Experiencing rapid weight loss after an ileostomy can be concerning. While minor weight fluctuations are normal, a sudden and significant drop, such as 6 pounds overnight, warrants careful consideration. This article explores the potential causes of extreme weight loss following ileostomy surgery, how to manage related issues like stoma leakage and bowel obstructions, and the crucial role of nutrition in maintaining overall health.
Initial Weight Loss After Ostomy Surgery
In the period immediately following ostomy surgery, initial weight loss can occur due to pre-surgery illness and post-operative recovery. It's also normal to lose some weight overnight due to respiratory water loss (exhalation) and transpiration (sweating).
Dehydration: A Significant Risk for Ileostomy Patients
Ileostomy patients are particularly susceptible to dehydration because the large intestine, which absorbs water from food waste, is either removed or bypassed. This can lead to increased fluid loss and subsequent weight loss.
Addressing Dehydration
- Electrolyte-Replacing Fluids: Drinking electrolyte-replacing fluids can help combat dehydration. Examples include sports drinks, fruit juice, vegetable juice, and broth. However, limit intake to two or three servings per day and avoid sugary drinks.
- Hydration Monitoring: Pay close attention to fluid intake and urine output to ensure adequate hydration.
Understanding and Preventing Stoma Leakage
Stoma leakage is a common concern for ostomates and can contribute to discomfort and potential complications.
Causes of Stoma Leakage
Stoma leakage typically results from a stoma bag that hasn’t been fitted correctly, the bag filling unexpectedly quickly, or the output becoming loose. Changes in diet, stomach upset, or even stress can affect output consistency and lead to leaks.
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Preventing Stoma Leakage
- Proper Bag Fitting: Double-check the fitting of your stoma bag, ensuring no gaps in the wafer and that the hole fits snugly around the stoma.
- Convex Wafers: If you have a flat or retracted stoma, consult your stoma nurse to determine if a convex wafer is suitable. Only use convex wafers if recommended by your stoma nurse, as improper use can damage the stoma.
Addressing Stoma Bleeding
Stomas are highly vascular and can bleed easily.
Causes of Stoma Bleeding
Bleeding around the stoma is often due to the bag rubbing against the stoma or during cleaning. This is usually not a cause for concern.
When to Seek Medical Advice
If the bleeding is coming from inside the stoma, contact your stoma nurse for advice, as this could indicate intestinal bleeding. If you are concerned about any bleeding from your stoma, consult your stoma nurse.
Managing Retracted and Prolapsed Stomas
Retracted Stoma
A retracted stoma lies flat to the skin or below the skin surface. This can affect the fit of your stoma bag and cause leaks, leading to sore and broken skin.
Managing a Retracted Stoma
- Use a stoma bag with a convex wafer to push the stoma forward.
- Use an ostomy belt to help support the stoma.
- Apply barrier rings or barrier paste to keep the output off the skin.
- In extreme cases, your surgeon may suggest re-siting your stoma for your comfort.
Prolapsed Stoma
A prolapse occurs when the stoma extends to an abnormal length. Untreated prolapses are more susceptible to abrasions or infection.
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Managing a Prolapsed Stoma
- Monitor the prolapsed stoma for changes in size and color, as the blood supply to the stoma could become compromised.
- Seek medical advice if the stoma becomes obstructed or looks paler than usual.
- Change your stoma bag to accommodate the size of the extended stoma.
- Your surgeon may decide to re-site your stoma if it becomes problematic.
Understanding Parastomal Hernias
A parastomal hernia occurs when loops of intestine bulge through weakened abdominal muscles behind the stoma.
Symptoms of a Parastomal Hernia
- A bulge or lump that forms behind the stoma.
- Unpredictable stoma output, with alternating diarrhea and constipation.
- The stoma may become retracted, or issues with the adherence of your stoma bag may arise.
- A dull ache or dragging sensation, particularly after the stoma has been active.
- Skin may feel thinner and stretched and may tear easier when removing your bag.
- In extreme circumstances, the loops of bowel may become strangulated and obstructed, causing extreme pain and vomiting. Seek emergency medical attention in this situation.
