Dealing with Watery Output: Is it Typical for Ileostomies?

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jambly405

Hello fellow ostomates.

I wonder if I am alone in this. Lucky me, I can eat most anything, but honestly, for me it is how rather than what you eat - chew thoroughly is the main thing. But fluids are a problem, yes, we have to keep hydrated, but even sipping drinks can often result in a very watery output! I had a Jpouch for 20 or so years and had an ileostomy around a year ago after changes in the pouch. I could drink a glass of water (or beer :)) without any problems with output, but now and despite using loperamide to slow things down I still have very watery output. Is this typical of ileostomies? I suppose I do have less ileum than I did after two procedures. Does it get better in time?

What bothers me is that it is really difficult to keep hydrated if water is simply being passed into the bag.

I have given up alcohol (boo) really doesn't work for me. Maybe have to give up coffee - might be the problem, or maybe it just happens from time to time and not too worry.

Meadow Snow

I'll preface this by saying that my stoma is brand new and also from a failed J-pouch. My Barbie Butt surgery was on March 3rd this year, so not even two months yet. I'm sure there's still loads I need to learn! What I've just started doing the past couple of days is, if I know I'll be chugging a drink, e.g., a cup of tea, I'll get a couple of marshmallows ready and just nibble on them while sipping on my tea. Thankfully for me, just sipping occasionally on a drink is okay for me, but I'm not drinking plain water. I have juice or put an electrolyte tablet into the water, basically just making sure it isn't plain. I think having spicy food also makes me more prone to liquid output as well, so yes, you guessed it, more marshmallows for me after a spicy dinner! Also worth remembering that chugging a liquid not long after eating will have a laxative-type effect and flush it all out.

Edit: Also, like you say, sometimes it will be more watery. So long as it is more toothpaste-like in consistency more often than it is watery, but if you're worried about it, then it's better to be safe than sorry and get yourself checked over by your stoma nurse if you have access to one.

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Keep a diary of what you're drinking and eating so you can get a clearer picture. Is it what you're drinking, or do you just have loose output as some of us do? You're better off not drinking just plain water; add cordial drink to it. You may just need a higher dose of loperamide or another med to slow output down, or a combination of a few. You really need to speak to your doctor/dietician or stoma nurse about that.

I'm guessing that, as you previously had a J-pouch, you've had some of your small bowel removed. That makes a big difference in having loose output.

I have loose output from having a large section of my small bowel removed, but I've never really had a problem with dehydration. Water comes straight through me too, but out the other end instead.

AlexT
Reply to Meadow Snow

I'll never look at toothpaste the same.

Meadow Snow
Reply to AlexT

You're welcome, Alex. That's how one of my stoma nurses describes it. And I have an app called OstoBuddy to help me track everything, including changes and the amount of supplies I have left. For monitoring output, you track how much you estimate is in the bag as well as the consistency. It goes from porridge (what you Yanks call oatmeal), to applesauce, to cake batter, to melted ice cream, to orange juice, to tea, to water. Although what the difference is between tea consistency and water consistency, I have no idea ‍. So now when you have breakfast tomorrow, you can look at it and think to yourself, "That's what my output looks like!"

 
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AlexT
Reply to Meadow Snow

I can't wait. Just to compare, mine (colostomy) goes from hard little chunks to what I'd describe as creamy peanut butter. If mine is watery at all, it's because I'm sick. I can drink as much as I want and it really doesn't change much.

Meadow Snow
Reply to AlexT

If I ever see peanut butter with chocolate chips, I'll know what the contents of your bag looks like, Alex.

hambo999

Hi there, I had an ileostomy about 18 months ago and for me, whatever I drink mostly comes out through my bag. I was quite surprised at this initially and spoke to my stoma nurse, and she said this was quite normal and told me to try more Imodium. This did thicken it up, but it's the volume that bothers me. I tend not to drink a few hours before sleep and have to watch what times I drink while at work as drinking definitely increases my output, whether it is watery or toothpaste-like. I do feel dehydrated and thirsty at times. It's a pain and a worry. I used to like a drink on my bedside table and have a drink when I woke through the night, but don't really do that now due to the increase in output...

jambly405
Reply to Meadow Snow

Thank you, Meadow. I think the failed jpouch is growing as a club, but one we'd rather not belong to! I too have different watery outputs from water through to toothpaste and occasionally thicker. I have not tried marshmallow as it is gelatin and I am a plant-based eater, but maybe I'll try them anyway to be pragmatic about this. As you confirm, it is not wildly unusual for the output to be watery. My Stoma Nurse insists that the ideal is a mashed potato consistency.

