Working the Overnight Shift

Something I have noticed and am curious about is this... My stoma is more active overnight than in the day. Or at least as active. It seems like he doesn't sleep. When my body is resting, it isn't resting. Sometimes doing as much as 800cc overnight. When I first got my relocation, I would have to get up at 2am and empty. It is less like that now, but still pretty active. Why would it do more work at night? I suppose it isn't really more than in the day, but it sure seems more. I always wake up with a full bag and still sometimes empty during the night. I go to bed between 1 and 4am and get up around 6...and don't eat anything after 8:30pm. Also, I empty before I go to bed. Given all of this, it does seem like it's more active at night when I am sleeping. Anyone else notice this?

Lee

I mostly have my main meal late in the day as it suits my circumstances, so mine is active during the night.

TBH I would prefer to have my main meal around midday, maybe doing it in the future.

So it depends on your input how your output is.

Hi Lee,

The answer to your question is that the intestines do their thing 24/7, not just while you're awake. You have 22' of bowel for a reason.....all that surface area can absorb nutrients while they're passing by. Your bowels also expand as they fill, so while you're sleeping your small intestine is busy absorbing nutrients and recycling your bile, while your colon is busy absorbing water and acting as a trash compactor so you don't have to be on the toilet all the time. When you remove part of that system you screw up the timing, and what ends up coming out of you and when. For example, I have about 3 1/2 feet of small bowel left and my colon is disconnected......so that 3 1/2 feet has to do all the work of what used to be 22 feet of bowel. It does a decent job, but physics is physics and if you dump something into one end of a 3 1/2 foot garden hose it's going to come out the other end much faster than if you dumped that same stuff into a 22 foot long garden hose. So pretty much whatever I eat is out of me in less than 2-3 hours. If I still had my full 22 feet of bowel that could take 24 hours or more. And that makes sense by the simple math.....3 feet gives me 3 hours, so 22 is about 7 times more bowel, and 7 times 3 hours is 21 hours. So unless your bowels are truly empty.........you're going to have output. Also, don't forget that your bowels have two valves that help regulate flow. One at the end of your small bowel, called an ileocecal valve that controls what flows into your colon, and then your sphincter in your rectum, which allows you to hold more in your colon until you can find a toilet. Most ostomy patients have one or both of those valves either removed on no longer active.....so there's no longer any control of your bowel flow by your body. Remember that your stoma is only the very end of whatever parts of your bowel you have left, so it's not a good indicator of what the rest of your bowels are doing upstream. So the tail of the dog could be wagging while the head of the dog is falling asleep..........if you know what I mean.

In your case the end of your bowel is doing its thing at night. You can adjust that by when you eat. That might not be practical or desired, but with critical parts of our bowels missing........we're pretty much along for the ride at this point. Of course WHAT you eat also determines how fast it travels thru your body, so maybe you should find a good dietician who specializes in IBD, and not diabetes or obesity, and see what they say. One word of caution.......MOST dieticians have NO experience with people like us.....so if they don't specialize in IBD patients.......stay clear. Your Gastro should be able to get you in touch with a qualified dietician. Lastly, a Nutritionist and a Dietician are NOT the same. You want a Dietician.

Hope that helps,

Bob

All I ever notice is I poop when I poop. &zwj

Bob's answer is bang on. I have an ileostomy and always have fairly significant output in the morning and am often up in the night to empty my bag. However, I do snack at night. But, I try to stay away from things that produce gas. I've only had my bag for 7 months, but it is all pretty routine now. It's also not a lot different for me, as I have been getting up at least 3 or 4 times every night for years. Age and arthritis does that. It is just that now I have the added pleasure of often emptying my bag on at least one of those times. :-)

Anyway, what you are experiencing is normal and Alex said it succinctly. You go when you gotta go.

Daniel

Hi Lee, yes mine is the same and I cannot remember the last time I slept without 3 plus toilet visits. I think I am accustomed to it now with the leg and shoulder bruises. Ha, I must curb furniture on the way to the bathroom!

Good luck and I hope yours gets easier!

Mine is the same way and I keep thinking that maybe it goes more at night because we are relaxed.

