Managing High Output with Ileostomy and TPN Challenges

I am a 12-week ostomate with high volume and on TPN. My doctor said in order to get off the TPN, my stool output has to get to 1.2 or lower. I am at 2 liters and can't seem to budge much, even with double doses of Imodium. I can't take Metamucil or anything high in fiber because of blockages. Does anyone have 2 liters and no problems?

The doctor is concerned because I am very thin, and he used TPN to put weight on me, which I did, but I can't go swimming, my preferred exercise, because of a bad hip. And the 14 hours a day on TPN, even mostly while sleeping, is a real pain.

Hi OstoElmer, sounds challenging. Is this a permanent situation?

That's a crazy situation, OstoElmer. Can they increase the TPN for you to gain more weight? With more body mass, it might work in your favor. I hope for your sake they can come up with something soon. Keep us up to date, please.

Regards, IGGIE

A double dose of Imodium (4 mg) is not very much for a high-output ostomy since the absorption rate of loperamide is very low in high-output ostomies. Ideally, 64 mg/day of loperamide, taken 4 times a day (once at each meal and at bedtime), is the most anyone would need. In very difficult cases, 96 mg/day was needed.

https://www.sps.nhs.uk/articles/using-loperamide-in-high-output-stoma-or-short-bowel-syndrome/

— Proud owner of lifesaving ostomy, vintage 2023, V6 colostomy engine.

How many Imodium are you taking a day (do you take it before or after eating), and are you taking any other meds or injections to slow it down and any supplements to help you gain weight? What's the reason for your high output? Have you had any small bowel removed? Has your diet had no effect on thickening your output? I know it doesn't always, from my own experience. I was on TPN for 18 months when I had a temporary high output jejunostomy. I won't say how many Imodium I took a day, as it was more than most people would take in a week. You can take more than the recommended dose with Dr's advice ONLY. Putting weight on was a real struggle for me; they used to encourage me to eat chips, crisps, cream cakes, chocolate, and everything else that's unhealthy for us, lol.

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TPN is a pain, I know it well. I've been on it since last October (different reason though).

See if they can adjust your delivery to 12 hours. Even that much change will free you up quite a bit. If you need to put on weight, they should up your calories a bit too.

I can't help with the output issue since I have a colostomy. You've received great advice already.

I'm up to taking 5 ml of Imodium 3 times a day. I read to take it 20-30 minutes before eating and not to drink anything 30 minutes prior to or after eating. I'm slowly increasing. I've gained almost 20 lbs, so the TPN has worked, but I get so dehydrated when I don't do TPN, and if I drink too much, I just pee more and get more dehydrated. I also drink Liquid IV; some flavors are okay. I just want to start my aquatic aerobic class again and can't with the PICC line. An internal line is not an option.

You keep getting dehydrated when off the TPN because your output is still too high. Keep increasing your Imodium (loperamide) because with your high output, little is being absorbed. When you are getting enough in your system, your output will slow, and you can get off the TPN.

— Proud owner of lifesaving ostomy, vintage 2023, V6 colostomy engine.