Why do I need to reduce the output of my stoma or fistula?
A stoma or fistula that produces large amounts of fluid can quickly lead to losses of water and sodium (salt). This can lead to dehydration, electrolyte imbalances and poor absorption of nutrients. You may feel thirsty, weak, dizzy, sick and have headaches.
How can I reduce the volume of my stoma or fistula?
It is possible to reduce the output of your stoma or fistula by adjusting your fluid intake, medication and diet.
How can I adjust my fluid intake?
When experiencing a high output, it is common that most of what you drink will not be absorbed and will be passed out of your stoma or fistula. You may feel increasingly thirsty. However, it is important to drink less of the following fluids as they will increase the volume of your stoma or fistula output:
- water
- tea
- coffee
- squash
- fruit juice
- fizzy drinks
Your doctor or dietitian will advise you about this.
You should limit these fluids to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .daily.
Drinking an oral rehydration solution such as Dioralyte® or St Marks Solution will help to replace lost water and salt (see below for instructions on how to make this up) and this does not need to be restricted.
Although other rehydration fluids (eg Lucozade Sport, Powerade and Gatorade) contain more salt than other fluids, they are not a suitable replacement for Dioralyte® or St Marks Solution. This is because they still do not contain enough salt to replace the salt lost through your stoma / fistula.
This is what happens when you drink water / tea / coffee / other low salt drinks:
This is what happens when you drink your oral rehydration solution:
If you are finding it difficult to limit your fluid intake, try the following:
- Use a smaller cup or have only half a cup at a time.
- Sip drinks more slowly.
- Use an ice-cube instead of a drink. One ice cube is about 25ml of fluid (remember to include this in your fluid allowance).
- Chew sugar free gum or suck on a boiled sweet if your mouth is dry.
As a rough guide a small teacup holds about 150ml of fluid and a mug holds 250ml of fluid. Remember if you feel thirsty drink more of the oral rehydration solution only. Do not increase your intake of other fluids as this will cause you to become more dehydrated.
What is an oral rehydration solution?
An oral rehydration solution contains salts, sugars and electrolytes. This combination stimulates absorption from the gut, preventing dehydration and replacing salts. There are two commonly used rehydration solutions: Dioralyte® and St Mark’s Solution. You will be advised by your doctor or dietitian as to which will be best for you.
| What is Dioralyte®? |
Dioralyte® is a glucose-salt solution consisting of: • sodium chloride - normal table salt • sodium bicarbonate - another type of salt. Also known as bicarbonate of soda. • potassium chloride - a salt that contains potassium. • glucose - a type of energy source. |
|---|---|
| How do I prepare Dioralyte®? | Ingredients come mixed in ready to use sachets. Empty contents of Dioralyte® sachets into a jug. Your recommended dose is ___________________________ sachets/litre. Add one litre of fresh drinking water and stir well until dissolved |
| What is St Mark’s Solution? |
St Mark’s solution is a glucose-salt solution consisting of: • glucose -a type of energy source • sodium chloride - normal table salt • sodium bicarbonate - another type of salt. Also known as bicarbonate of soda. |
| How do I prepare St Mark’s Solution? |
Ingredients come individually and will need to be mixed together. Combine all ingredients: • six heaped 5ml teaspoons glucose powder • one level 5ml teaspoon sodium chloride (salt) powder • one heaped 2.5ml teaspoon sodium bicarbonate powder Add one litre of drinking water and stir well until dissolved. |
- The solution should be sipped throughout the day.
- A small amount of ‘sugar-free’ squash or cordial may be added to flavour the solution. Lime, grapefruit or blackcurrant seems to flavour it best. You can also squeeze some fresh lemon/ lime to add flavour. Please ensure you have included this in the one litre volume added.
- Remember to stir the solution before each drink to ensure that the powders are mixed well.
- Store the prepared solution in the fridge as this can make it more pleasant to drink. We do not recommend ice cubes as these will melt and increase the water volume which will dilute the solution.
- A fresh solution should be made up each day, and can be stored in a refrigerator for 24 hours.
Further supplies of Dioralyte® and St Mark's Solution ingredients may be obtained on prescription from your GP or bought ‘over the counter’ from any pharmacy and some supermarkets.
My oral rehydration solution is . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
How much oral rehydration solution should I drink? Aim to drink . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . litres every day.
If you become thirsty, especially in hot weather, you should try to drink an extra half (500ml) to one litre daily of your ‘oral rehydration solution’.
What should I do if I cannot take the oral rehydration solution?
It is quite common for people to find the oral rehydration solutions difficult to take at first. This usually improves over a few days so do keep trying! If you cannot drink the solution, you should tell your doctor / dietitian / nurse / pharmacist.
