Staying Hydrated With An Ostomy

It’s key to understand that the fluids you’re putting into your body may affect your ostomy output. In general, there are three categories of fluids to consider. These are isotonic, hypotonic and hypertonic fluids. Isotonic fluids contain similar amounts of water, electrolytes, and sugar compared to what naturally occurs in your blood and body fluids. Hypotonic fluids either do not have any added electrolytes or sugar, or the concentration of these is lower than that found in body fluids. In contrast, hypertonic fluids contain electrolytes and sugars that are in excess to those identified in body fluids.

Water, tea, and coffee (hypotonic fluids) and sugar-containing fluids (hypertonic fluids) such as pop and fruit juices both promote ostomy output. So, how do you stay hydrated if even water can lead to increased output? The key is to create isotonic solutions, also known as oral rehydrating solutions (ORS). Isotonic fluids have a similar sugar and electrolyte composition to the cells in your body. Therefore, when drinking these, you are at lower risk of fluid shifts in the gut.

In addition to the fluids you drink, there are additional factors that affect your ostomy output. Here are some tips that can help you decrease your output.

• Limit lactose. If you have undiagnosed lactose intolerance or other food sensitivities, you may face additional challenges with increased output.
• Keep a food journal. It’s worth keeping a journal that tracks your response to certain foods.
• Limit caffeine. Caffeine consumption can increase gut motility through enhanced peristalsis, and this, combined with hypotonicity (remember, since coffee is a hypotonic fluid), further increases ostomy output, especially when consumed in high volumes.
• Wait 30 minutes before consuming solids and liquids. Eating solids and liquids together, even adding a glass of water with your meals, can lead to higher output. Liquids empty from the stomach at a faster rate than solid foods. Rapid stomach emptying contributes to enhanced outputs. Spacing out your solids and liquids optimizes gastric emptying.
• Have multiple small meals throughout the day rather than fewer, larger meals. This strategy aids in optimal gut motility, leading to decreased output.

You may be aware that a diet high in fibre is good for promoting regular, solid bowel movements. However, it’s important to recognize the distinction in types of fibre. Insoluble fibre includes fruit and vegetable skins, seeds, and raw vegetables. It may irritate the GI tract, leading to abdominal discomfort, high ostomy outputs, and even bowel blockages.         

On the other hand, soluble fibre helps regulate output by altering the motility of the gut. Examples of soluble fibre include fruits (with peeled skins), some cooked vegetables, lentils, psyllium, barley, and oatmeal. Additionally, supplements such as psyllium fibre (e.g. Metamucil) can also be effective if you have trouble consuming enough fibre in your diet. On average, women need 25g of fibre, and men need 38g daily. If you plan to add soluble fibre supplements to your diet, start at half the recommended dosage and work your way up to the target dose over time. This gradual transition decreases the probability of side effects such as bloating or cramping. Talk to your medical provider to discuss fibre supplementation as an option to manage your high ostomy output.  

In addition to the steps listed above, it’s important to remember that medical management also plays an important role. Always talk to your medical provider about what’s best for you; these are some strategies you may discuss:

1. Increasing Imodium. You can take up to 16mg per day spread out throughout the day. Remember to time it with your meals, taking it 30 minutes before.
2. Add Lomotil. This slows down transit and reduces stoma output. Take it 30 minutes before meals.
3. Add Codeine 15-30mg. Take it 30 minutes before meals with your other medications to reduce output.  This option may not be suitable for everyone, but it works effectively if you have not responded to the above strategies.
4. Add acid-lowering therapy. For example, Omeprazole may be prescribed to reduce stoma output.
5. Add Octreotide subcutaneous injections. These work to reduce stoma output and are administered before food.
6. Consider IV hydration. This would take place at a day medicine clinic and may be required for those with short bowel, electrolyte abnormalities, or severe symptoms.

• LyfeMD. This is an app developed by leading medical professionals and is a holistic guide to optimal health and well-being with a chronic condition. It has specific dietary plans and recipes for gastrointestinal (GI) diseases. It also features a physical activity, yoga, and mindfulness plan to target improved mental health.
• LyfeMD’s Guide to High-Output Ostomy Nutrition. This quick-read PDF is an additional valuable resource to managing high-output ostomies. It includes information on nutrition, hydration, medications, and supplements.
• Short Bowel Syndrome’s ORS Recipes. This PDF features different ORS recipes for you to try, including the World Health Organization’s (WHO) ORS recipe. It also has a variety of juice-based and sports drink-based recipes.
• High Output Ostomy Products. Consider this pouch system from Hollister. It’s designed specifically for managing high-output ostomies and is easily drainable. Also, check out this ostomy bag from Coloplast.
• Magnesium and Potassium. Curious about this vital mineral and electrolyte? Check out these PDFs for more information on their role in your body.
• Food Reference Chart. Check out this food reference chart designed for those with ostomies. It’s a great place to learn how common foods can affect your output.