High Output Stoma
When part of your bowel has been removed, the remaining bowel might not be able to fully absorb nutrients, fluid, and electrolytes (salts). They pass through the bowel quickly and this can lead to a high stoma output.
Stoma output is considered high when it is more than 1.5L per day (approximately 5-6 full stoma bags). This is often a temporary condition; especially, following surgery (i.e., 6-8 weeks).
Through a combination of dietary changes, fluid restriction and medication, you can increase your bowel absorption of nutrients and fluids and reduce your stoma output.
A high stoma output can result in dehydration, electrolyte disturbances, and weight loss.
Signs of dehydration to look out for include:
- Less frequent, lower volume and darker urine
- Dry mouth, lips and eyes
- Increased thirst
- Feeling dizzy or lightheaded, especially on standing
- Muscle cramps
- Headache
- Feeling weak/tired
Eating tips
Digestion starts in the mouth where chewing and saliva breaks down food, which helps make it more easily digested and absorbed by your gut.
If we eat too quickly and do not chew our food well, the food requires more digestion lower in the gut. After surgery the bowel is shorter, leading to reduced digestion.
The following can help improve digestion and reduce loose stools, cramps, bloating and gas:
- Eat slowly and chew your food well
- Avoid talking with your mouth full
- Eat little and often (smaller meals with snacks in between meals)
- Try and relax during meal times.
Natural thickeners
Some patients report food containing gelatine such as jelly, marshmallows and jelly babies help to thicken their stoma output. Other foods found to be beneficial are over-ripe bananas, mash potato, and boiled white rice.
Fibre
Fibre is a complex carbohydrate found in plant-based foods that cannot be easily digested. Too much fibre can increase the amount of time it take for food to pass through your gut. This can lead to an increased and watery output from your stoma.
The following table gives examples of high fibre foods and suitable alternatives.
| High fibre foods (avoid) | Low fibre foods (recommended) |
| Wholemeal/seeded bread, rice, and pasta Potatoes with skin on | White bread, rice, and pasta Peeled potatoes |
| Wholegrain cereal (e.g., Weetabix, Shredders, Bran Flakes), porridge, muesli | Rice and corn-based cereal (e.g., Coco pops, Rice Krispies, Cornflakes) |
| Fruit with skin on, seeds, pith, and membrane e.g., berries, oranges, grapes, pineapple Under-ripe fruit e.g., green bananas/mango | Tinned, pureed, cooked fruit or fresh fruit without skin, pith, or seeds e.g., peeled apple, pear, peach, plums, melon, ripe bananas and mango |
| Raw vegetables e.g., lettuce, celery, peppers, tomatoes Vegetables with skin on and seeds Hard to digest vegetables e.g., sweetcorn, peas, mushrooms, spinach, kale, cabbage | Peeled and well-cooked vegetables without seeds e.g., onions, carrots, swede, butternut squash, broccoli, cauliflower, beetroot, parsnip, courgette, and aubergine. Cooked, de-skinned and non-seeded tomatoes e.g., sieved tinned tomatoes or passata |
| Pulses (e.g., lentils, kidney beans, chickpeas) | Cooked and pureed pulses |
| Dried fruit, nuts and seeds and any food containing these (e.g., cereal bars, crackers) | Smooth peanut butter in small amounts |
*This table is not an exhaustive list, please ask your Dietitian if you have any queries.
You can gradually introduce more fibre once your stoma output settles. This should be done in small quantities, 1 food at a time, depending on tolerance.
Possible irritants
Shortly after surgery, you may experience an increase in stoma output when consuming the following irritants:
- Caffeine, switch to decaffeinated options when able.
- Alcohol, especially avoid binge-drinking.
- Fatty and greasy foods, including creamy sauces and high-fat meats (e.g., steak, bacon, sausages)
- Spicy foods, especially those containing chilli.
Fluids
Drinking too much regular fluids, while your bowel is not absorbing properly, will increase your stoma output. This makes you thirstier, so you drink even more, which makes your stoma more active. It’s like a cycle.
If your stoma output is high, you may be advised to restrict your intake of regular fluids by your doctor or dietitian. Regular fluids include water, juice, squash, tea, and coffee.
Sports drinks, such as Lucozade and Gatorade, are better choices as they don’t cause an increase in your stoma output. They also contain electrolytes, which are lost through your stoma.
To maximize fluid absorption, try to avoid drinking at mealtimes (leave a 20-minute gap) and sip rather than gulping fluids.
If this persists, please contact your stoma nurse, dietitian and medical team for further advice.
Oral Hydration Solutions
If you are dehydrated, oral hydration solutions such as Dioralyte or St Mark’s Solution may be recommended to help your bowel absorb fluids and salts and help to reduce your stoma output.
It is best to sip the oral hydration solutions over the day.
- Double strength Dioralyte: mix 10 Dioralyte sachets in 1L of water (or 2 sachets in 200ml water). This solution also contains potassium and magnesium.
- St Mark’s Solution: mix six teaspoons (5ml) of glucose, half teaspoon (2.5ml) of sodium bicarbonate (baking soda) and one teaspoon (5ml) of salt in 1L of water. These ingredients can be bought from pharmacies and some shops, or they may be prescribed by your GP.
Oral hydration solutions can taste salty making them difficult to drink. To remedy this, try:
- Keeping them chilled
- Drinking through a straw
- Adding a small amount of squash, fresh lemon or lime juice
Salt
To replace salt lost from your stoma, add a little salt to meals (½ – 1 teaspoon per day) or include some of the following salty foods in your diet:
| Smoked fish (e.g., haddock, kippers) | Pate’ |
| Tinned fish in brine | Bacon, ham, sausages |
| Crisps | Tinned/processed meats |
| Cheese | Instant noodles |
| Olives in brine | Meat extracts (e.g., Bovril) |
| Stock cubes | Yeast extract (e.g., Marmite) |
Malnutrition
When you have a high output stoma, it’s difficult to get all the nutrients you need from food. You might struggle with weight loss, reduced muscle mass and strength.
We recommend choosing foods/drinks high in calories and protein, ‘fortifying your meals’ (i.e., adding extras onto food to increase calorie and content). You may also need nutritional supplements like Fortisip.
Ask your doctor, nurse, or consultant to refer you to the dietitian who will help you with this.
The following are examples of dietary advice your dietitian might give you:
- Swap a low-fat yogurt for a full fat Greek style yogurt.
- Swap a rich tea biscuit for a shortbread.
- Add a handful of grated cheese to your scrambled eggs / mash potato.
- Add a tablespoon of honey to your cereal.
- Swap a cup of tea or coffee for a glass of milk.
Vitamins and minerals
As you may have to restrict your intake of fruit and vegetables, you may need to take a multi-vitamin and mineral supplement in addition to your diet. Ask your dietitian about this.
Medication
You may be prescribed loperamide and/or codeine phosphate to help slow the time it takes for food and fluids to pass through the bowel. These are best taken 30-60 minutes before meals.
You may also be prescribed anti-secretory medication such as omeprazole or famotidine that reduces the amount of stomach acid produced, which will also help reduce your stoma output.
References
- Thomas, B and Bishop, J (2007) Manual of dietetics practice. 4th Ed. Kent. Blackwell Publishing.
- BIFA (2021) ‘Top Tips for Managing a High Output Stoma’ https://www.bapen.org.uk/about-bapen/bapen-special-interest-groups/bifa
Contact Details
Nutrition and Dietetics
Address/based in the hospital: Agile Office, Queen Elizabeth hospital, Gateshead
Monday – Friday
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