefully I'll arrive at a solution eventually.

The senna I took has had zero effects so far. It's supposed to work on the colon, and I obviously don't have one. I thought it may work quite quickly, but nothing so far.
 
I usually just pour some water in my bag, close it up, give it a bit of a shake and drain it, works just fine at cleaning my bag when things are a bit thick.
I do this too.

UnXmas, there are several products online that connect to your toilet's water line - some use special bags that have a water inlet on the top, but most just flush the pouch.
 

UnXmas

Banned
I do this too.

UnXmas, there are several products online that connect to your toilet's water line - some use special bags that have a water inlet on the top, but most just flush the pouch.
I've been looking online today at "bidet showers", are there products specifically for stoma pouches? The supplier I get my stuff from doesn't seem to do anything like that. I'll do some more investigation.
 

UnXmas

Banned
Well the senna worked. And took as long to work as it says it should for a person (presumably a constipated person) with a colon. Hopefully this is reliable and I won't instantly become tolerant to it like I did with the lactulose. It also caused no side effects, whereas the lactulose made me feel sick when I took a high dose.
 
I've been looking online today at "bidet showers", are there products specifically for stoma pouches? The supplier I get my stuff from doesn't seem to do anything like that. I'll do some more investigation.
What country are you from again? There are several US manufacturers around, but if you're from the UK, it might take some searching.
 

fuzzy butterfly

Well-known member
Hi unxmas sorry this is quite late in the evening and hope it hasnt disturbed you. Boy o boy you are having a mare of a time. My heart goes out to you. Im also suffering the under weight one... Do you take any of the build up drinks like fresubin or complan ect, to help with weight gain? . Iv kinda resigned my self to being around 8 1/2 stone now used to be 10 st, but was down to 6st10 a year ago. I really hope you stoma nurse can help you get some where with your problem. Best of luck n best wishes. If i find any other info il let you know ..
 

UnXmas

Banned
Hi, yes I have a lot of Ensures and Calogen shots. My bmi was 10 when I went into hospital last year I think, I'm 165cm and was 29kg. (Or 5'4" 65lbs which I think isn't much more than four and a half stone.) I'm about 35kg now.

I took senna again this morning, I'll see how that goes later. I ordered a little portable pump/shower thing to try to clean the bags with that too.
 

UnXmas

Banned
Had a good result from the senna today. I guess not having a colon doesn't matter, though it's hard trying to predict timing when every website only talks about it acting on the colon.
 
I'm thinking of getting these a little shower head that you attach to a bathroom tap, to use to clean the output from the bag.
This is probably your best bet if the cup and water is a bit of a problem. Even try to source one of the old style shower heads with the rubber suckers that attach to your taps, with the rubber pipe that connects the shower head, cut the shower head off so you're left with a little hose pipe device which you can insert into your bag. You can control the flow of water from the taps so you can take your time and go at your own pace, which I would imaging would be a bit less messy and wet than the spray from a shower head.
 

UnXmas

Banned
The senna didn't work well today. I took it first thing in the morning, then this afternoon I had loose output that emptied very easily and cleanly. But now it's evening and my bag's filling up with thick output. So tomorrow I could try a second dose in the afternoon, but I'm not sure if this is just going to end up with me needing even more.

I'll try the shower thing when it arrives, but I am starting to think just changing my bag twice a day is the best solution. I've got my bag-changing routine perfected so it only takes me a couple of minutes. I don't even pay anything for the bags since it's all paid for by the NHS here. It seems wasteful to change that often, but it's very easy!
 

fuzzy butterfly

Well-known member
Hi unxmas. Aw you are lot under weight , crikey i thought i was bad at 6st 10 im 5ft6 . Its hard to gain the weight though when u have lost so much as it seems to affect your ability to put weight on unless you're on steriods. I went to 9 st odd when on them n lost a stone when i stopped, now im up and down between 8st n 8 1/2st but cant seem to get any higher. I try n eat all the stuff that makes most people put on weight but no luck. I feel i could eat my own body weight in chocolate every day n not go ova 81/2 st.. As for the bag cleaning yes the old rubber shower fixed to taps with head cut off would probably work pretty well as thistle said. You can get them at the pound shops i think ,so if it didnt work it wont have cost alot to try it. Wish u best of luck and hope it works. Sending best wishes Mandy
 

UnXmas

Banned
I manage to lose weight on prednisone, it didn't even make me hungry, and I know many people would love to be able to avoid that side effect.

I will try the shower, but it's still going to mean cleaning out a bag of yuck a couple of times a day. The first year with my ileostomy was so easy, I changed my bag only once every three days, and even then it didn't look/feel dirty around my stoma and on the inside of the bag. At least I'm not having any leaks, or blockages.
 

fuzzy butterfly

Well-known member
Oh lordy you are an enigma !!!lol Ye quite a, few would like not to gain on steriods !! I must admit mine was watery most of the time and it is pretty easy to keep clean when watery, but when its thick its much more awkward n messy. I do feel that as your weight is so low are laxatives the best way to go, as you need the food to be in your system as long as poss to get the most out of it and gain weight. Im not sure this is the case mind so best to check with stoma/ ibd.
nurse, as she will know best. You probably have though but if you are having a real struggle speak with her again n see if she can come up with anything new . Best wishes
 

UnXmas

Banned
Yes, I'd wondered if laxatives would affect my weight. But I've also heard they cause dehydration if you have an ileostomy, but since I must lose so little fluid when my output is so thick, I thought the laxative may not matter. I definitely have no symptoms of dehydration. I'm not sure if the same would be true with weight, I've not tried them enough to get an idea of that yet.
 

