10. High Ileostomy Output

Patient is able to identify potential complications, preventive measures for, and management of, high ileostomy output.

High ileostomy output (over 1000cc in a 24-hour period) may occur following the construction of the pelvic pouch with a loop ileostomy. The stoma can be constructed quite proximal following pelvic pouch surgery to avoid tension on the bowel. This surgical scenario may result in higher than normal stool outputs.

With high ileostomy output, the patient would experience the following signs and symptoms:

• liquid watery stool
• emptying the appliance more than 8-10 times per day
• signs of dehydration: increased thirst, dry mouth and skin, decreased urine output, fatigue, shortness of breath, stomach cramps
• signs of sodium loss: loss of appetite, stomach cramps, cold arms and/or legs, fatigue, feeling faint
• signs of potassium loss: fatigue, muscle weakness, shortness of breath, decreased sensation in arms/legs, gaseous bloated feeling

The patient needs to be encouraged to:

• increase fluids
• decrease foods that may contribute to high outputs - fruit juices, sweetened drinks, coffee, spicy foods, beer
• increase foods and fluids high in sodium - salt, milk, cheese, egg nog, tomato juice, bread, butter, pickles, cola beverages, chicken soup, bouillon, pretzels
• increase foods and fluids high in potassium – orange juice, tomato juice, tea, bananas, potatoes, melon
• separate fluids and foods - wait 30-45 minutes after eating to have fluids
• reduce intake of sugars and sweets
• include foods higher in soluble fibre - applesauce, bananas, tapioca, barley, oats

If outputs remain high, medications such as Imodium™ or Lomotil™ may be introduced to help slow the tract. Medications should only be administered under the supervision of a physician. Intravenous replacement fluid may also be required.

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