Normal Stool After Ostomy Surgery

Knowing what stools will be like after ostomy surgery is important

Ostomy surgery (ileostomy and colostomy) is done to treat several different digestive diseases and conditions, as well as acute injuries. During ostomy surgery, part of the large and/or small intestine is removed and a small piece of the intestine that is left is brought outside the body through the abdomen. That intestine piece is called a stoma, and through it is how stool then leaves the body after ostomy surgery. An appliance is worn over the stoma to collect the waste, which is emptied into the toilet periodically during the day. 

Having ostomy surgery is a scary prospect for most people, but it can be a life-saving operation for those who need it. Ostomy appliances (sometimes also called “bags” or “pouches”) come in a variety of sizes, shapes, colors, and styles to accommodate different bodies and lifestyles. Ostomy systems are odor proof and there should not be a smell unless there is a leak and the appliance needs to be changed.

Stool will look different after ostomy surgery, which brings up many questions about what is the “new normal” and when it might be time to call the doctor or an enterostomal therapy (ET) nurse about the appearance, smell, or frequency of stool. This article will give some guidance as to what stool after ostomy surgery might be like and how diet could affect it.

“Output” is the term that’s often used to refer to stool from an ostomy. Output can be “high” or “low,” or it could be thicker or more liquid based on a number of factors, including diet.

Stool After Colostomy Surgery

During colostomy surgery, part of the large intestine and/or rectum is removed. A part of the large intestine is brought through a surgical opening made in the abdomen for stool to leave the body. A colostomy bag is placed over the stoma to collect the stool as it leaves the body. From the point where the small intestine meets the large intestine, the parts of the large intestine are the ascending, transverse, descending, and sigmoid colon. The different types of colostomies are named after the part of the intestine that is used to create the stoma. 

Stool Consistency

After colostomy surgery, stool may look different than it did prior to surgery but should tend to still be fairly formed. People with a colostomy will not have control over when a bowel movement takes place from the stoma. The ostomy appliance might need to be emptied a few times to several times a day. The large intestine is where water is absorbed from stool, which helps to make the stool thicker. The more of the large intestine that is intact, the more formed the stools may be.

Stool After Ileostomy Surgery

In ileostomy surgery, the colon is either partially or totally removed and the stoma is created from a piece of small intestine. With no large intestine to absorb as much water from it, stool becomes thinner. Stools may thicken up as the body adapts and the small intestine starts to absorb more water, but this is something that happens long-term.

At first, stool will be thin and output may be high. If part of the small intestine is also removed during surgery, this will have the effect of further increasing the frequency of output and making stool more watery.

Stool Consistency

Many people with an ileostomy try to adjust their diet so that the consistency of the stool is similar to toothpaste. However, it is going to be different for each person based on a number of factors.

Without the colon, foods are not broken down in the same way that they were with a colon and that can result in finding what appears to be partially-digested food in the ostomy bag. This is particularly true for raw vegetables and fruits. This may be an expected occurrence but if it is troublesome or there are questions about absorbing enough nutrients from foods, it should be discussed with a physician.

Loose Stools

A sudden increase in output that is thinner than typical could indicate diarrhea. Diarrhea from a routine viral illness can have a significant impact on a person with an ileostomy, so taking in more fluids is important. It can be challenging to know when to see a doctor about diarrhea but in general, being unable to keep up with fluid loss is a reason to call the doctor.

It may be necessary to also replace electrolytes such as potassium and sodium, which are easily lost when there is diarrhea. Eating potassium-rich foods (sweet potatoes and bananas, for instance) or higher sodium foods (such as pretzels) may help, but in some cases, treatment might be needed. In some cases, IV fluids might be necessary, especially if there is also a chronic condition such as inflammatory bowel disease (IBD, Crohn’s disease or ulcerative colitis). 

Color

Output from an ileostomy can also come in a variety of colors based on diet. Foods that are naturally or artificially brighter colors can cause the stool to change color. Some people may forget that they have eaten a food such as beets and then be surprised that output from the ileostomy is bright red. For some people, using an app to keep track of foods may help in understanding what is affecting the output and in what way.

Foods That Increase Output

In some cases, diet can help to either thicken stools up or to make them more watery based on what the needs and preferences of the ostomate are at the time.

Every person is different, and that means that some trial and error may come into play when figuring out the best eating plan that works for the ostomy as well as any ongoing health conditions. There are, however, some rules of thumb when it comes to diet.

Food That May Lead to More or Thinner Stool

  • Alcohol
  • Caffeine
  • Corn syrup
  • Honey
  • Juice
  • Soda
  • Sugar alcohols (sorbitol, mannitol, or xylitol)
  • Table sugar

Foods That Decrease Output

For those with an ileostomy, output tends to be thinner and more frequent, prompting about six to eight bathroom trips a day. Some people who have an ileostomy may be looking for ideas on how to firm stool up a bit and decrease output and/or trips to the bathroom. Experimentation might be needed to see what works best to make stool thicker, but there are some foods that tend to have this effect for many people with an ileostomy.

When output is high and liquid, it is important to keep up fluid intake as well, with not only water but also sometimes with oral rehydration preparations that can be made at home or purchased over the counter at a drugstore.

Food That May Thicken Stool

  • Applesauce
  • Bananas
  • Fruits
  • Grains
  • Oatmeal
  • Pasta
  • Potatoes
  • Smooth peanut butter
  • Tapioca
  • Vegetables
  • White Rice

A Word From Verywell

Knowing what is “normal” and what is not after ostomy surgery can be challenging, and therefore, asking a lot of questions during visits with a colorectal surgeon, an ET nurse, or a gastroenterologist can be helpful. Connecting with other patients who have similar surgeries via social media can also help in understanding how to cope with what’s expected after having an ileostomy or a colostomy surgery.

It’s important to take note of changes in stool consistency, frequency, or color with an ostomy and to act on it quickly. This is particularly true when the reason for the ostomy is an ongoing illness such as colon cancer or IBD, which may require more treatment. Ostomy surgery often means a new lease on life, and with some basic common-sense adjustments, going back to regular activities and lifestyle is an attainable goal.

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