I too have learned not to chug liquid down, but even sipping I get an occasional watery OP. Reluctantly, I shall have to keep a diary of foods/liquid and see if I can get this under control. I have tried psyllium husks, but with limited success. I doubt whether any of us want to journal everything we eat and drink, but maybe I will have to (I did in the early days of my ileostomy).

Anyway, thank you for your answer and good fortune with your ileo journey.

jambly405
Reply to hambo999

Hello, Hambo99. Thank you for your post. Your experience sounds like mine and I'm relieved to hear your stoma nurse is more realistic about the situation. Mine insists that a mashed potato output is the ideal.

It is something that is barely mentioned in the pre-operative literature I had access to. Much of the commercial ostomy suppliers in the UK are uniformly upbeat about life with a stoma. A great deal is made of foods, but liquid and attendant problems barely get a mention. This applies to hospital literature as well apart from rehydration fluids. I took St Mark's mix for far longer than I should have - I was discharged with a high output stoma, but that improved over the weeks post-surgery.

Thank you for your post and best wishes for the future.

Immarsh

Hi all, I have had my ileostomy for over 55 years, since I was 15, and for most of that time the only problem I had was with raw veggies (celery, cabbage) and some nuts. My output was sometimes watery, but generally speaking it was "normally liquid/muddy range. I always drank a lot (of plain water) and rarely had issues of dehydration. The more I drank, the more I peed, and the guide for that, the paler the better. If it was yellow, I needed more water. All was fine until a few years ago. I started to feel explosions of gas, and even though I switched to a pouch (Convatec) with a vent, I found the gas continued ending up in liquid, and then green liquid, and then almost yellow liquid. In the last 2 years, I've been hospitalized 2x for dehydration, with no real pathology, infection, or cause. I finally went to my gastro doctor (who I had not seen in years), and he diagnosed it immediately. Since I don't have any large intestine, he said I might be missing specific enzymes (?) to digest some foods. My output often had a very foul odor, which I never had in the 50 years of having an ostomy. He recommended reading up and trying to follow the FODMAP Diet. It's based on eliminating the hard-to-digest sugars, carbs/artificial sugars that are found in many vegetables, fruits, and juices (tomatoes, lemon limes, some green veggies, garlic, onions, artificial sweeteners, and carbonated drinks as well). I was devastated and felt like I was back to that teen with ulcerative colitis. Back to a very limited diet. But I did a lot of reading and categorized the specific foods. Once you eliminate the "identified" problem foods, it's okay to try them (one at a time) on occasion, like allergy/taste testing. I love pizza and Italian food, but I react to tomatoes, so I only have a little sauce or a piece of pizza. I can cook with onions and garlic, but it's best if I don't eat much of either. At the time, I was guzzling lemon crystal lite, but it's no longer on my list. Hard cheeses are okay, but soft cheeses may cause problems. I avoid most dairy, but use almond milk. If I have to have milk, I do indulge in ice cream occasionally, just not every day. It's a challenge, and it makes preparing some of my favorite dishes a bit difficult, but I've noticed major changes and more consistent output. My pouch was filling with gas 2-3 times a night, and I had to get up to release it, or I would break the seal on my wafer. That's improved with the diet, and sometimes, I don't even have to empty. So if you're having specific issues related to gas and foods, check out the FODMAP diet. It might work for you. Best of luck to all. Marsha

jambly405
Reply to Anonymous

Hello Damian. Thank you for your post. It seems from replies that a watery output is not particularly uncommon. My stoma nurse insists that a mashed potato consistency is the gold standard, whilst omitting to tell me it is not that common. That is the value of talking to fellow travelers!

Keeping a journal is a good idea and something I have done in the past and maybe will do again. I do take loperamide, but weirdly in my experience it loses some of its potency if I use it too regularly. I wonder about the long-term effects of using an opioid? I suppose we have to be pragmatic about the situation we find ourselves in.

Best of luck and thank you.

Meadow Snow
Reply to jambly405

For me, I currently use 1 loperamide capsule three times a day with my meals. It seems to be working at the moment. Also, for thickening output, I've got a sort-of cheat sheet that I downloaded onto my phone and iPad from the Coloplast website called "Dietary Advice for Ostomates". And in the 'to thicken flow' box, it suggests banana, boiled milk, boiled rice, cheese, marshmallows, noodles, pasta, jelly babies, potato, semolina, and bread.

Edit: Just had a thought - do you have / are you able to buy any vegan gummy sweets? Maybe that might help and you wouldn't need to eat anything with gelatin that way. You're in the UK, right? Apparently UK Starbursts are vegan, as are Haribo sour rainbow strips and Rowntrees jelly tots, according to veganmarketing.co.uk. Hope this helps!

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