Reducing the Risk of Parastomal Hernias
- Wear a stoma belt and specialist support underwear.
- Avoid lifting anything heavier than a kettle in the first three months post-surgery.
- Hold your abdominal muscles when coughing or sneezing.
- Wear light support from the start and definitely wear support during exercise.
- Avoid gaining rapid amounts of weight.
Addressing Blockages/Bowel Obstructions
Some people may experience partial or complete bowel blockages/obstruction with a stoma.
Causes of Bowel Obstructions
Blockages can be caused by certain foods that the bowel may find difficult to digest or by adhesions and scar tissue within the bowel that can prevent fecal waste from passing through.
Symptoms of a Bowel Obstruction
- Acute abdominal pain
- No output or extremely watery output
- Nausea or vomiting
- A swollen, hard abdomen
Relieving a Bowel Obstruction
- Stop eating solids.
- Increase fluid intake.
- Drink a warm drink such as tea to help stimulate the bowel.
- Take a warm bath to ease abdominal pain.
- Draw your knees to your chest and rock from side to side to help move a food blockage.
- If you have extreme abdominal pain and are vomiting, seek emergency medical attention to resolve the obstruction and to avoid perforation of the bowel.
The Importance of Nutritional Status
Nutritional intervention is crucial not only after stoma creation but also considers the patient’s nutritional status before surgery.
Pre-operative Nutrition
Poor nutrition before surgery can lead to worse postoperative outcomes, including wound infection or patient death. Preoperative screening for malnutrition is essential.
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Malnutrition Screening Tools
- MUST (Malnutrition Universal Screening Tool): A quick assessment of the patients’ risk of malnutrition, consisting of BMI assessment, evaluation of casual loss of body weight in the last 3-6 months, and the presence and possible impact of acute disease on the patient’s nutritional status.
- PONS (Perioperative Nutrition Screen): A questionnaire that indicates the need for preoperative nutrition and clinical or nutritional intervention.
- SGA (Subjective Global Assessment) and MNA (Mini Nutritional Assessment): Tools used for in-depth assessment of nutrition, particularly in patients with ileostomy with High Output Stoma (HOS) and colon cancer patients undergoing ileostomy surgery.
Comprehensive Nutritional Assessment
An in-depth assessment of the patient’s condition is performed through a nutritional interview, anthropometric measurements, and biochemical and immunological tests.
Nutritional Deficiencies and Stoma Location
Nutritional deficiencies may affect patients to a greater or lesser extent, depending on the location of the stoma creation.
- Ileostomy: People with an ileostomy are more prone to nutritional deficiencies because most of the digestive system is served temporarily or permanently, and henceforth the mechanism of nutrient absorption is disturbed.
- Colostomy: The risk of nutritional deficiency is greater when the colostomy is created due to inflammatory bowel disease (CD or UC).
Nutritional Considerations for Ileostomy Patients
Having an ileostomy means that stool does not travel the typical intestinal pathway, affecting how stool comes out and how the body absorbs important vitamins and minerals.
Dietary Recommendations
- Small, Frequent Meals: Changing one’s eating habits can also help the body absorb nutrients better. For example, a person could eat smaller meals more regularly, such as every 2-3 hours.
- Low-Fat Products: A person who has had an ileostomy and wants to lose weight could consider eating low-fat products, such as low-fat dairy and lean proteins, and steamed or boiled fruits and vegetables, which should be peeled and deseeded.
- Avoid Skipping Meals: Skipping meals can lead to missing out on essential nutrients and vitamins.
Specific Nutrient Considerations
- Vitamin B12 (Cobalamin): Pay attention to the level of vitamin B12, which is absorbed in the ileum, in the presence of Castle’s intrinsic factor.
- Vitamins K, B, Folic Acid, and Short-Chain Fatty Acids (SCFA): In the case of an ileostomy, when the entire colon is absent or not in continuity, the patient has also been deprived of the endogenous source of vitamins and nutrients produced by the gut microbiota.
- Fat-Soluble Vitamins (A, D, E, and K): When an ileostomy is established in the initial section of the ileum, the surface area of nutrient absorption may be significantly reduced. Monitor the consumption of fat and of fat-soluble vitamins.