I wondered if it had to do with being relaxed. Like it just lets go of what it's been holding onto. The last time I eat in the day is 8:30 and it is a small snack, and I go to bed around midnight. I empty before bed, but sometimes in the morning there is 700cc in the bag! Sometimes when it gets that full, it leaks. That is frustrating. I don't want to have to get up in the night, but it seems like I might have to. I have an ileostomy, so I don't have any colon left to slow things up. It seems like my stoma takes whatever is left from the day and spits it out while I am sleeping. Some things come out right after I eat, but other things like fruit don't come out until the next day. That always makes me nervous about blockages.

Lee

Same here, including the bruised ankles!

My husband's ileostomy is a little over a year old. We always have to empty it once during the night no matter what he eats or what time.

I find eating my main meal earlier than most people. Usually around 4:00 to give myself time to get most of the meal out before bedtime. However, sometimes I cheat and take an anti-diarrhea med before bedtime. That will slow things down so I don't have to get up in the middle of the night.

Just have to say this is a remarkably informed and well-articulated answer. I'll be looking for w30bob entries in the future! Thank you.

I'm still learning how to time my meals so I'm not the person who can give you advice. Only sympathy! I've had an ileostomy since May of this year, and I have been eating dinner before 6 pm to avoid heavy-duty output at night. However, I still get up twice in the night since I go to bed pretty early by most standards: 10 pm or so.

Before my surgery, my husband and I used to eat supper late when he came home from work. That would be 7:30 or 8 or even later. That doesn't work for me now. So I feel a little disappointed that we don't have that time together anymore. We're trying to find some middle ground but it takes time while, as the patient, you're dealing with so many changes and learning curves that straightening out schedules isn't automatic. I usually starve myself a little if the home care nurse is visiting the next day because I don't want my stoma to be active when she's helping me change the appliance (I'm experiencing some skin irritation issues that have persisted). I'm too in love with food to avoid it for long, but sometimes it's necessary to make switching appliances more manageable.

So . . . your post has reminded me to watch when I eat and when output follows. The more aware I am, the more control I can establish maybe?

After experimenting for 3 years, post-op, most of what I was taught is true. Your bowel never goes to sleep. Peristalsis. Lying down slows it. We all grew up eating supper. Eating supper at noon is weird! I quit eating by 7-7:30. I too, get up to empty at 2 am. I go back to bed for 4-5 hours. Notice my bag is only 1/2 full. If I hike the early am (today's heat), I first drink OJ with a Melba toast (low ash) and take my pills. Being I have not had a meal in 12 hours, I can go up to 6 hours before I have to empty. Handy on a 4-hour hike, as I eat a PBJ after 3 hours (Mayo's advice). I then eat every 3 hours to get my nutrition back up. You call your stoma "He". I call mine "little buddy". When he gurgles, I smile and reply: "Say little buddy" (Alan Hale Jr.-RIP). Give yourself more time to adjust. "It's a long road to Eden"

I like this entry. I walk my dogs in the morning. My American Labrador can't get enough exercise. If I haven't eaten since 6 pm the night before, the walk is a lot easier because a bag that's not weighted down with output doesn't tug on my skin. A stealth belt helps a little. I'm also still having liquid output that seeps onto the skin around the stoma that stings. I am still in search of the right barrier. And still trying to figure out how to avoid skin that breaks down due to leakage. I miss my morning iced tea with tons of lemon juice. The acid makes the stinging worse. The nurse told me coffee was okay, so I may have to switch my normal morning lift.

Anyway, I make sure to hydrate in this hot weather before I walk.

I can never change an appliance after eating, nor can I take a shower after eating for the same reason. It has to be 3 to 4 hours since I ate before I can change or shower without a bag on.

Lee

Little buddy is a good name. I called mine Marvin as in Marvin the Martian, because when I saw him after surgery I thought he looked like a Martian coming out of my stomach. When he talks I say "Hi Marvin" or "Is that right Marvin." My mom tries to carry on a conversation with him if he talks a lot for like 10 minutes.

Lee

Hi Lee,

I call mine Herb. I don't know why... It just struck me as kinda funny. My wife, though, is unamused. Hopefully, as time passes, things will get better for you.