UnXmas

Banned
I think I blame the amount of food I'm eating for this problem. Every time I've gained weight, my bowel symptoms steadily and permanently decline. This is the first time I've gained since getting a stoma, and this has been becoming more and more of a problem. I've eliminated fibre as a possible cause. I think if it were just the surgery itself and the new, end stoma, I think it would probably have happened straight after the surgery, and wouldn't keep on get worse. There are good reasons why I am underweight. My body does not like food. And I have appaling gastroenterologists who force me to eat and don't even try to help my stomach problems. :(
 

fuzzy butterfly

Well-known member
Aw hun, you really have a rough time of it dont you!!!. Do you mind me asking what area you live in and who is your gastro consultant. Just because if you are in my area i can recommand mine. You are entitled to swap docs untill you get one that your happy with. Its your health and quality of life they are dealing with here. Its not fair you are not getting the help you need!!.
 

UnXmas

Banned
Hi, I've been through many doctors! I actually have two great surgeons, and many other good doctors, but I was basically forced to see this gastro during a couple of months while I was in hospital last year. I'm not seeing her again, but when I was in-patient, I'd had two emergency admissions so I didn't get much choice. I'm nowhere near Manchester anyway, but thanks for offering!
 
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UnXmas

Banned
I've taken double the recommended daily dose of senna today (yes, not a sensible thing to do, but I do this with all my meds: if it's not working well enough, I take more and more until it does) and I've had a tiny amount of fairly solid output so far. Why is my stoma so constipated?!
 

fuzzy butterfly

Well-known member
Ah i see ye when sometimes you dont have choice , but what gets me is if they havent got crohns or family member/ close friend, they really dont understand how painful and frustrating this monster can be!! I eat as much or as little as i want now i just go with what my body tells me, coz we are all so different no set way or pattern works for all. If something makes me looser or thicker i just vary it so when i loose i have something to thicken it a bit. I know you have probly tried pretty much everything hun. But please dont feel you have to eat loads just coz they say so. Smooth peanut is great for weight gain but its supposed to be a thickener, it may do the opposite for you as you seem to have a naughty stoma/bowel lol. Wish i could magic it to looser for you hun ....
 

UnXmas

Banned
I pretty much do have to eat lots because otherwise I end up being forced into hospital. I have a hundred different medical problems so there's no way I can avoid doctors.

I really don't understand why laxatives just stop working. Do you need a colon for them to work? I've had three times the recommended dose of senna today and have had about three quarters of a bag of solid output. :angry-banghead:
 

fuzzy butterfly

Well-known member
Aw darling :(. Iv been on the web to see if i can find any thing or one that might help u. Theres ostomy lifestyle who offer advice from people with ostomies, via email at,advice@ostomylifestyle.org or phone 0800 731 4264. Also theres by email..info@crohnsandcolitis.org.uk or phone. 0845 130 2233. Mon-fri 10am-1pm with a call back service out of these hours.
Have u considered u may have strictures as iv just read they can cause constipation etc. As they develope as part of the healing process sometimes, it may be a reason??? . Hope any of the above is of some help. As for the colon thing not sure but maybe any of the above or your stoma/ibd nurse should know hun..
 

UnXmas

Banned
Thank you so much mandy. I'm not sure if I could have strictures. Less than a year ago I had a small bowel MRI and an upper endoscopy, and last September I had surgery, so I would have thought they'd have identified any strictures, though I'm not sure how quickly they can develop.

Today I tried using my pump thing. It did work, it took a lot longer than it takes to change my bag, but I guess I could improve with practice. It did get quite messy too. I'll ring my nurses too.

Thank you again for all your help and suggestions.
 

fuzzy butterfly

Well-known member
Hi your very welcome. If you haven't had scan since your surgery last september they may have developed since. Not sure how long they take to develop myself. It maybe worth an ask to see if they are a possibility !!. Ye i guess it might take a little while to get the hang of your pump thingy, but im sure ul get the time
it takes down n it being less messy as you master it. Your nurses my be able to help with technique with the pump too. Heres hoping it helps keep things cleaner for you :). Also i hope your nurses can help with the thining of your output . Well im getting ready for work :( hate working the weekend !! . Im here to have a chat or a moan at if need be, il try and give support and advice as much as im able. I keep trawling the web for info so i can be as helpful as poss. Best wishes n good luck with the pump...
 

fuzzy butterfly

Well-known member
Hi unxmas I've read now that strictures can develop quite along time after OP so may be worth asking if it might be them causing you issues.Best wishes n Take Care
 

fuzzy butterfly

Well-known member
Hi nosegay, here are some foods that are ment to thicken output.. Banana,potatoes,marshmallows,jelly,jelly type sweets, cheese,eggs,all assuming you can eat any or all of the above, I think there are more ,just.can't think of them at the mo... Best wishes ..
 
Thanks Mandy I just wish I had more of my small intestine instead of 160cm. Unfortunately that's Crohns and some people will have thicker output with the more they have left
 

fuzzy butterfly

Well-known member
Thanks Mandy I just wish I had more of my small intestine instead of 160cm. Unfortunately that's Crohns and some people will have thicker output with the more they have left
Ah ye that wont help , but i had pretty watery output n only had 12-15cm removed, but it was still rare it was thick..oh ye crohn's is your own personal monster am sorry to say...no 2 crohnies are the same !!:ghug:
 
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