Managing High Output Stoma (HOS)
The presence of a high-output stoma produces an increased amount of fluid (>1500/2000 mL/day) and is associated with electrolyte disturbances.
Addressing Food-Related Issues
Adjusting the diet to one’s own needs and excluding certain foods from it may also increase the risk of malnutrition in patients with a stoma in the small intestine.
Foods That May Cause Issues
- Fibrous Skins and Seeds: As a general rule, people should try to avoid fibrous skins and seeds after having an ileostomy. The body does not digest these, so they move through the intestine unchanged, potentially affecting the ileostomy.
Foods to Thicken Output
- Ripe bananas can help thicken your output.
- Consider adding foods such as rice, pasta, cheese, applesauce, smooth peanut butter, pretzels, yogurt, and marshmallows.
The Role of Oral Nutritional Supplements
Oral nutritional supplements can provide calorie-rich nutrition for those who experience weight loss after having an ileostomy.
Examples of Supplements
- Boost
- Carnation Instant Breakfast
- Ensure
- Glucerna, for those with diabetes
- Kate Farms Nutrition Shake
- Orgain Nutrition Shakes
Consulting a Nutritionist
Consult a nutritionist regarding how much you should consume and how often.
Weight Management Strategies
Losing weight after having an ileostomy involves consuming fewer calories than one burns in a day.
Diet and Exercise
With a doctor’s approval, a person can also exercise after having an ileostomy. They could take walks or try an online or in-person fitness class.
Eating Habits
- Serve meals on a smaller plate.
- Avoid alcohol.
- Plan meals and snacks in advance.
Addressing Odor and Gas
Some people find that their ileostomy bag can cause bad smells when it is full.
General Well-Being Tips
- Eating Several Small Meals at Regular Intervals on a Daily Basis: Eating at routine times can help a person better identify when they may need to change their ileostomy bag.
- Chewing Food Thoroughly: Doing this will make digestion easier.
- Not Eating Large Meals or Snacks at Night: Eating a large meal could cause the ileostomy bag to become over-full and require changing during sleeping hours.
- Limiting Alcohol Intake: Alcohol can contribute to dehydration, bloating, and gas.
Supplementation
Having an ileostomy means that food material does not reach the colon for nutrient absorption as it does with a colostomy. As a result, a person may be more vulnerable to nutritional deficiencies.
Types of Supplements
Most supplements should be liquid or chewable but non-gummy to ensure that the body can break them down. Some examples include chewable multivitamins and liquid or chewable calcium supplements, such as calcium citrate.
Nutrient Deficiencies of Particular Concern
- Calcium
- Magnesium
- Iron
- B vitamins
- Folic acid
- Fat-soluble vitamins, including vitamins A, D, and E
Ostomy Reversal: A Return to Normalcy
An ostomy reversal is an operation to reverse an existing colostomy or ileostomy.
Why Consider Ostomy Reversal?
Most people choose to have it because they’d prefer to use the bathroom in the old-fashioned way again. This procedure represents a chance to return to the way life was before ostomy surgery.
When Can Reversal Be Performed?
Your surgeon will discuss the possibility of ostomy reversal with you before your original colostomy or ileostomy procedure. This possibility will depend on the nature of your condition, the type of treatment you need, and how well you recover from it.
Experiencing Weight Changes: Personal Accounts
Many individuals with ileostomies experience weight changes, both weight loss and weight gain. These experiences highlight the variability in how people react to foods and the importance of personalized dietary strategies.
Weight Loss Experiences
Some individuals experience weight loss due to decreased absorption of nutrients and calories, leading to the need for high-protein diets and nutritional supplements.
Weight Gain Experiences
Others find themselves gaining weight due to increased hunger and altered metabolism, requiring careful monitoring of calorie intake and dietary choices.
Seeking Professional Guidance
Consulting with a dietician, stoma nurse, or physician is essential for addressing extreme weight loss after ileostomy. These professionals can provide personalized advice, monitor your condition, and recommend appropriate interventions to maintain your health and well-being.