New stoma. Loop ileostomy.

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Hi-

Just returned home from hospital after surgery for a loop ileostomy today and have a couple of questions for those with some experience:

I'm currently putting out about 1.2 litres from my stoma which is a bit more than desirable. Any tips for slowing the flow and thickening up the output? I'm eating marshmallows and jelly babies on advise from the gastro nurse. The other side of that is hydration, of course. Anyone with a more detailed knowledge- if I'm putting out that much but drinking a fair big more than that of squash, tea, isotonic drinks, hydration should remain acceptable through this first patch.

Thanks.

Davi
 
It can take several weeks to adjust but peanut butter is particularly helpful. I am not sure if that is good in the beginning since you need to be low fiber. It's probably ok just ask the doctor.
 
Hey-
Thanks. I've got completely smoothe peanut butter which I believe is fine. Thanks for the tip. Just keen I get the output down quick so I can be less concerned with constantly keeping an eye on hydration. Also, it's be better to not have a big sloshing bag on my stomach! A thicker mix would be easier to manage I guess.
 
I found that stewed Apple really helped to slow down and thicken up my output when I had my Stoma; I had a loop ileostomy too. Things should settle down over the next few weeks and become more manageable.

If you're finding your output is too watery, as well as eating food that can thicken it up, you can also get gel capsules to put in your bag. They're called AbsorbaGel sachets and used to work really well for me.
 
My output was really high in the beginning as well.

Potato chips (crisps, you might call them?) really helped slow things down and thicken my output. I was very excited about this...gave me a legitimate reason to eat A LOT of potato chips!

Sounds like you're getting enough fluids...you'll learn to watch for the signs of dehydration before you get there...monitoring urine colour, feeling thirsty/dry sticky mouth, my lips start feeling chapped, lightheadedness (especially when I go to stand up). I also put my head back and stare at the ceiling...when I bring my head back to look straight ahead, if I feel lightheaded doing it, I go and drink water.

It'll take time, but you'll get to know your own body's signals. And your output will both slow down and thicken.

Take care,

Kismet
 
I've been told mixed things about hydration with an ileostomy. A lot of websites say you need to drink extra, because you're no longer absorbing the fluid back into your body that would previously have been absorbed by your colon. However, I've also heard that drinking too much will wash things through your system too quickly and actually make you more likely to become dehydrated. My own surgeon told me not to drink too much, as I'd not only wash all the liquid through, but food as well, making it harder for me to gain weight (I'm very underweight).

I generally listen to my own surgeon, but he comes out with odd things at times and I've not yet worked out if this is one of them. My second surgeon told me there are no set guidelines - if you have symptoms of dehydration, you should look at your fluid intake and experiment with more or less, different foods, etc. to find what works. This is presumably only if you're mildly dehydrated - if it's a serious thing, I think you're best checking with a stoma nurse or doctor in case you need IV fluids.

I've also been told, I believe correctly, that you should increase your salt intake too, as the colon would previously have been absorbing salt, the same as it was absorbing fluid. But many people have more than enough salt in their diet beforehand, so again only address this if you're getting symptoms.

Personally I prefer watery output. I know it's not supposed to be the healthiest, and we're told to aim for "toothpaste" consistency, but watery output doesn't leave such a mess at the end of the pouch when you empty it. When I have toothpaste consistency, I change the bag very often because it never seems clean. I usually do have toothpaste consistency, I get watery output maybe a quarter of the time, but it seems unrelated to what I've been eating. But then, before I had a stoma I would have bad diarrhoea days regardless of diet.

There are many foods, many already mentioned, that can slow and thicken output - foods with pectin in (jelly babies, apple sauce), smooth peanut butter, white bread and white rice, cheese, bananas. But for me these make no difference. I often do stick to low fibre foods, but to avoid blockages, which are a big problem for me, rather than to slow things down.

Medications - codeine, loperamide, co-phenotrope can all help slow things down too. My reactions to these medications have been surprising: before I had an ileostomy, loperamide and co-phenotrope really helped with diarrhoea if I took high doses; codeine seemed to have no effect. Amitriptyline (which wouldn't ordinarily be prescribed primarily to treat diarrhoea, but which causes constipation as a side-effect) had an extremely constipating effect on me when I had no stoma. But with the ileostomy, I can take all these meds with no difference whatsoever. That doesn't bother me, as I said, I find watery output preferable, but I find it odd. We seem to have very unpredictable reactions to medications, so it may be worth checking with your doctor if trying any of these or upping the doses can help you.

Have you been measuring your fluid intake as well as output? When I've been in hospital for various things, doctors have tracked both - that is, urine and stoma output are measured and compared to the amount of liquid I'm drinking. This can give you a good idea of what's going on, though I'd imagine it's a bit tricky to do this when not in hospital. Despite have watery output fairly regularly, my total stoma output volume was actually on the very low side of normal. I've had three surgeries in which a new ileostomy was created, each time my output slowed down within a few days of the surgery.

I wouldn't worry too much unless you're getting symptoms of dehydration (check to see if you have a low blood pressure, check the colour of your urine, and pay attention to how thirsty you're feeling). Hopefully some diet changes and maybe medications, or products like gel you can put in the pouch to absorb liquid will help make the output easier to manage.
 
Crisps, jacket-less baked potato, applesauce, pasta, and even cheesecake are good for thickening up output and slowing it down a bit.
 
If your worried about it being liquid then try absorbing tabs. I know Hollister carries them. You put two tabs in your pouch and it turns the liquid into a gel like output. I found these at work. I am an intake coordinator for a DME company and one of our items are Ostomy supplies. Ostomy Pouch Absorbent Tablets with Deodorant is then name and they are made by ReliaMed®.
Item #: ZROGT180
Manufacturer: ReliaMed Misc
If you want to order them this is the item number. I use them and they work wonders. Ive never had a thick output and I asked one of my patients what to do and she told me about these.
 
I had to resort to Loperamide to get my output under control, have been on it ever since (October 2010) and have recently been diagnosed with BAM.

When I came out of hospital I was told to eat all the things mentioned in the above posts and to add salt to my food. I was still drinking 3 x Fortisip a day at the time but my stoma nurse was concerned about taking in too much liquid and its affect so I cut them down and then stopped completely
 

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