What medications might I need to take?
You may be advised by your doctor to take anti-diarrhoeal medications such as loperamide, which works by slowing down the passage of food and fluid through the gut, reducing stoma output. It's best to take loperamide 30 to 45 minutes before your meals and again before bed.
Other medications that may be suggested to reduce your stoma output include codeine phosphate and omeprazole/ lansoprazole/ pantoprazole – these should be taken as directed by your doctor.
What dietary changes do I need to make?
- Eat little and often.
- Take your time to chew food thoroughly.
- Add salt to your food (one teaspoon per 24 hours).
- Choose high salt foods for example, crackers, cheese, crisps, salted meat/ fish.
- Limit intake of high fibre foods (please see table below for additional information on fibre).
Low fibre diet
| Suitable foods | Unsuitable foods |
|---|---|
|
Suitable foods
Meat and fish All types |
Unsuitable foods Except products made with wholemeal pastry or breadcrumbs. |
|
Suitable foods
Dairy products Milk (all types), cheese (all types), yoghurts (natural or fruit flavoured), cream, eggs, fromage frais. |
Unsuitable foods |
|
Suitable foods
Fats and oils Butter, margarine, cooking and salad oils. |
Unsuitable foods |
|
Suitable foods
Cereals and baked products White flour and baked products made with white flour (for example, bread, pastry, crumbles, pasta, spaghetti, macaroni), white rice, tapioca, sago, cornflour, custard and blancmange. Rice Krispies and cornflakes. Plain biscuits, (for example, Rich Tea, Morning Coffee and Marie), plain crispbreads and crackers. |
Unsuitable foods Wholemeal, brown, bran and soya flours and foods made with these flours, wholemeal pasta, brown rice, wholegrain cereals (for example, Weetabix, All-Bran, porridge, muesli and any cereal with added nuts and/or dried fruit), digestive, bran biscuits, flapjack, biscuits containing nuts or dried fruit (for example, fig rolls, Garibaldi), rye and whole grain crispbreads, oatcakes. |
Fruit
Where possible, avoid skins, seeds and stalks. Keep to a maximum of two portions a day.
| Suitable foods | Unsuitable foods |
|---|---|
| Suitable foods Apples, apricots, cherries, fruit cocktail, grapefruit, grapes, kiwi, lychees, mango, melon, nectarine, oranges, peaches, pears, pineapple, plums, rhubarb, satsumas, strawberries, tangerines. | Unsuitable foods Dried fruit, banana chips, bananas, blackberries, cranberries, currants, dates, figs, gooseberries, loganberries, prunes, raisins, raspberries, redcurrants, sultanas. |
Vegetables
Where possible, avoid skins, seeds and stalks. Keep to a maximum of two portions a day, in addition to potato.
| Suitable foods | Small portions occasionally | Unsuitable foods |
|---|---|---|
| Suitable foods Asparagus, aubergine, beetroot, carrot, celery, courgette, cucumber, leeks, lettuce, marrow, mushroom, onion, pepper, potato (not cold), radish, swede, tomato. | Small portions occasionally Beansprouts, green/ French/ runner beans, broccoli, cabbage, cauliflower, mangetout, parsnips, spinach, spring greens, sweet potato. | Unsuitable foods Pulse-type beans (for example, baked, broad, butter, kidney) Brussels sprouts, chickpeas, lentils, peas, sweetcorn. |
Miscellaneous
| Suitable foods | Unsuitable foods |
|---|---|
| Suitable foods Ice cream, lollies, sorbets, jelly, milk puddings, honey, syrup, lemon curd, jam, marmalade (avoid pips/ seeds), Marmite, Bovril, corn snacks, crisps, boiled sweets, chocolate, toffee, seasoning, spices, tea, coffee, cocoa, Ovaltine, squashes, fizzy drinks, fruit juices, soups, oxo. | Unsuitable foods Nuts, seeds, peanut butter, wholemeal savoury snacks, cereal bars, confectionery containing fruit and nuts, pickles and chutneys, lentil, pea and bean soups |
What shall I do if I have a poor appetite and weight loss?
Some people find their appetite is reduced and they don't feel like eating. Your dietitian can supply you with some practical and written information to help add extra nourishment to your diet. It is a good idea to keep an eye on your weight and contact your dietitian if your weight is dropping. Your dietitian may recommend some nutritional supplements that are high in energy and protein and contain vitamins and minerals. These are available on prescription on the ward, from your GP or on request by your dietitian. As your absorption of nutrients may be reduced, your doctor or dietitian may also prescribe a vitamin or mineral supplement.
Where can I find more information?
Please contact your dietitian if you require further advice.
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