High Liquid Output with Ileostomy: When to Seek Medical Help?

Seeking input.

I am just over four weeks in with my ileostomy. Things are progressing as they should.
However, since late last night, my output has increased and turned to liquid (broth-like consistency).

I have stopped eating solids and increased electrolyte intake among other drinks (tea and water). So far, in the past 10 hours, I have roughly outputted 2L.

I have no pain. However, I do have nausea (no vomiting).

Question:

-At what point do I venture to the ER? Could this just be a stomach bug, and am I just overthinking it?

Thank you in advance

Start using Loperamide if you haven't yet (Immodium, same active ingredient, not as pricey). Drink some protein, a smoothie, a supplement; sometimes for us, the nausea was because the stomach was empty of food but full of bile. Zofran and Compazine for nausea; we're nearly two years in and still use one or the other, or both, nearly every day. 2L is a lot of output for that short a time.

Wishing you the best; there are a lot of smart, experienced people here, and you'll get some great ideas from them. Welcome!

I have a colostomy, so I am not experienced with ileostomies. But it seems like ileostomies frequently have liquid output. I've been struggling with very liquid output from my colostomy. It's practically water half the time.

Have you tried adding foods that thicken output, like bananas, marshmallows, applesauce, potatoes without skins, etc.?

Since this is a change and you are so fresh from surgery, you might call your surgeon tomorrow.

As long as you are keeping hydrated and have no pain, I think it's safe to wait until you can contact your surgeon.

Wait for opinions from people with ileostomies.

Hi NewToThis22,

I've had an ileostomy for almost a year now. I had some times when I had very liquid output. Try potato chips, marshmallows, applesauce, even rice or mashed potatoes. They work for me. I found that when I eat something really sweet, like frosting or some homemade mints, it can make my output very liquid, so I try to eat only a small amount. I find that potato chips (I like the baked ones—not as greasy) work very well. You'll figure things out fast. I also use Diamonds from Convatec in my pouch to absorb the liquid when it is very liquid.

To be honest, as your surgery is very recent, I would get checked out to be on the safe side. Hopefully, it's just a stomach bug or food poisoning. It is best just to ride it out without taking anything to slow it down to get it out of your system. If you start having blackouts, seek urgent medical attention. Water is the worst thing you can drink when your ileo is running wild; it will come out almost as fast as it goes in, but you're doing the right thing by keeping your fluid intake high.

My Ostomy Journey: Ryan | Hollister

Hi New,

At just 4 weeks, your body is still trying to figure out what the hell just happened, so I'll tread lightly. By switching to a liquid diet, you're probably doing the worst possible thing. Well, OK, to be fully truthful here... if you still have your terminal ileum, your small bowel can absorb a little water, but not much. And if it's gone... you're an open fire hose. You have to realize that as an ileostomate, you can no longer hydrate (i.e., absorb liquids) the way normal people with a colon can. That's because the colon is what absorbs all the liquid you drink to keep you hydrated, and yours is probably in a medical waste dumpster if it hasn't been incinerated to ash by now. And without one, almost all of what you drink (with the exception I'll get to in a second) just ends up right in your bag. What's worse is that when you drink something too sweet or salty, your small bowel will pull water from your body to try to dilute it to a ratio it can deal with... which just dehydrates you even faster. That's probably why you're nauseous.

So the first thing is to address motility. As mentioned, things like Immodium, Loperamide, Diphenoxylate, etc., can slow your shit down... literally. The other way is to eat fats. Fats cause the stomach to hold onto its contents the longest and release them slowly into the small bowel. Carbs are incredibly bad for everyone, as they cause spikes in blood glucose, which causes inflammation... but that's a story for another day. Next is to find yourself some Oral Rehydration Solution (ORS) or make your own... it's very easy. Essentially, it's any liquid that's in the proper ratio of sodium to glucose to water so that your small bowel will recognize it as something it can absorb, since the small bowel focuses on glucose and sodium absorption. When those two things are at the correct ratio, the water gets a free ride on the back of the sodium and glucose molecules into your small bowel, and you get hydrated. Ain't that the shit?? But if the ratio is wrong... well... we already covered that. I've talked about ORS on here a million times, so do a quick search or Google it, and you'll have more info than you'll need on it. Just remember you can make it out of practically anything, as long as the ratio of sugar (glucose) and sodium (salt) is correct for the amount of water you're mixing it with. And once you get the hang of it... it's easy peasy.

Try those two things, and you should be feeling better pretty quickly. If not, you'll probably have to upgrade to Premium membership to get the 'good' advice that actually works.

Just kidding!!!!

Let us know how you make out!!

;O)

G-Day NewToThis22,

Why have you stopped eating solids and increased your fluid intake?

Go back to eating food and see how you go.

More liquid in means more liquid out.

Regards, IGGIE

When I experience this, I try to eat crackers, toast, etc. It often helps.

Welcome, fellow Maritimer!

I've had my ileostomy for about 18 months, and my output has undergone a lot of changes over that time.

