Stomach Pain After Ostomy Surgery: Is It a Blockage?

I had surgery for an ostomy about 7 weeks ago. It has been going fine except for a very high output. I've been following my doctor's instructions by following a high-fiber diet and adding Citrucel twice a day (2 heaping tablespoons in a small amount of applesauce). I've now added two Imodium crushed up in applesauce in the morning and evening. It's been several days of using the Imodium. Today, after breakfast, my stomach started to hurt, like an old-fashioned stomach ache. It doesn't feel like a Crohn's blockage, and I don't currently have any narrowing in my colon or small intestine. My output has slowed since breakfast, but there is still some output. Does this sound like a blockage? Thanks for any advice.

It does sound like one; go see your stoma nurse and let her check you out. If you start to vomit, head for the emergency room.

Regards, IGGIE

Hi Pearl, I would add more fluids like tea, fruit juice, and less Imodium. Good luck.

It sounds like the Imodium is slowing things down to a crawl, and that would cause pain. Maybe eliminate it and do it more naturally, like Ron said.

If it feels like a stomach ache you've had before, I would give it a few hours and, as already suggested, drink more fluids. Skip the next Imodium and walk around your house a bit more if you feel well enough to, as that can help things start moving. If it is a blockage, it might be just one of those; we all get them at times for no apparent reason.

Words of Encouragement from Ostomy Advocates I Hollister

Someone will need to explain this to me because I have a generic high school education. You have high output naturally(?), yet you take high fiber and Citrucel. Both the high fiber and the Citrucel (laxative) make you poop more. Then, you start taking Immodium to slow it down? Why? Of course, you're going to have a stomach ache if you're going a lot and then try to stop it all of a sudden by plugging yourself up. Or did I read all of your info wrong?

Alex, you always see right through stuff and get straight to what is really wrong. Your feedback is so valuable because of that. Pearl is new to the whole bag thing, doing what the doc said. I remember doing that early on because I didn't understand everything and assumed he was right. We all learn as we go along.

I agree with eefyjig. Your feedback is spot on and invaluable.

Did you eat something for breakfast you don't usually eat? It could be just a regular old tummy ache. If you are still having output, just not as much, it probably isn't a full blockage. It could be a partial blockage. It could also be too much Imodium or too much fiber. As said, if there is vomiting, go to the ER, but otherwise, you can try a heating pad or try changing positions. Drinking plenty of fluids is on the instructions for taking Imodium.

I assume you have a colostomy since you state that you have no narrowing in your small intestine or colon. I don't know how you know this without imaging — if you did have imaging, it would tell you if you had a blockage or constipation. I assume no narrowing is an optimistic guess. A high-output ostomy is output greater than 2 - 2.5 liters per day, and that is not normally the case for colostomies. Is your output just higher than you would like to see it? You are still early in your healing and recovery, and your output will change. You should not be trying to moderate your output at this stage.

There is only one type of fiber that can reduce output:

"If a gel-forming soluble fiber can resist fermentation and retain its high water-holding capacity throughout the large bowel, it can provide a dichotomous, stool-normalizing effect to soften hard stool (increase BM frequency) in constipation, and firm loose/liquid stool (decrease BM frequency) in diarrhea."

Psyllium (Metamucil) has been shown to soften hard stool/reduce symptoms in patients with chronic constipation and improve stool form/reduce symptoms in chronic diarrhea, lactulose-induced diarrhea, Crohn's disease, and phenolphthalein-induced diarrhea.

The use of fiber to normalize output, whether diarrhea or constipation, is only relevant in the colon; that is, if you have a colostomy.

Loperamide (Imodium) can be used to slow output, but two Imodium, AM and PM, are not useful for high output. For high output, you would need to take a minimum of two capsules at each meal and two at bedtime for a total of 16 mg/day. If you have a colon, then why are you crushing the Imodium? If the Imodium is moving through your colon so fast that you are seeing them in your output, then certainly you will need to take more to get enough absorption to be effective.

