Your stoma is always active due to factors like diet (fizzy/fibrous foods, large meals), fluid intake (not enough or too much too fast), swallowed air, or underlying medical issues like short bowel syndrome (SBS) or infections, leading to high, watery output (High Output Stoma, or HOS), requiring management through diet adjustments (like eating main meals earlier), hydration, and sometimes medication (loperamide), but always consult your Stoma Nurse or doctor for persistent activity.
Fluid allowance
Drinking too much regular fluid can make your stoma output increase. This makes you thirstier, so you drink even more, which makes the stoma more active. It's like a cycle. We therefore recommend a specific fluid allowance for the regular fluids you drink.
Your doctor, dietitian or stoma nurse may suggest you restrict your fluids to a certain amount per day. Your doctor may prescribe medication to slow down your bowels e.g. loperamide, (you should speak to your doctor or a pharmacist regarding the best timings to take this in relation to your meals).
An ileostomy is generally quite active, with people usually draining their stoma appliance between five to seven times in a 24–hour period. With a bowel obstruction you may notice that you pass a reduced amount of output and need to drain your stoma appliance less frequently.
You may also notice your stoma move slightly or change in size when you stand up or cough, causing your stomach muscles to tighten, this is perfectly normal.
If the skin around the stoma does not appear to be similar to the skin on rest of your abdomen, it is likely that you have a skin issue that needs to be addressed. The skin barrier should protect your skin. If the skin is irritated (red, moist, or sore to the touch), the pouch seal can fail and leakage.
It usually takes around 8 weeks to recover from a colostomy and get back to your usual activities. It's important to rest and take the time you need to adjust to the change in your body.
Signs of a blockage include clear output, thin liquid with a strong odor, cramping near the stoma, swelling of the stoma or abdomen, and lighter urine or a decrease in darker urine.
If your stoma produces more than 1 litre of fluid per day, then it is considered to have a high output and you may be at risk of becoming dehydrated. As well as obtaining nutrients from food, the bowel has an important role in absorbing fluid and electrolytes (salts).
If you still have your anus intact and you don't have a separate stoma for anal discharge, you'll continue to pass occasional mucus through your anus. This will feel similar to a bowel movement. The inactive colon continues to produce mucus as it always did, to lubricate and protect the skin.
Foods that may cause loose stools or diarrhoea:
High intakes of vegetables, particularly; cabbage; green leafy vegetables, lettuce, celery, green beans, tomato skins, broccoli. High intakes of fresh fruit or dried fruit. Wholegrain cereals and wholemeal bread. Nuts, seeds, pulses or coconut.
Aim to eat your main meal before 7pm in the evening to allow your stoma to do all the work before you settle for bed. Another option is to eat a lighter meal of an evening and the heavier meal mid-day as this will help with the output slow down overnight.
If your stoma output is less than 1 litre in 24 hours drink freely but do not exceed 2 litres of fluid a day. Avoid drinking large amounts of plain water. If you have a high stoma output, more than 1.5 litres per 24 hours you will need to speak with a healthcare professional.
Ballooning occurs when gas expelled through the colon collects inside the bag causing it to inflate. Most bags have a filter which allows this gas to escape. Occasionally the filter will block and the bag needs to be changed. If this happens to you regularly, it may be worth trying a different bag.
What Is the Life Expectancy with a Stoma Bag? Stoma bags, or colostomy bags, do not impact your life expectancy in any way. The underlying condition which creates the need for a stoma bag may impact your health and life expectancy, but not the stoma bag itself.
The best position to sleep in when you have a stoma is on your back, or on your side. If you prefer to sleep on your stomach, this will be fine at the beginning of the night but increases the chances of leaks as the night progresses and your bag fills.
Think about what you eat before bedtime.
At the end of the day, the more that goes in, the more has to come out! Also certain foods may make your stoma more active than usual and understanding what those foods are is something you will learn as your stoma life progresses.
If you allow it to get too full, the weight of the stool may pull the pouch away from the skin. A person with an ileostomy will need to empty the pouch about five or six times in a 24-hour period. If you have a colostomy, you will need to empty the pouch two or three times in a 24-hour period.
Medication. You may be prescribed anti-diarrhoea medications like loperamide or codeine phosphate to thicken up the faeces and help reduce the stoma output. These are best taken up to 60 minutes before you eat.
As the obstruction gets worse, your symptoms may happen more often and become more severe. You may have frequent vomiting, extreme bloating, and intense abdominal pain. These are signs of a complete obstruction, in which stool and gas are mostly or totally blocked from leaving the body.
If you are using a closed bag, you may be changing it 1-3 times a day, it varies from person to person. For those with a drainable bag, particularly with a urostomy or ileostomy, you may be changing it daily or even every other day.
When the skin becomes infected it can start to look inflamed and the infection tends to cause some swelling around your stoma. The skin colour often changes from a healthy pink/reddish colour, to pale, bluish purple or even black. If there is any discharge of blood or pus this is often a definitive sign of infection.
Bowel blockage or obstruction
If less poo is coming out of your stoma than usual, or your stoma stops producing poo, you may have a bowel blockage. A blockage is serious because your bowel could burst (rupture), and you may need further surgery.
Temporary stomas are created for a minimum of six weeks. It takes this time to allow for the swelling of the tissues to settle down. Some stomas may not be reversed for several months for various reasons including your general health and recovery from the surgery.
Parastomal hernia
As the hernia develops and grows, it can cause the stoma to become retracted which can cause issues with the adherence of your stoma bag. If your hernia is large, you may experience a dull ache or dragging sensation, particularly after the stoma has been active or towards the end of the day.