Speeding up stoma output

[UnXmas]

I just posted this as part of a reply on the gastroparesis thread:

I've been wondering lately how much my fullness is actually to do with the amount of food I've just eaten. I've noticed that the times when I feel most full and feel like I just don't want to force any more food down, are just before my stoma starts working. So I'll feel very full for maybe a couple of hours, then my stoma bag fills up and I feel much better - not hungry, but not so stuffed. So at least some of the full feelings are coming from my intestine rather than stomach. But either way, a system empty of food is much more comfortable!

My stoma is usually pretty much inactive during the day, then in the evening the bag fills up a couple of times, and sometimes a bit more output comes out overnight while I'm asleep. When the bag does fill in the evening, it happens very rapidly. So I go all day feeling fuller and fuller, then the bag will fill in a matter of minutes (seconds sometimes!), and I feel relieved and the fullness diminishes. Then it fills up again, same as before - very quickly - and then the fullness is much better.

This pattern hasn't changed over the last several weeks while I've been in hospital and eating a lot more to gain weight. Now the fullness by the evening is awful, and I've started getting rectal pain with it, and sensations that I need to have a bowel movement in the "normal" way (I know this is considered to be a normal symptom for many with an ostomy, though I'd never had it before I started eating so much). I still have a rectum, but I have an end ileostomy so there's no way anything can actually come out of my rectum.
The other day, for some random reason, I had a minor upset stomach - I felt incredibly full right after breakfast, then I had watery output, the bag filled in a few minutes, and as soon as it had done so the fullness went. Then, because everything was out of my system, I didn't feel nearly as full the evening of that day as I normally do in the evening.

Some of you will know from my posts that I am extremely underweight (hence the hospital admission) and that I need a lot more calories than the average person in order to gain. So I'd really like to know if I can do anything to help with feeling so full so that I can eat more without so much discomfort.

My output is usually a good consistency, but I was thinking that laxatives may help - that if I took laxatives early in the day, my stoma would empty then rather than building up and not emptying until the evening.

Has anyone else experienced this problem? Anyone had to use laxatives with an ileostomy? Is there a possibility a laxative would flush things through so that I'd end up absorbing even less calories from my food than usual?

 

[DJW]

Hi
How long have you had the stoma?

What types of food are you eating?
I'd stay away from laxative unless the doctor advises this. You could get dehydrated quickly.
You may want to increase you fluid intake with meals.

I suggest giving the stoma nurse a call. You may be dealing with a narrowing somewhere which is slowing things down.

 

[nogutsnoglory]

I agree with DJW that laxatives and an ostomy can be very dangerous and dehydrate you quickly.

Are you sure you feel so full because of stool or maybe it's gas bloating you and you can try simethiocone?

 

[2thFairy]

Don't take laxative, but it sounds like you need something for gastroparesis. What are you currently taking for it?

 

[UnXmas]

How long have you had the stoma?

What types of food are you eating?

I had my stoma surgery last October, then had it changed from a loop to an end last April.

I've just come out of hospital after a month-long stay, where they were trying to get my weight up. On top of three meals and three snacks a day, plus high-calorie drinks (juice, coke, hot chocolate), I've been having 1500 calories of supplements a day, prescribed by the dietician (and now I'm out of hospital, I still have them at home). I eat a low-fibre diet because I have difficulty tolerating fibre.

The hospital did try me on an NG tube, but my digestive system couldn't tolerate it.

Are you sure you feel so full because of stool or maybe it's gas bloating you and you can try simethiocone?

I think I have both stomach-fullness and fullness from my bowel being full. I have a gastric-emptying scheduled. I feel it's the stool making me full too, because of how much emptier I feel once the stoma's worked, and how much easier it is to eat once that's happened. I used to be the same before the stoma too - when I was finally able to have a bowel movement, I felt much less full.

I've dried domperidone for the stomach fullness and just about every treatment there is available for bloating (including simethicone), but none help. I tried things like charcoal, peppermint tea, etc. too.

I had to take a laxative the other week for a test while in hospital, and once it was all out of my system (which was just a few hours after I took it, which the doctors thought was pretty normal - they reduced the dose and had me take it closer to the test time than people without stomas) I felt more comfortable than I have in a long time regarding eating.

 

[Cosmojo]

Yea that sounds like a motility issue to me, hopefully your gastic emptying study gives you some insights.