My output is more watery when I drink tea, coffee, or wine. They all trigger your body to eliminate more fluids. Ileostomy output does tend to be more liquid-like to begin with because there is no large intestine to absorb the excess. But over time, it should become more of a toothpaste consistency.

It takes a few months for your small intestine to adjust to being the sole source of digestion. Being only a month out from surgery, your body is still making major adaptations.

Nausea is no fun at all. What kind of solids were you eating? You could try eating very small portions several times a day rather than larger meals. But if your nausea keeps up and you're not feeling better in a week or two, I would contact your surgeon or at least your ostomy nurse to get a proper opinion. Each of us is very different in the way our bodies react to this major change to our gut.

You've already received some great practical advice from this group. We're here to support you and help you through these rough patches as your journey begins. Please keep us posted on your progress. You'll figure this out!

M
xo

Loperamide, and eat some solids, reduce liquid intake. It's easy to become dehydrated with an ileo, especially if the output is liquid. A bit like filling a bucket that has a hole in it, keep putting more fluid in; it's just going to run straight out. You need to slow your small intestine down to give it a chance to absorb some of the fluids.

Also, jelly babies or marshmallows and potato are good at soaking up some of the excess fluids the small intestine won't absorb.

Good catch, IGGIE.

I've always had a lot of diarrhea, and an all-liquid diet has been recommended to me to slow down the colon. It worked (pre-surgery). I think the theory was to rest the colon by giving it no solids.

But with no colon, it would not work the same and probably not at all.

Thank you to all for the feedback! Much appreciated.

After some arm twisting from the wife, I headed to the ER just to ensure that things are okay. I am not in pain, but I still have nausea.

The last time my wife twisted my arm and headed to the ER, I stayed for 10 days and had surgery.

However, I have taken some good points. Thank you.

Cheers

Why would you stop eating solids? If you are only consuming liquid, you are only going to get liquid output. Try eating a banana or some toast. Maybe a little peanut butter. These things thicken up output. Keep drinking electrolyte drinks so you don't get dehydrated, but try adding some mild foods into your diet. If that doesn't work, try Imodium.

Don't freak out.... I've had mine for almost 5 years and rarely is it not like a waterfall. For one, your body needs time to adjust to it. You'll find over time that certain foods will come out like water and sometimes like an applesauce consistency. It all depends on how far up your ostomy is. Every time I go into the hospital, they're always worried mine is too watery because of the dehydration issues. BUT for some, it's normal. Also, it depends on diet. Foods like cucumbers, fruits, eggs, and lunch meat, at least for me, come out like water, even noodles. The one thing that frustrated me was people saying, "Oh, eat rice, toast, or bananas to make it thicken." Sometimes it works, sometimes it doesn't for some people. If I know I'm going to have something and it's going to come out like water, I take an Imodium Walmart generic brand (way cheaper and works). Now, if this doesn't seem to work, again give it time. You can ask your doctor about Loperamide, like Brightside suggested. Also, being new, don't freak out with color changes from food coloring, especially red food dyes. Red Gatorade or cherries may look like blood at first. Mostly red and blue from my medication will make my output usually yellow/orange. This can be too much fat in your food. Green usually is bile. Brown should be the "normal," and I wouldn't cut back on fluids. Make sure you're getting enough electrolytes in. You can discuss this with your doctor. Some of us can develop kidney issues, not to scare you. I had issues before I got my ileostomy. Long story, but then because I was unaware at the time that because my output is watery 90% of the time, I needed extra fluids. When I got sick the first time about a year after getting my ostomy, my kidneys suffered from not drinking enough. Your doctor can do blood work to check your electrolytes if it becomes a problem. Any questions you have, feel free to ask. I learned a lot on here. I wasn't prepared like some people knowing they needed an ostomy. I just woke up with one from surgery. No one knew my colon ripped after a botched gallbladder surgery and found out when they opened me up because of an infection. You'll learn as you go, and it will become your new normal once you get used to it. Take care 🫂

Hi Rose :)

You mentioned liquid output sometimes depending upon how far up the small colon the ileostomy is.
I've always wondered about how much small intestine I have left. I know it isn't much because my large intestine was taken out 5 years prior to the ileostomy. When the ileostomy was done, it was emergency surgery due to twisting of the small colon and necrotic tissue. (Yes. Painful and ICU)

So, much of the small intestine was removed as well. Would that equal more liquid output?
I find that it doesn't take much “real food” at all for me to feel really sick.
😟 It's been 3 years.

It could be from what I understand...as far as eatting...i wounder if enzyme treatment with Zenpep or Creon would work...they help break down fats on ur food...I'm on the because I lost a 3rd of my pancreas and my bile ducts are constantly inflamed...and its the only thing that helped me keep food down and not feel like it was churning in my stomach.Creon is what the hospitals will give you ..Zenpep cost more but I feel is better, but it's made different....You can talk to your GI about it or your regular doctor if intrested..hopefully it will help or you can find a soultion. 🫂