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High Stoma Output
Guidelines for Enhanced Recovery
Patients
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What is a normal ileostomy output?
Output from an ileostomy in approximately 500-700ml per day.
If you need to empty your pouch which is half full more than 5
times per day you must inform the stoma team as this is classed
as a high output.
What should the output consistency be like?
As a general rule your output should be a porridge/toothpastelike consistency.
Why is it important I maintain this consistency?
Sometimes after surgery your stoma output can temporarily
become loose and watery. If this happens for more than 24
hours it results in poor absorption of nutrients, salt and fluid
from your diet. This can lead to you becoming dehydrated.
It is important that you follow the instructions in this leaflet to
prevent you from becoming unwell from dehydration if you
have a high output from your ileostomy. If you are unable to
follow these instructions then it may result in you being readmitted to hospital or needing further treatment.
How can I prevent this?
nn Low fibre diet – this will reduce the amount of bulk moving
through your bowel, helping to rest it.
nn Add extra salt to your meals and try to increase your intake
of salty foods.
nn Try not to drink before, with meals or 60 minutes after
meals.
nn Restrict your fluid intake to no more than 1500ml per day
as the more you drink, the more will come out of your
stoma.
nn Medications.
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Medications that can be taken
The following medications can help to slow down and
thicken up your output:
nn Loperamide (also known as Immodium)
nn Codeine Phosphate
Loperamide
Start with 1 capsule (2mg) up to 4 times per day – it should be
taken 30-60 minutes before each of your meals.
If necessary this dose can be increased to 2 capsules (4mg) up to
4 times per day.
Please consult your enhanced recovery team or GP if you feel
you need a larger dose. Loperamide does not need to be
prescribed and can be brought over the counter.
Codeine Phosphate
If your output is not responding to Loperamide alone, Codeine
Phosphate can be added. This needs to be prescribed by a
Doctor.
Start with 1 x 30mg tablet up to 4 times per day – it should be
taken 30-60 minutes before each of your meals.
If necessary this dose can be increased to 60mg (2x30mg
tablets) up to 4 times per day.
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How can I tell if I am still dehydrated?
You may feel thirsty, tired, light headed and have a headache.
You may be passing less urine and it may be darker than normal.
What should I do if I am still feeling dehydrated?
nn Rehydration solutions will help replace salt and sugar
lost through your stoma and help dehydration. A simple
rehydration solution can be made at home using the
following recipe mixed together:
6 level teaspoons of glucose (sugar)
1 level teaspoon of salt
1000ml water
2.5g sodium bicarbonate
Some of the water can be replaced with concentrated fruit
squash to improve the flavour.
nn Restrict your oral fluid intake to 1000ml per day (you
can also have 1000ml of the above rehydration solution
additionally to this)
nn Contact your stoma care nurse, ERP nurse or GP as you
may need assessment
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Helpful Hints and Tips:
Foods that may help thicken up the output:
White bread Jelly cubes Marshmallows Pasta Bananas Potatoes
Jelly babies
Biscuits/cakes
Rice/Rice pudding
Smooth peanut butter
Foods that contain extra salt:
Crisps/Twiglets Bovril
Marmite Stock cubes
Salted biscuits/crackers
Smoked fish
Processed meats e.g. pork pie, bacon, salami
Lower fibre foods:
White bread/cereals/rice/pasta are better than wholemeal/
brown versions
Avoid fruit and vegetables, especially those with skins, pips
and seeds. Tinned fruit is okay.
Plain cakes, biscuits & chocolate are suitable but avoid any
containing dried fruit, nuts or coconut.
NHS Constitution. Information on your rights and responsibilities.
Available at www.nhs.uk/aboutnhs/constitution
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www.nbt.nhs.uk/colorectal
If you or the individual you are caring for need support reading
this leaflet please ask a member of staff for advice.
© North Bristol NHS Trust. This edition published May 2014. Review due May 2016. NBT002471