Sorry you are having such a hard time putting on weight- but hey its an excuse to eat lots of cake

 

[UnXmas]

Sorry you are having such a hard time putting on weight- but hey its an excuse to eat lots of cake

Lots of people have said things like that to me... trouble is when I'm eating this much and feeling this ill, food seems disgusting! And when I do want something, I find myself craving a nice salad with cucumber and tomatoes, and apples and pears that are unripe and crunchy with all the skin on, because between having to eat low-fibre and having to eat high-calorie foods, I'm hardly able to eat this kind of thing! (Though I think I've discovered a good tip for people who are trying to eat healthy or loose weight - deprive yourself of fruit and vegetables for a while and you'll want to eat them!)

 

[Cosmojo]

I'm sorry I didn't mean to be insensitive I've never experienced that feeling...Does the high fiber stuff still bother your system after a stoma? Do you expect a lot of healing yet or is this your new normal?

 

[2thFairy]

High fiber right after stoma surgery has a high occurrence of causing an obstruction.

 

[UnXmas]

I'm sorry I didn't mean to be insensitive I've never experienced that feeling...Does the high fiber stuff still bother your system after a stoma? Do you expect a lot of healing yet or is this your new normal?

No need to appologise - I didn't mean to imply you were insensitive; I think the reason lots of people have said it to me is because it's the most natural thing to think that being able to eat lots of high calorie foods and not get fat would be a very enjoyable thing. I'm sure I'd think the same if I hadn't experienced the way I feel now, when every message my body is sending me is that it doesn't want food!

Eating too much fibre used to make my diarrhoea worse; now I have the stoma, it causes blockages. I can eat a little, but three times I've tried increasing the amount of fibre in my diet, and each time it resulted in a few days of me doubled over with stomach cramps and retching every time there was output coming out of my stoma.

One of those times was after the surgery that gave me an end ileostomy rather than a loop, and although my current ileostomy can handle quite a bit more than the loop one did, I'm being extra cautious now because it's really going to mess up my weight gain mission if I get a blockage now, so I'm sticking quite strictly to a low fibre diet. I'm allowing myself just one fibrous piece of fruit or veg a day, and not having any whole grains, nuts or seeds. I'm still eating low-fibre fruit and veg like bananas and avocados and pureed fruit, but even those I'm not having much of, since I need to concentrate on high-calorie foods. My supplements contain all the vitamins and minerals I need anyway, and I've been prescribed a whole assortment of vitamin pills, so I'm probably saturated in vitamins, even though I'm eating little fruit and veg.

I've had my new stoma since April, so it should have finished healing by now.

 

[Tricky Dicky]

No need to appologise - I didn't mean to imply you were insensitive; I think the reason lots of people have said it to me is because it's the most natural thing to think that being able to eat lots of high calorie foods and not get fat would be a very enjoyable thing. I'm sure I'd think the same if I hadn't experienced the way I feel now, when every message my body is sending me is that it doesn't want food!

Eating too much fibre used to make my diarrhoea worse; now I have the stoma, it causes blockages. I can eat a little, but three times I've tried increasing the amount of fibre in my diet, and each time it resulted in a few days of me doubled over with stomach cramps and retching every time there was output coming out of my stoma.

One of those times was after the surgery that gave me an end ileostomy rather than a loop, and although my current ileostomy can handle quite a bit more than the loop one did, I'm being extra cautious now because it's really going to mess up my weight gain mission if I get a blockage now, so I'm sticking quite strictly to a low fibre diet. I'm allowing myself just one fibrous piece of fruit or veg a day, and not having any whole grains, nuts or seeds. I'm still eating low-fibre fruit and veg like bananas and avocados and pureed fruit, but even those I'm not having much of, since I need to concentrate on high-calorie foods. My supplements contain all the vitamins and minerals I need anyway, and I've been prescribed a whole assortment of vitamin pills, so I'm probably saturated in vitamins, even though I'm eating little fruit and veg.

I've had my new stoma since April, so it should have finished healing by now.

The supplements you're getting, are they the Fortisip, Forticreme and Calogen ones ? They were the ones I was prescribed. Didn't like them much, but they were bearable, especially Calogen.

I don't want to rub it in, bit I am also in a position where I have to put on weight, but I can pretty well eat whatever I like, and I'm eating a lot - probably more than before I was ill. I still have to stick to my diet fot kidney failure, but that's just avoiding some things.

I have toured all the local restaurants for the cause. I think a full English at the restaurant down the road may be on the cards for tomorrow morning. It's tough, but doctors orders, otherwise I'll never get back on the kidney tranplant list.

