Dealing with Constipation Issues with a Colostomy

I have been having low or no output for some time, induced, I think, by my diet for Type 2 diabetes. It consists of lots of fruit, veggies, eggs, sourdough bread, ...) But this diet seems to be bad for the colostomy ... the low output being caused by stool buildup.

I went to the ER last week to see what was going on. (Spent hours waiting .... this is the Ontario health care system). They did a CT scan, in case of a bowel obstruction or a twist. No problem there, but the scan showed that the colon (I presume the bottom of the large intestine, where my stoma is) was full of stool.

The ER doctor (a resident, not a staff doctor) was the one who came back with the results, saying I was constipated, and gave me a sheet of paper that said how to treat constipation. I was so out of it (it was now about 10:30 PM ... I had been at the hospital since around 2 PM) that I didn't really question it. I should have. They knew I had a colostomy but didn't think of the implications.

The treatment was three days of a high amount of Miralax or the like (10 teaspoons in 500 ml - 2 cups) three times a day. Once at home, I wondered how my pouch would handle all that output ... I don't think it could. It would fill up very quickly, unlike a normal person who could hold it until getting to the toilet; I have no way of controlling anything. Once it starts coming, I suspect it would keep on for a while. So I decided that wasn't a good idea. There was nothing in the treatment about doing it with a colostomy ... it seems to be a standard document about treating constipation for a normal person.

With the lousy state of our health care system, I don't have anywhere to go for help. My family doctor knows nothing.

This is more of a rant rather than expecting any assistance, but I thought it was worth a try.

Hi OF, get a large drainage pouch for irrigation and then take the Miralax. Also, maybe add fruit juice to your daily diet.

This is an exact copy of a post I wrote earlier today…not sure if ileostomy or colostomy reacts the same to Metamucil or fiber powder, but you may want to give it a shot…park yourself outside the bathroom door with a good book for as long as it takes.”

”Sep 19, 2025 7:00 am

Ileostomy here….I find a daily dose of psyllium fiber powder, same as Metamucil, keeps output more consistent….initially, the doc suggested this; however, early on in my journey, 5 years ago, my emergency surgery left my head spinning, and probably most advice sailed right over my head. This site helped to stop the spinning head. If you are not already taking fiber on a daily basis, you may want to ask your doctor about it - then do what your own body responds to….not to dis the docs, but in my experience, sometimes they get it wrong…..jb    ”

Frankly, what's inside needs to come out. You don't want a blockage, which would be the next step.

I agree with Ron, get a large bag and do it.

Going forward, use a fiber supplement daily to prevent problems.

When you're feeling better, call the ER and try to talk with someone in charge and tell them that they should have a staff member who has some knowledge about treating someone with an ostomy there, or at least on call.

My Ostomy Journey: Ryan | Hollister

I'm sorry you went through that, but the fact is that treating constipation with a colostomy is no different than treating it for a 'normal' person. I went through a year with a colostomy and was constantly constipated and getting blockages, which weren't really blockages, just stool that wouldn't move. I treated it with Miralax daily in pretty large quantities and remember well my pouch filling up quickly. In my case, it was a non-functioning colon, and the solution was an ileostomy. In your case, it seems to be diet-related, and some daily psyllium fiber might help. If it doesn't, I would suggest using Miralax daily, just not a large amount. All it does is bring liquid into your bowel, which will help avoid constipation in the future. I have complaints about our health care system too, but in all fairness, in your case, there really wasn't anything else they could have recommended. It sucks that you had to wait so long to be seen though.

Terry

The hospital prescribing Miralax seems to be a standard thing (I'm in the United States).

What usually works for me is Senna tea, warm lemon water, walking, hot showers, and applying mild pressure to the "mass." The output will slowly start to pass, and once the "plug" (as I call it) comes out, the rest will follow.

It might empty throughout the day with you needing multiple bathroom trips, but it should resolve within 12-24 hours. (Everyone is different, but this has been my overall experience).

How long have you had your colostomy? (I've had mine for 27 years).

Thanks to all who replied. I've only had mine since April 2023. It was rectal cancer, so they took out about 12" of the large intestine, leaving the rest (most of it) intact. So I never really had any problems with eating.

