Diagnosis
You can detect a high-output ileostomy by keeping track of your stoma output. This is the quantity of stool in the stoma bag each time you empty it.
When you are discharged from hospital, you will be given a journal. Use this journal to record your daily stoma output for two weeks after your operation. Note the quantity of stool (in ml) every time you empty the bag, then add up the quantities per day.
If the stoma output exceeds 1200 ml within 24 hours, this is referred to as a high-output ileostomy and measures must be taken.
Alarm signals
The most important warning sign for a high-output ileostomy is an excessively high stoma output. With excessive stoma output, you will need to empty the stoma bag abnormally frequently (more than 8 times per day, also at night) and the stools will have a watery consistency.
Furthermore, pay close attention for the following alarm signals:
- General lethargy, feeling weak, fatigue
- Dizziness or vertigo when standing up
- Weight loss (more than 10% of one's body weight)
- Thirst
- Less frequent urination, dark-colored urine
Possible complications
A high-output ileostomy can lead to various complications:
Your body needs steady levels of water and salts to function properly. Losing large amounts of intestinal fluid can cause you to become dehydrated, in which case you are losing more fluid than you are taking in.
The kidneys act as a filter for excess waste products and water. With a high-output ileostomy, kidney function is disrupted and urine production is lower.
One of the small intestine’s key functions is to absorb various nutrients, including sugars, fats, proteins and electrolytes. In the case of a high-output ileostomy, the absorption of electrolytes such as potassium and sodium may be disrupted. These electrolytes are important for regulating, amongst other things, blood pressure and fluid levels in your body.
Due to the rapid loss of a lot of fluid, it may be difficult for your body to absorb nutrients, if at all.
Weight loss following the formation of an ileostomy is normal, but should not exceed a total of around 10% of your body weight.
Due to excessive output, the stoma plate may come loose or stools may leak underneath it. This often leads to local irritation, pain, redness and itching.
Skin problems can also occur even if you do not have a high-output ileostomy. If you experience serious problems, it is best to contact a stoma nurse or doctor. You can find more information in the information pack you were given on discharge.
If any of the above complications arise, hospital admission may be necessary to restore the fluid levels in your body.
What to do in case of a high-output ileostomy?
If you have developed a high-output ileostomy, it is important to follow these guidelines carefully:
- Choose foods high in salt.
Eat salty crisps and crackers. Add extra salt to your meals.
- Limit your fiber intake.
Do not eat too many wholegrain products, raw fruit or raw vegetables.
- Drink no more than 1 to 1.2 litres per day.
The more you drink to compensate for fluid loss, the worse the problem will become. After all, the fluids will end up directly in your stoma bag, which only perpetuates the problem.
In this case, you may drink 0.5 litres of a drink of your choice: water, tea, coffee, sports drink, etc. We recommend that you drink mainly salt-rich drinks for the remaining 0.5 litres. For example, a salty broth, instant soup or, if necessary, St. Mark’s solution.
- Keep track of your weight daily to monitor any weight loss.
- Take medication if necessary.
Start by taking anti-diarrhoea medication 30 minutes before each meal, three times a day. Increase the dose if necessary, following the guidelines provided by your doctor when you were discharged from hospital. Once your stools thicken and the volume decreases significantly, you can gradually reduce the dosage.
Do not start taking any other or additional medication on your own initiative. Always consult your GP or doctor first.
Have you followed these guidelines carefully without any discernible improvement? And are you experiencing one or more alarm signals? If so, please contact the stoma care nurse.
Prevention
Even when stoma output is within acceptable limits (< 1200 ml/day), it is important to observe the following tips:
Drink sufficient liquids.
In total, you should drink at least 1.5 to 2 litres,according to your thirst. In principle, all drinks are permitted. However, limit your intake of sports drinks to a maximum of 0.5 litres per day.
- Be careful during warm weather. The risk of dehydration is greater because you sweat more.
- Choose foods rich in salt and eat the occasional ripe banana.
Questions or problems
- Non-urgent questions: stomazorg@uzleuven.be
Urgent questions during the week (from 09:00 to 16:00):
- tel. 016 34 37 75 (stoma team)
- tel. 016 34 42 65 (abdominal surgery secretariat)
The stoma nurse will try to solve the problem over the phone or make an appointment aimed at helping you as soon as possible.
Urgent questions outside of working hours or during the weekend:
tel. 016 34 44 40 (nurses on hospitalisatie 17 - abdominal surgery ward)