An ostomy is a surgically created opening that connects a part of the bowel to the outside of the body, allowing for the elimination of waste. This procedure is performed for various medical reasons, such as inflammatory bowel disease or cancer. While an ostomy can greatly improve a patient’s quality of life, some individuals may experience a condition known as a “high output ostomy.” This condition represents a significant concern for patient well-being due to its potential complications.
Defining High Output Ostomy
A high output ostomy occurs when the volume of fluid discharged from the stoma exceeds normal levels. An output greater than 1000-1500 milliliters (mL) over a 24-hour period is considered high, though this can vary based on a person’s oral intake. Normal ostomy output usually has a consistency similar to porridge or toothpaste, and is emptied about four to six times daily.
Ostomies are broadly categorized into ileostomies, colostomies, and urostomies, depending on the section of the bowel or urinary tract involved. High output is predominantly a concern with ileostomies, which involve the small bowel, as it is less efficient at absorbing fluid and salt compared to the large bowel. In contrast, high output is rarely seen in colostomies, which involve the large bowel. A high output stoma can also be referred to as ileostomy diarrhea.
Common Causes
Several factors can contribute to a high output ostomy. Surgical considerations play a significant role, particularly the length of the remaining small bowel; a shorter bowel can lead to reduced fluid and nutrient absorption. The location of the stoma also matters, with those formed higher up in the small bowel more likely to have a higher output. Sometimes, a high output ostomy is a temporary issue, such as immediately after surgery or during an intestinal infection.
Underlying medical conditions can cause this issue. Crohn’s disease, short bowel syndrome, and enteritis can increase output. Recurrent bowel disease, internal fistulas, small bowel diverticula, celiac disease, and hyperthyroidism can also be causes. Partial or intermittent bowel obstruction can also result in high output.
Certain medications can affect stoma output. Antibiotics and laxatives increase bowel movements. Opioid or steroid withdrawal, as well as prokinetic drugs like metoclopramide, can also elevate output. Dietary choices also play a part, with high sugar intake, some types of fiber, and consuming large amounts of fluid with meals increasing output.
Symptoms and Associated Risks
Individuals with a high output ostomy experience several symptoms. Frequent emptying of the pouch, often 8 to 10 times daily, is a common sign, with the output being watery. Other symptoms include excessive thirst, a dry or sticky mouth, reduced urine output, and a headache. Patients may also report lightheadedness, dizziness, fatigue, and muscle cramps.
Health risks associated with high output are primarily due to excessive fluid and electrolyte loss. Dehydration is a concern, as the body struggles to absorb enough water. This can lead to acute kidney injury. Electrolyte imbalances, particularly low levels of sodium, potassium, and magnesium, are common.
Malnutrition and unintended weight loss are additional risks due to insufficient nutrient absorption. Chronic dehydration can lead to end-stage renal failure. Patients may also experience skin irritation around the stoma due to frequent watery leakage.
Management Approaches
Managing a high output ostomy often involves several strategies to reduce fluid loss and maintain fluid and electrolyte balance. Dietary adjustments are a primary focus. Patients are often advised to avoid sugary drinks, fruit juices, and fizzy drinks, as these can increase stoma output. Limiting high-fiber foods, especially insoluble fiber, may also be recommended, as these can increase output.
Eating smaller, more frequent meals can aid in better absorption of nutrients and prevent bloating. Including binding foods such as rice, tapioca, bananas, oatmeal, white pasta, and white potatoes without skin can help thicken stool consistency. Adding extra salt to meals and cooking can help replace lost sodium.
Fluid management is also tailored. Instead of drinking large amounts of plain water, which can increase output, patients are encouraged to sip oral rehydration solutions that contain specific ratios of glucose and salt. These solutions promote better fluid absorption into the gut. It is also recommended to avoid drinking fluids for about half an hour before and after meals to improve nutrient absorption.
Medications can play a role in slowing bowel transit and reducing output. Anti-diarrheal medications like loperamide are commonly prescribed, often at higher doses and taken before meals. Codeine phosphate may also be added, though it can cause sedation and addiction. Proton pump inhibitors, such as omeprazole, can help reduce output, especially for “net secretors” (those whose output exceeds oral intake). Regular monitoring of daily weight and stoma output volumes is important to assess effectiveness.
When to Consult a Healthcare Professional
Consult a healthcare professional if persistent high output continues despite initial management efforts. Seek evaluation if stoma output remains significantly greater than 1000-1500 mL per day over an extended period. This is especially true if the output has been watery for over 24 hours.
Signs of severe dehydration, such as extreme thirst, confusion, dark or strong-smelling urine, or no urine output, require medical assessment. Symptoms of severe electrolyte imbalance, including severe muscle weakness, heart palpitations, or severe cramps, warrant urgent consultation. Report any sudden colicky abdominal pain, borborygmi, visible peristalsis, or temporary stopping of stoma output, as these could suggest a partial obstruction.