I would do what the doc says and just stay near a bathroom until it is resolved. I fell about 3 weeks ago, and the doc put me on opioids for the pain in my ribs, which meant I needed to drink Miralax at least twice a day to keep things moving. I had the same experience while on chemo; it slowed everything down, and I was drinking MiraLAX to keep things moving. My regular bag was fine with the output; it just would kind of dump out a bunch, I would take care of it, then another bunch would dump, and I would empty again. Miralax is actually pretty gentle compared to some of the stuff out there.

I spent many, many years with constipation as a chronic issue, so I've looked into every conceivable treatment. It lived on Miralax for years, and I can't really remember exactly how much I was taking, but I was taking it twice a day, and my stool was pretty much in liquid form. Your situation seems to have become chronic, so finding a maintenance amount of Miralax to take on a daily basis might be what you need. You shouldn't have to take enough to have liquid stool, just enough to make things easier to move. Experimentation is what it might boil down to. Surgeons know nothing about aftercare with ostomies. Even an ostomy nurse will probably not help much, as your situation is basically a normal colostomy, complicated by your diabetes and requirement for a specific diet. Treating the constipation will be the same as with anyone who is constipated. I would not recommend anything with senna in it (even tea), as you can develop a tolerance for it, as with many constipation remedies. The nice thing about Miralax is that it won't hurt you and you don't develop a tolerance. As I said, it only introduces water into your colon. If you use it regularly in a maintenance amount, you should be able to avoid getting constipated and needing large amounts. Good luck. I empathize with you as I know the frustration and discomfort of living with constipation. Been there, done that!

Terry

Terry: a maintenance dose after things get cleared up is no problem. But it appears that I am badly clogged up. I have no idea how far up the colon the stuff goes (my colostomy is right at the bottom where my rectum used to be). The CT scan basically said that the colon was full of stool. How much is 'full'? How hard is it? If it were not for the warning not to use Miralax with a blockage, I would try it. I have no idea why that warning, bit I am quite scared to try something that might make things worse.

I am quite scared ... so is my wife. I'm 83 and she is 80. The strain on both of us is enormous. If something isn't done, the bowel could rupture, or just keep filling up and up and up ...

I am eating very little, since I don't want to make things worse. And of course that is making me quite weak.

I am worried that the Miralax regime the hospital doctor (a resident, not a staff doctor) suggested (3 doses of Miralax, 10 teaspoons in 500ml ...a bit over two cups of water) 3 times a day for three days will create a lot of output in short time that the pouch can't handle. I can't sit on the toilet for three days with the pouch open hanging down into the bowl. If this were only for a few hours, I could manage.

Someone here commented that it needs to be treated before it becomes a blockage. I think it is. If food is going in as it has been for a while, and not coming out, what else is it? 

I guess my real problem is that there are a lot of suggestions, from the hospital, from you folks that I am afraid to try. What if they make things worse? The status quo isn't good, but "worse" is even worse.

Again, thanks for listening and caring. Just talking about it here makes me feel less alone.

This may seem like a crazy suggestion, but have you reached out to the hospital's stoma nurse and/or nutritionist?

OK, I hope I can put your mind at rest a bit. The CT scan showed nothing abnormal except large amounts of stool in the colon. There is no 'obstruction,' or what we laypeople call a blockage. A true obstruction means something other than stool, i.e., a twisted bowel, or some other physical abnormality. The Miralax people have to put these warnings on labels, as if you had a true obstruction, you wouldn't want to use their product. By the way, Miralax is polyethylene glycol, sold under lots of different names besides Miralax. The hospital told you to use it, and I think you should trust them on this one. Get yourself some large capacity pouches (I think all the ostomy companies make them), so you can handle the large amounts of output in a short time period. This should work for you. Move around as much as possible to help things, as being sedentary will not help. Don't stop eating and drinking unless they told you to. You need the energy and the hydration. Don't be afraid of it. It won't make things worse. You would be amazed at just how much the colon can hold. Good luck, and keep us posted with your progress.

Terry