Ileostomy · Output and hydration

High output stoma

When an ileostomy runs high, more water isn't always the answer. What counts as high output, the signs to watch for, the food and drinks NHS hospital teams suggest, and when to call.

Written by María G. · hola@siilostomy.com · Last updated: 7 October 20268 min read

Porridge and ripe bananas: simple food choices can help thicken output.

Quick answer

A high output stoma (or high output ileostomy) is when more comes out of the stoma than your body can cope with, so you lose fluid and salt faster than you take them in. Guy's and St Thomas' defines it as more than 1 litre a day. East Kent Hospitals asks people to speak to their stoma care nurse or dietitian when output is above 1.2 litres in 24 hours. Signs include watery output, emptying more often, leaks, a dry mouth, dizziness and dark wee. Hospital teams usually suggest low-fibre, salty food and not drinking around mealtimes. They may also prescribe an oral rehydration solution instead of lots of plain water, and sometimes a medicine such as loperamide.

700–1,000 mla healthy daily output, according to East Kent Hospitals
1.2 Lin 24 hours: speak to your stoma care nurse, says East Kent
Low fibreand high salt: the diet Guy's and St Thomas' recommends
30–60 minbefore food: when Guy's and St Thomas' says to take loperamide, if prescribed

What counts as a high output stoma?

A high output stoma, or high output ileostomy, is when more comes out of the stoma than your body can cope with. Food and drink pass through your bowel quickly, so your body can't absorb enough fluid, salts and nutrients.

Hospitals draw the line in slightly different places, so it helps to know whose number you're reading:

How two NHS hospital trusts describe ileostomy output
Source	What they say
East Kent Hospitals	A healthy ileostomy output is between 700 and 1,000 ml a day. If it is more than 1.2 litres in 24 hours, speak to your stoma care nurse or dietitian.
Guy's and St Thomas'	A high output stoma is when the output is more than 1 litre a day.

Your own stoma care nurse may use a different number for you. What matters most is a clear change from your normal: more output, thinner output and more trips to empty.

High output can start soon after surgery. The good news, says Guy's and St Thomas', is that with time the bowel may absorb better, and output may thicken and reduce. Later on, a short rise can have everyday causes: its team lists tummy bugs, stress, antibiotics and spicy food.

Signs of a high output stoma

East Kent Hospitals lists these signs. If you have any of them, it asks you to speak to your stoma care nurse or doctor:

In the bagWatery output, emptying or changing your bag more often than usual, and bags that leak.
In how you feelA dry, sticky mouth, sunken eyes, headaches, low energy, tiredness or low mood.
Signs of dehydrationFeeling dizzy when you stand up, weeing less, with wee that is dark and strong-smelling, or cramps in your hands and feet.

Guy's and St Thomas' warns that losing a lot of fluid can lead to severe dehydration, low salts and minerals, and weight loss, so act on these signs early. The NHS says to get urgent advice if you have signs of dehydration, or severe cramps, nausea and vomiting.

Checking in with yourself on a high output day: woman standing at her kitchen worktop with a glass of water, black SIIL wrap below her T-shirt — A calm check on a loose day: how you feel, how often you empty, what you drank.

Drinks: why more water isn't always the answer

It sounds the wrong way round, but with a high output stoma, drinking lots of plain water can make things worse. Guy's and St Thomas' explains that too much ordinary fluid can increase your output and leave you more dehydrated and thirsty. Plain water also has none of the salt you're losing.

Your team may set a limit. Guy's and St Thomas' tells each patient how much "free" fluid, such as water, tea, coffee and squash, to drink a day; it might be 500 ml to 1 litre. Don't cut back on your own. Ask your team for your number.
Oral rehydration solution. A salty, slightly sweet drink that helps your bowel take in water and salt. Guy's and St Thomas' patients usually drink about 1 litre of it a day. Make it up exactly as your doctor, dietitian or nurse tells you: the hospital warns that the dose on the packet won't give you enough salt.
Don't drink around mealtimes, if you can.
Skip some drinks altogether. Guy's and St Thomas' advises against alcohol, fizzy drinks, caffeine, and drinks with the sweeteners sorbitol or mannitol.
Sip, don't gulp. East Kent says sipping can help your body absorb fluid.

Not the same as every ileostomy

This advice is for high output. When output is under 1 litre a day, East Kent's advice is different: drink freely, but no more than 2 litres a day, and add squash to it instead of drinking large amounts of plain water. Our ileostomy diet guide covers everyday eating and drinking.

Food that helps thicken output

While output is high, Guy's and St Thomas' recommends a diet that is low in fibre and high in salt, and high in protein, fat and sugar. In practice:

Lean on

White bread, white rice and pasta
Potatoes without the skin, and oats
Meat, fish, eggs and cheese
Full-fat milk, yoghurt and butter
Salty foods, and a little salt on your meals
Smooth peanut butter, bananas, apple sauce and marshmallows, which East Kent lists as foods that can thicken output

Go easy on

Raw fruit and vegetables
Skins, seeds, pips and pith
Dried fruit and nuts
Sweetcorn, peas, beans, lentils, celery, coconut, mushrooms, pineapple and tomatoes
Spicy or fatty food, bran and artificial sweeteners, which East Kent links with looser output

Eat regularly. Smaller, more frequent meals may suit you better, especially early on.
Chew well and take your time.
Skip heavy meals just before bed.
Add salt. Guy's and St Thomas' suggests sprinkling about half to one teaspoon a day on your meals, unless your doctor has told you to limit salt.

