An ostomy is a surgical procedure that creates an opening, called a stoma, from an internal organ to the outside of the body. This allows waste, such as stool or urine, to be eliminated. Stoma output characteristics, like volume and consistency, vary based on the type of ostomy and a person’s individual physiology.
What Is a High-Output Stoma?
A high-output stoma is clinically defined by the volume of waste it expels over a 24-hour period. An output exceeding 1,500 to 2,000 milliliters per day is considered high. This is a significant increase compared to a standard ileostomy output, which ranges from 600 to 1,200 milliliters daily. The consistency of the output is also a feature; in cases of high output, it is watery and frequent.
This condition is much more common in individuals with an ileostomy, where the stoma is created from the small intestine, than in those with a colostomy. The reason for this is that the large intestine, which absorbs water and electrolytes, is bypassed in an ileostomy. This removes the body’s main site for fluid reabsorption, leading to a more liquid and higher-volume output.
The small intestine can adapt over time, a process known as intestinal adaptation, where it gradually increases its absorptive capacity. However, this adaptation has its limits, and the remaining bowel may not be sufficient to absorb the large volume of fluid that passes through it. This includes ingested fluids and the body’s own digestive secretions.
Causes of High Stoma Output
The reasons for a stoma producing a high volume of output are varied. In the immediate post-operative period, a high output is common. This occurs as the bowel begins to function again and has not yet adapted to the anatomical changes, and for many, this is a temporary phase.
Anatomical factors are a significant cause, with short bowel syndrome being a primary contributor. Short bowel syndrome occurs when a large portion of the small intestine has been surgically removed, leaving less than 200 centimeters of viable bowel. This reduced length limits the surface area available for nutrient and fluid absorption. A partial bowel obstruction or a narrowing near the stoma can also lead to high, watery output as fluid builds up and is then released.
Infections and illnesses can trigger high stoma output. Gastroenteritis, often caused by viruses or bacteria, can increase intestinal secretions and motility. Specific infections like Clostridium difficile can also affect the small bowel, leading to a surge in output. Inflammatory conditions like Crohn’s disease can cause inflammation that impairs absorption.
Certain medications increase stoma output. Prokinetic drugs like metoclopramide, which speed up transit through the gut, can be a cause. The withdrawal from medications, such as opiates or steroids, can also have a similar effect. Dietary choices also play a role; consuming high-sugar foods or large quantities of hypotonic fluids can draw more fluid into the bowel.
Health Complications from High Output
The continuous loss of large volumes of fluid and electrolytes through a high-output stoma can lead to several health complications. These issues arise because the body is losing essential substances faster than it can replace them, with consequences ranging from mild discomfort to medical emergencies.
Dehydration is the most common complication. Excessive fluid loss leads to symptoms like persistent thirst, dry mouth, fatigue, and dizziness. A noticeable sign of dehydration is a decrease in urine output, with the urine becoming dark and concentrated. Severe dehydration can progress rapidly and impact the function of organ systems.
Electrolyte imbalances are another serious consequence. Stoma output contains minerals like sodium, potassium, and magnesium, necessary for nerve and muscle function. The loss of these electrolytes can cause symptoms like muscle cramps, weakness, confusion, and nausea. Low levels of sodium can be problematic, as it is a primary driver of fluid retention.
Over time, a persistent high-output stoma can lead to malnutrition and weight loss. Rapid food transit through the shortened intestine means there is not enough time for adequate absorption of calories, proteins, vitamins, and minerals. This malabsorption prevents the body from getting the nutrients it needs to function.
A severe complication is acute kidney injury (AKI). The kidneys are highly sensitive to the body’s hydration status. Severe dehydration reduces blood volume and blood flow to the kidneys, impairing their ability to filter waste. This strain can cause damage to the kidneys, sometimes requiring hospitalization. The liquid and enzymatic nature of the output can also cause peristomal skin irritation and soreness.
Managing High Stoma Output
Effectively managing a high-output stoma involves a combination of dietary adjustments, fluid management, and medical interventions. The primary goal is to thicken the stoma output and reduce its volume, which allows the body to absorb more fluids and nutrients and helps prevent serious complications.
Dietary modifications are a foundation of management. It is recommended to increase the intake of starchy and soluble-fiber foods, which can help thicken the stool. Foods such as bananas, white rice, pasta, potatoes, and oatmeal are beneficial. It is advisable to limit foods high in insoluble fiber, like raw vegetables and nuts, as these can increase transit speed.
Fluid management is a specific aspect of controlling high output. While it may seem intuitive to drink large amounts of water when thirsty, this can worsen the problem. Hypotonic fluids, including water, tea, and coffee, have a lower concentration of salt and sugar than body fluids. Consuming them can pull electrolytes from the body into the intestine, increasing stoma output and exacerbating dehydration. Instead, the focus should be on oral rehydration solutions (ORS), which contain a balanced mixture of glucose and salt designed to enhance absorption.
When dietary and fluid strategies are insufficient, medical intervention is necessary. Medications that slow down the movement of the bowel are commonly prescribed. Loperamide is often the first-line treatment, and codeine phosphate can also be effective. In persistent cases, drugs that reduce gastric secretions, such as proton pump inhibitors like omeprazole, may be added. For severe high output, injections of a medication called octreotide might be used under specialist care.
It is important to know when to seek medical help. If signs of severe dehydration appear, such as dizziness, confusion, or a significant drop in urine output, contacting a doctor or stoma care nurse is necessary. If dietary changes and prescribed medications do not lead to an improvement, professional medical advice should be sought.