Fluids and watery Output

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) rea;;y 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.

I’ll preface this by saying that my stoma is brand new and also from a failed j pouch, my barbie butt surgery was 3rd March 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, eg a cuppa 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 ok 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 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. 

Keep a diary of what your drinking and eating so you can get a clearer picture and is it what your drinking or do just have loose output as some of do. Your better of not drinking just plain water adding 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 Dr/diaticain or stoma nurse about that.

I'm guessing as you previously had a Jpouch you've had some of your small bowel removed to that makes big difference in having loose output. 

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

😂 I’ll never look at toothpaste the same. 🤢😁 

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 apple sauce, 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!” 💩💩💩😂😂😂

😂 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 cause I’m sick. I can drink as much as I want and it really doesn’t change much. 

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

Hi there I had an ileostomy about 18 months ago and for me what ever 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 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, and 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…

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 gelatine 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 learnt not to chug liquid down, but even sipping I get an occasional watery OP. Reluctantly I shall have to keep a dairy 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.

Hello, Hambo99. Thank you for your post. Your experience sounds like mine and I'm relieved to hear you 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 gets 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.

Hi aLL,   I h ave my ileostomy for over 55  y ears, 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 out put was sometimes watery,    b ut generally speakin g it was  " normaly liquid/ muddy range...    I alway drank a lot ( of plain water)   and rarely had issues of dehydration...   the more I drank, the more I peed, and the guide for t hat, the paler the better...If it was yellow, I needed more water...    All was fine until a few  years a go..   I started to fill with explosions of gas, and e ven though I switched to a pouch ( convatec) with a vent....I found  the  gas con tinued ending up in liquid...an d then green liquid, and t hen almost yellow liquid..   In the last 2 years  Iv'e been hosspitalized  2x  for dehydration, with no real pathology,   infection, or cause...   I finally went to my gastro dr... ( who I had not seen in years),   and he diagnosed it immediaately...   Since I dont 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 5o  years of having an ostomy..   He recommended r eading up, and trying to follow the FODMAP Diet...    It's based on eleminating the hard to digest sugars, & carbs/  & artificial sugars  th          at are found      in many vegetables, and f ruits and juices (   tomatoes, lemon limes, som e green veggies ,  garlic, onions,  artificial sweetners  and carbonated drinks as well..   )  I wa s devestasted, and felt like I wa s back to that teen with  ulcerative colitis.       / back to  a very limited diet..   But I did a lot of reading...and categorized t he specific foods .   Once you eliminate the " identified" problem fooods,   it's ok to t ry them ( one at a time) on ocassion....   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 crystle lite, buy it's  no longer on my list..   Hard cheeses are ok,   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 ocassionally...   Just not every day.      It's a challen ge, and it makes preparting some of m y favorite dishes  a  bit  difficult..   but I've noticed major chan ges,  a nd more  con sistant 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 em pty...So  if you're have s pecific issues/ related to gas, and foods,   check out the FODMAP diet..   It might work for you....   Best of luck to all...   Marsha

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 travellers!

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 looses some of its potency if I use it too regularly. I wonder about the long term effects of using an opoid? I suppose we have to be pragmatic about the situation we find ourselves in.

Best of luck and thankyou.

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!