Food for a high output stoma: man serving white rice and chicken at his kitchen worktop, black SIIL stoma belt over his T-shirt — Simple, salty, low-fibre food: white rice, chicken and a ripe banana.

If you have diabetes, East Kent notes that you may want to avoid some of the foods higher in simple sugars, so check with your team. It also warns that some high-fibre foods, such as popcorn, nuts and seeds, can cause a blockage in the first 6 to 8 weeks. Know the signs of a stoma blockage: output that slows or stops, cramps, bloating or feeling sick.

For your fridge door

The foods that thicken and loosen output, on one page

The free Stoma Nutrition Guide puts it all in one printable PDF:

foods that thicken or loosen output
easy low-fibre swaps
hydration ideas that aren't just more water

Get the nutrition guide

Medicines your team may use

Food and drink are only part of the picture. Guy's and St Thomas' says its team may prescribe:

loperamide (Imodium) or codeine phosphate to reduce output, taken 30 to 60 minutes before food;
a medicine such as omeprazole or lansoprazole, which reduces the amount of acid your stomach makes.

Your team prescribes these and sets the doses. Don't start, stop or change them on your own. Also remind every doctor and pharmacist that you have an ileostomy. The NHS explains that many medicines are made to dissolve slowly, so they may come straight out into your bag; ask about liquid or powder forms.

Keeping your bag secure on high output days

Thin, frequent output is harder on the seal, and East Kent lists leaking bags among the signs of high output. A few habits help:

Empty your bag more often, before it gets heavy.
Measure your stoma regularly, as the NHS advises, so the opening of your bag still fits well. Output on the skin irritates it and loosens the seal.
Ask your stoma care nurse whether a different bag would suit you better while output is high.

A stoma belt can help too. It holds a filling bag flat against your body, so its weight doesn't drag on the baseplate as you move. It supports the bag; it doesn't replace a baseplate that fits well.

Man and woman wearing black SIIL stoma belts

For heavy, busy daysThe SIIL Stoma BeltA soft belt that keeps a filling bag close to your body, with a zip-access pocket so you can empty your bag without taking the belt off.See the stoma belt →

When to call your stoma care nurse or GP

Get urgent advice from your GP or NHS 111 if you have an ileostomy and

signs of dehydration, such as feeling dizzy when you stand, very little or dark wee, or cramps;
severe cramps, nausea and vomiting;
a stoma that hasn't been active for more than 12 hours;
a very high temperature, or you feel hot, cold or shivery;
a lot of blood from inside your stoma or in your bag.

The NHS lists these as reasons to get urgent advice after an ileostomy, because they can be signs of an infection or a serious bowel blockage. The examples of dehydration come from East Kent's leaflet.

Guy's and St Thomas' adds two rules for a high output stoma. If your output stays higher than usual for more than 2 days, contact your team or ask for an urgent appointment. If your output stops or slows down a lot, it's an emergency: call 999 or go to A&E.

For everyday life once things settle, including sleep, work and travel, read our guide to living with an ileostomy.

High output stoma: common questions

What is a high output stoma?

It is when more comes out of an ileostomy than your body can cope with, so you lose fluid and salt faster than you take them in. Guy's and St Thomas' defines a high output stoma as more than 1 litre a day; East Kent Hospitals asks people to speak to their stoma care nurse above 1.2 litres in 24 hours.

What is normal ileostomy output?

East Kent Hospitals describes a healthy ileostomy output as 700 to 1,000 ml a day.

What are the signs of a high output stoma?

East Kent Hospitals lists watery output, emptying more often than usual, leaking bags, a dry sticky mouth, sunken eyes, dizziness when standing, less and darker wee, headaches, tiredness and cramps in the hands and feet.

What foods slow down a high output ileostomy?

Guy's and St Thomas' suggests low-fibre, starchy and salty foods, such as white rice, white bread and pasta, potatoes without skin, oats and cheese. East Kent Hospitals adds bananas, apple sauce, smooth peanut butter and marshmallows as foods that can thicken output.

Should I drink more water with a high output stoma?

Not plain water in large amounts. Guy's and St Thomas' explains that too much ordinary fluid can increase output and make you more dehydrated. Your team may limit plain drinks and prescribe an oral rehydration solution instead.

Does loperamide help a high output stoma?

Guy's and St Thomas' lists loperamide among the medicines its team may prescribe to reduce output, taken 30 to 60 minutes before food. Take it only as your doctor or team advises.

Can a high output stoma get better?

Often, yes. Guy's and St Thomas' notes that with time the bowel may absorb better, and output may thicken and reduce.

Is a high output stoma dangerous?

It can be if it isn't managed. Guy's and St Thomas' warns that it can cause severe dehydration, low salts and minerals, and weight loss. Call your stoma care nurse or GP as soon as you notice the signs.

Keep reading

Sources and further reading

Written by María G. for SIIL Ostomy. The amounts above are what these hospitals tell their own patients; your stoma care nurse, dietitian or doctor will set the right ones for you.

Keep reading