Your stoma is active at night because of normal digestion, but it's often amplified by eating or drinking too much close to bedtime, especially foods that cause gas, leading to a full pouch that requires emptying, a common experience with ileostomies where output is frequent, especially early on, but manageable by adjusting meal timing and using thickening agents if needed.
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.
It's worth taking time to find a mattress that will give you the right support especially as your sleeping position may well be different with a stoma. Generally the advice is to sleep either on your side (the opposite one to your stoma) or on your back.
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.
The physiological reasons for an HOS in patients with a short bowel and jejunostomy are: loss of the normal daily secretions produced in response to food, hypotonic fluid drunk (with excessive thirst), gastric acid hypersecretion and rapid gastrointestinal transit.
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.
Octreotide can reduce stoma output by 1-2 L/24 hrs. A trial of 2-3 days of subcutaneous octreotide 50 micrograms twice daily may be worthwhile. Stop treatment after 72 hours if there is no noticeable reduction in output.
If you normally eat later in the evening or soon before you go to bed, this could be increasing your night time output. If this sounds like you, then varying your meal times could help to reduce stoma bag leakages during the night as your stoma is less active.
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).
Skin irritation around your stoma is usually caused by leakage from your ostomy pouch and the output from your stoma getting underneath the adhesive and onto your skin. It is uncomfortable and can stop your pouch from working well. The skin around your stoma should look similar to the skin on the rest of your body.
Aim: Anecdotally, many ostomates believe that eating marshmallows can reduce ileostomy effluent. There is a plausible mechanism for this, as the gelatine contained in marshmallows may thicken small bowel fluid, but there is currently no evidence that this is effective.
If the bag fills unexpectedly then it could be down to a change in diet, a stomach upset or even something like nerves and stress can affect your output.
Ballooning occurs when your stoma bag blows up with wind. This is usually due to the filter becoming wet or blocked from stoma output.
A high output ostomy is when you have more than 2 litres (8 cups) of fluid from your ostomy in a 24 hour period. The output is usually very watery and needs to be emptied 8 to 10 times or more a day. The output may also be very difficult to pouch and often leaks.
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.
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.
The 3-6-9 rule is a guideline for interpreting abdominal X-rays to detect bowel obstruction, stating normal upper limits are 3 cm for the small bowel, 6 cm for the large bowel (colon), and 9 cm for the cecum; diameters exceeding these suggest dilation, a key sign of obstruction, with larger measurements increasing the risk of rupture (e.g., >6cm small bowel, >9cm cecum).
Gently massage around your stoma and abdomen as this could dislodge the blockage. A heat pad or hot bath may help your abdominal muscles to relax. Drink plenty of fluids so that you don't become dehydrated. If your stoma is swollen, you may need to cut the hole of your stoma bag slightly larger.
Sometimes the colon or ileum can become narrow near the stoma. Certain foods may get stuck in the narrowed part of the colon or ileum and cause an obstruction (blockage). These same foods could also make the stoma swollen and irritated. An obstruction is more likely to happen with an ileostomy than with a colostomy.
If you keep having pain and cramping with no output from your stoma for more than 2 hours, and you can't reach your doctor or ostomy nurse, go to the emergency room.
Make sure your colostomy bag fits well to prevent gas and odor leaks. Choose a pouching system that works for your body and helps with gas release. Eating less of foods like cabbage, onions, and carbonated drinks can reduce colostomy gas.
Watch when you eat
If you normally eat later in the evening or soon before you go to bed, this could be increasing your night time output. If this sounds like you, then varying your meal times could help to reduce stoma bag leakages during the night as your stoma is less active.
Medications that may not be absorbed adequately include certain antimicrobial agents, digoxin, mesalazine, levothyroxine, and oral contraceptives. Enteric-coated or extended-release medications should be avoided by those with an ileostomy because the medication is absorbed or partially absorbed in the colon.
The normal amount of output from an ileostomy in a 24 hour period is between 500mls – 1 litre. Depending on your stoma bag size, this may be the same as emptying the bag when it is 1/3 – 1/2 full 4-6 times a day. Anything above 1 litre in 24 hours is considered a high output.