Ileostomy Output: Liquid vs. Apple Sauce Consistency

Hi everyone.
I'm 2 weeks post-surgery, trying to get used to this very new life.
I have a quick question, wondering what longtime ostomates think here.

My doctors and nutritionists in the hospital kept telling me that I want an ‘apple sauce' consistency output. Mine is liquid, and I'm happy about it. Way easier and faster to empty liquid than apple sauce.
Why would I want a thicker consistency if I can have it liquid? What are the benefits this way or the other?

Thanks

 

Clara 

Hi Clara

Watery output can be an issue because it can be easier for output to find its way between your skin and the appliance, instigating a leak and reducing time between changes. However, this does not apply to everyone all the time; mine tends to move between looser, to just like rainwater at times. There are a number of factors that will produce very loose output, such as drinking too much water too fast, as it will probably pass straight through; coffee can do the same and can contribute to dehydration. Many foods create loose output as well. Others have issues with output that is too firm. There are things such as psyllium husk powder, loperamide, and some foods which can firm up output, but I find the foods inconsistent, so I don't chase them. Looser output also has a self-cleaning action when emptying too 😂

You are still very early in the process and your body is still trying to work out what is going on and will for a while longer. In time, you will learn what works for you.

Two weeks is very early; at that stage, you're eating normally, so loose output is normal. As you start your normal diet again, it will probably firm up more. Just standard advice saying output should be like apple sauce or porridge. I think when they say it, they're thinking more about dehydration from high output. My ileostomy output used to be very solid for the first 15 years, then 20 years ago I lost a lot of my small bowel and have had very loose, watery output ever since. It's never been a problem.

Clara, as your ostomy normalizes after the initial few months, you will find that your diet will dictate how thick or watery your output is.  Some foods will thicken it (potatoes gets me, for example) and others will thin it out (milk products).  I feel like if it's too watery too much of the time that I'm losing too much fluid in the output and that can risk dehydration.  But it's always going to fluctuate throughout the day.

I had my surgery 13 days ago, and mine still alternates between fluid and semi-solid. I use a drainable ostomy bag, and draining it is still something that takes time for me to get used to :(

It was easy when I was in the hospital; the nurses would clean it out, but now that I am out of the hospital and have to do it myself, it is quite tricky! It is indeed easier when it's just liquid, but the bag becomes heavier and kind of pulls on the skin attached to it.

 

Words of Encouragement from Ostomy Advocates I Hollister

I agree, emptying is definitely something I’m not used to and not sure I’ll ever be totally ok with it. It’s a big deal… 

 

Thank you Henry, Ben and Axl. Appreciate your replies. 
How long does the early days stage last? I know I’m super early at the moment, but wondering how long it will take my body to adjust? And does it get easier once my body adjusts? 

Your adjustment period has both physical as well as psychological components.  We're all different, obviously.  A positive attitude will be a benefit.  And yes, it'll get easier.  Hang in there, kid.  

Hi Clara, I agree with the others about prolonged liquid output contributing to dehydration. This is most likely why you were told how to thicken it up. I understand your saying that liquid output is easier to take care of and it is - pour out, clean, done (I tend to like this, too!) Over time, everything will even out and you'll notice your output responding to the foods you eat. Yes, applesauce to thicken and I would add butternut squash soup, too. Just try not to be liquidy ALL of the time, rehydrate with water, and add a little salt to your diet.

Thicker output means more nutrients have been absorbed.

Hi Clara,  Ditto what everyone else has said.  I have an ileostomy, and agree that liquid output is easier to deal with as far as emptying goes, but does become more problematic when out and about, simply because the more liquid in your output, the more volume, so your pouch will become heavy and need emptying more often.  Not always easy when out in public.  You also risk having absorption issues with long term liquid output, as everything can pass through you so quickly, your body isn't able to absorb all the nutrients it should.  My output varies throughout the day and night and depends a lot on my diet and liquid intake.  You will get there and find where you are comfortable and what works for you.  It's early days.  

Terry

I am a lot like Terry in that my output changes in consistency throughout the day. A further caution to liquid output in addition to dehydration issues, if you are quite liquidy, the transit time in your intestines is pretty fast. If you are taking meds, sometimes it is so quick that pills don't get a chance to dissolve. Shamrock mentioned a number of foods that would help thicken your output; try a few and see what works best for you. I like applesauce, potatoes, and bananas.

Thank you so much for your replies. It is early days and I alternate between being grateful that I’m post surgery and regretting the fact I ever did it…. 
Thanks for your tips, I appreciate it. 

All this is making me think of something else now, if foods pass through an ileostomy so fast that even pills can be undigested how does it work with calories? Do we absorb less calories from foods we eat with half the digestive system out of the picture? 

I currently use a small and big bottle with a long spout. I use the small one for when I just want to clean really quickly or when I wake up at 3 a.m. and just want to go back to sleep asap 😆

I use the big bottle (to use it, you turn it upside down and the spout has holes on its end so it sprays water and you just have to squeeze the bottle to spray water inside the bag) for a thorough cleanup.

But I think I might have been too eager in cleaning it because the skin around my stoma is a bit itchy and irritated.

According to my doctor, yes, we absorb only around 30-40% from the food we eat; that's why he advised me to eat more than before. For those with a reversal ileostomy, he also said once it is reversed, people tend to put on weight because they have been used to the habit of eating more. 😅

In the very early days, I would find tablets in the bag. The doctor said to crush them in a mortar and pestle, for example, and put them in a little water and drink it to avoid them passing through before dissolving. It works well but tastes like crap. Check with the doctor first, as some medications may cause issues with this process. As for calories, who knows? I am naturally slim, but there are all shapes and sizes of people with an ostomy.

I think this may be wishful thinking Clara!  Would be nice.  I did lose a lot of weight after all my surgeries (4), but once it was all over and I stabilized, I put it back on again.  I don't think I'm any different now than I was pre-ostomy, I still need to keep active and watch what I eat, or I do start to gain weight.

Terry