 

[UnXmas]

I'm having Fortisips, Ensure Extra Plus, and Calogen Extra Shots. I'm going to ask for a prescription for Forticreme too, because I like eating cold, semi-liquid puddings (yoghurts, ice cream, custard, etc.) so I think I might get some more calories by exchanging my current puddings for Forticreme. I don't mind the Ensures, but I'm picky about the Fortisips - some Fortisips I found disgusting, and I hate the Fortijuices too. I didn't like the Calogen shots at first, but I adjusted to the taste quite quickly and don't mind them now, especially as they're so small you can just down them, so getting through one isn't a chore like getting through a bottle of Ensure can be.

Sorry to hear about your kidney problems,Tricky Dicky. It's tough having to manage multiple health problems. How much does it limit your diet?

 

[Tricky Dicky]

I'm having Fortisips, Ensure Extra Plus, and Calogen Extra Shots. I'm going to ask for a prescription for Forticreme too, because I like eating cold, semi-liquid puddings (yoghurts, ice cream, custard, etc.) so I think I might get some more calories by exchanging my current puddings for Forticreme. I don't mind the Ensures, but I'm picky about the Fortisips - some Fortisips I found disgusting, and I hate the Fortijuices too. I didn't like the Calogen shots at first, but I adjusted to the taste quite quickly and don't mind them now, especially as they're so small you can just down them, so getting through one isn't a chore like getting through a bottle of Ensure can be.

Sorry to hear about your kidney problems,Tricky Dicky. It's tough having to manage multiple health problems. How much does it limit your diet?

When I first heard about the Fortisip fruit drink, I thought it sounded ok, what can be wrong with a fruit drink ? Well, I found them pretty horrible really, a chalky aftertaste. I managed some when I had to. The calogen, on the other hand, I really liked, I thought it was quite creamy.

The kidney diet is mostly limiting the amount of potassium I have, which is not easy as it's in many food. The main things to avoid are bananas, tomatoes, potatoes. Plus some other lesser things. I don't touch bananas, but I still have potatoes and tomatoes but am careful about how much I have. I can avoid potatoes happily as rice is one of my favourite foods. Tomatoes are difficult to avoid completely, they're in most Italian and Indian foods, which I love.

The main issue with kidney problems, for me anyway, is not so much the diet, but the diaysis. It's 4 hour sessions, 3 times a week at the hospital. In reality it takes most of the day. I do early sessions at 7 on mon, wed and fridays, but to do a session then, I have to be up at 5, the transport arrives shortly after 6, then after the session I may get home after 2, so that's most of the day gone, 3 times a week. Hopefully I be able to dialyse at home st some point, then I can think about getting back to work.

Multiple medical problems are a pain. Having cancer was a big one, but having to start dialysis at the same time was really tough.

 

[UnXmas]

That sounds awful. Having just spent almost five weeks in hospital, I know the feeling that treatment (never mind the illness itself) is absorbing your life away. I hope you get some more of your days back to yourself again soon.

When I was having such trouble getting low-fibre meals in hospital, my dietician (on the gastro ward) contacted other wards to see if they were having similar problems - she mentioned that patients on the renal ward were having trouble with their meal choices being very limited. I imagine it was the need for low potassium that was the issue. From what you say, it sounds like it needn't be a very limited diet, but I bet the NHS was giving them menus full of potatoes and tomatoes, so they had little left to choose from. That was what was happening on my ward; lots of us were on low-fibre, and it's not a particularly restrictive diet, but so many of the menu choices were full of beans or sweetcorn or salad or other things we couldn't have.

 

[Tricky Dicky]

That sounds awful. Having just spent almost five weeks in hospital, I know the feeling that treatment (never mind the illness itself) is absorbing your life away. I hope you get some more of your days back to yourself again soon.

When I was having such trouble getting low-fibre meals in hospital, my dietician (on the gastro ward) contacted other wards to see if they were having similar problems - she mentioned that patients on the renal ward were having trouble with their meal choices being very limited. I imagine it was the need for low potassium that was the issue. From what you say, it sounds like it needn't be a very limited diet, but I bet the NHS was giving them menus full of potatoes and tomatoes, so they had little left to choose from. That was what was happening on my ward; lots of us were on low-fibre, and it's not a particularly restrictive diet, but so many of the menu choices were full of beans or sweetcorn or salad or other things we couldn't have.

Spot on. Having been an inpatient several times now on the renal ward, i can't figure out why they present you with a menu of potato and tomato. The only time I've seen a limitation, when I was in 2 weeks ago, the guy opposite me asked for apple juice for breakfast and the server said that he wasn't allowed to serve it to renal patients. The guy persisted and the server went to ask a nurse, and they let him have the juice after all. Don't understand.