Other safer things you can try are foods to thicken your output: cheese, cheesecake, smooth nut butters, pretzels, white rice, tapioca, matzo, water crackers, marshmallows, and Jell-O, bananas, applesauce, oatmeal — bananas work for me.

Finally, if you have high flow, you may be experiencing dehydration. You should ensure you stay hydrated.

My recommendation is to lay off the high fiber, Citrucel, and loperamide; it is much too soon in your recovery to be trying this — keep a food diary to see how various foods affect your output. mySymptoms is a mobile app you can use as a food diary.

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

Thank you.

Thanks

I like your comments; they are spot on. The only other thing I would add is to introduce banana flakes to that: 2 tablespoons of that and 2 tablespoons of Metamucil. Do that 3 times a day and drink all the fluids you can. My wife uses Liquid IV. It is kind of pricey but really works well. Good luck.

Mike

Thank you for the responses. It helps to see others' ideas.

A Traveler, I did have a colostomy this past February at the Mayo Clinic in Rochester, MN. The surgeon did say that it might result in a high output following the surgery. I have had Crohn's since I was 21 (now 68), and I have had many surgeries throughout the years due to blockages in my small intestine. My Crohn's seems to be controlled for now; I am currently on Stelara. However, I seem to have a new talent for producing scar tissue. About 18 months ago, investigative surgery found that the scar tissue on my large intestine was so bad that it was squeezing my colon shut from the outside. The surgeon felt that a colostomy would be the most appropriate, but since we hadn't talked about that option, he and my husband did not feel comfortable doing it right then. I was better for a short time, but the scar tissue once again made it very difficult to eat.

They went back in, cut away scar tissue for a couple of hours, and then did the colostomy. I am thrilled that I am able to eat again, but putting on weight is still very difficult because everything comes through so quickly. I've gone from 79 pounds to 83 pounds now. Sometimes I can see dinner come out within three hours, and some medications come out intact. The reason for this is probably my short intestine. I am inches away from having a "short gut." Because of this, the small intestine is not able to absorb much liquid. I believe you are right that things may change; it is still early on, and the colon may pick up the slack. Since it is on the descending colon, I am hoping that this is the case.

You mentioned Metamucil; I am taking Citrucel, which some say causes less gas than Metamucil, and Mayo said either was fine. They also suggested crushing the Imodium into applesauce, probably so it stands a better chance of being absorbed. They want me to use a step method, adding more every 12-24 hours until I am taking 6 tablets a day. I have tried all the foods you mentioned above; nothing helps yet. My local gastroenterologist suggested adding Lomitil. We are going to London and Norway at the end of April, and I was hoping to have a bit of control before then since it can be hard to find bathrooms, especially quickly in an emergency. The Imodium and Citrucel do make the stool thicker, although not all of the time. The bag can still fill up as fast as half an hour with all liquid. Ugh, however, I am very glad I had the surgery; not everyone realizes how fabulous it can be eating food again! :)

I have been using the banana flakes too; my ostomy nurse suggested them. I also use the IV fluid packets; I get them at Costco. Great suggestions too!

You mention adding Lomotil; I hope that is instead of loperamide since they both do the same thing — you don't want to take both at the same time. It's surprising your output is that liquid and your colostomy is on the descending colon. Since your output is so liquid, you should try gelling sachets.

https://www.convatec.com/ostomy-care/forms/request-sample-diamonds/

How many times per day is your bag filling up? Why are you eating so much fiber?

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

I had not heard of banana flakes, but I will definitely give them a try along with the Metamucil. If it works, it will save me money because I am currently eating 4-5 bananas a day to get semi-solid output. Two loperamide (Imodium) with each meal and two before bedtime for a total of eight per day worked great for me, but my cardiologist changed my HBP, and the new medication doesn't work well with loperamide. Thanks for the banana flakes suggestion.

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