If you ever need to seek treatment elsewhere it is important to let whoever is caring for you know that you have a high output stoma.
What is a high output stoma?
A high output stoma is a stoma which passes more than 1 to 1.5 litres in 24 hours.
Why do I have a high output stoma?
This may be due to your stoma being too high in the small bowel for normal absorption to occur i.e. not enough small bowel is available to absorb water and salts. Or your bowel is having a temporary functional disorder causing the increased output i.e. the bowel is present but not absorbing salts and water correctly.
What are the risks associated with a high output stoma?
- Dehydration (either long or short term).
- Electrolyte imbalance (salts).
- Medication may not be absorbed (avoid enteric coated capsules/tablets if possible).
- Weight loss or difficulty maintaining healthy body weight.
Signs and symptoms of a high output stoma
You may experience some but not necessarily all of these signs and symptoms:
- Excessive watery loss from your stoma.
- Dry mouth/thirst.
- Passing less urine which may be dark in colour.
- Feeling sick or vomiting.
- Feeling tired and/or drowsy.
- Cramping in hands and feet.
- Feeling low in mood.
- Sunken eyes.
When you have a high output stoma most of the fluid that is taken by mouth is not absorbed and will be passed straight out of the body, into your stoma bag. As this happens you will feel increasingly thirsty because sodium (salt) has been flushed out and you will become dehydrated.
Sweet, salty drinks will be absorbed and help reduce your stoma output (see Electrolyte Mix).
Ways to slow down your output and prevent dehydration
- Make sure you eat some starchy carbohydrate food with each meal (see section on diet).
- Avoid high fibre foods and laxative foods (see section on diet).
- Snack between meals.
- Take your prescribed anti diarrhoea medication 30-60 minutes before your meals and before you go to bed.
- Add extra salt to your meals to help replace the salt you are losing from your stoma.
- Avoid drinking at mealtimes and sip your drinks at other times of the day.
- You may be prescribed an electrolyte replacement drink (Dioralyte or Electrolyte Mix). You must make sure you take this daily as prescribed.
When you have a high output stoma your body finds it difficult to absorb all the nutrients you need. You may need to eat a lot more food than you used to. Your Dietician can advise you.
- 6 teaspoons (20g) glucose powder.
- 1 level teaspoon sodium chloride (salt).
- ½ teaspoon sodium bicarbonate.
- 1 litre of tap or bottled water.
Mix all of the ingredients together, this is best made up the night before and chilled in the fridge. One full litre of Electrolyte Mix should be drunk every day. Other drinks (tea, coffee, soft drinks etc) should not exceed a total of another litre, or five cups per day.
If adding flavouring (cordial or squash), please ensure this is added before making up to 1 litre (so that the total including flavouring is 1 litre).
IMPORTANT: Drink the electrolyte mixture gradually through the day rather than drinking the full litre in one go.
Foods to help thicken the output
- Low fibre carbohydrate foods e.g. potato (no skins), pasta, rice, white bread.
- Foods containing gelatine e.g. fruit gums, jelly, marshmallows, jelly babies.
- Stewed apple.
- Pectin (used for making jam).
- Other foods: Eggs, cheese, milk, yoghurt, puddings, one banana/day and smooth peanut butter.
Foods to avoid which loosen output
- Raw fruits and fresh fruit juices.
- Raw vegetables.
- Spicy foods e.g. curry.
- Fried and fatty foods.
- Leafy green vegetables.
- Some sweeteners e.g. sorbitol have a laxative effect.
Remember to avoid fluids while you are eating as this increases the rate that food passes through the digestive tract. Sip rather than gulp fluids and eat slowly, chewing food properly.
The medicines prescribed for those with high output stoma perform one of two functions. They either slow down the passage of food/drink in the bowel (anti-diarrhoeal medications), or reduce the amount of fluid produced by the bowel (anti-secretory medications).
Some of the most commonly prescribed medications are listed below:
- Loperamide (Imodium®).
- Codeine Phosphate.
- Co-Phenotrope (Lomotil®).
These need to be taken 30-60 minutes before food to work best.
- Omeprazole (Losec®).
- Lansoprazole (Zoton®).
- Rabeprazole (Pariet®).
All of the above medication can be taken by mouth except for Octreotide, which needs to be given by injection. These medications are usually prescribed in much higher doses than in someone who does not have a high output stoma.
For further information
Colorectal/Stoma Care Department
Telephone: 01935 384 367 (direct dial with answer phone)