With a near flush stoma in a belly fold which is rather difficult to keep a wafer attached, I much prefer watery output so the stoma doesn't extend much and disturb the careful seal I've created to keep a bag on long term.
I do drink plenty of water and an electrolyte drink occasionally. I ensure I'm urinating and it's a normal yellow or clear, not dark orange or dry which would indicate dehydration.
As a new Ileostomate, you may find my next paste of information beneficial.
Gas is usually a diet issue as digestive enzymes breaking down your food produces gas as a byproduct. However certain foods cause more gas than others. A list is provided as part of my paste guide below.
Could be a reaction between meds as well.
Nighttime dumping is just a fact of life with those who have an Ileostomy. But there are things one can do to reduce the nighttime dumping and get some sleep.
1: With a good bag on, eat from am to about 2 pm. Frequent small and nutritional meals. After that only very small hunger avoiding tiny snacks. This will give time for your stoma to clear out and not fill the bag during the night as much.
2: Sleep only on your back with your upper body slightly raised, with pillows under each arm to train yourself to remain put. This will avoid a lot of issues and cause content to drain to the bottom of the bag.
3: Train yourself at night to tap your bag to check if a dumping is required. Feel around the stoma if a pancaking bubble is forming because if ignored it will force the wafer off and cause a leak or a blowout even.
4: After each dumping, put in a couple of drops of liquid antibacterial dish soap into the bottom of your bag followed by some water and gently (don't squeeze!) wash it out. Follow by two rinses where one (if necessary or in the case of pancaking) lay down and massage/rinse the upper part of the bag and dump. Then perhaps a final rinse. Leave a drop of the dish soap and a tiny bit of water in the bag to control future odor. Say goodbye to stinky bags!
5: Clean stoma area in shower using nothing but antibacterial liquid soap (kills infection of weeping wounds also) and after each spewing as it contains oils that interfere with adhesion, apply nothing else. Blow dry area very well so even wounds feel very dry to the touch. Adhesives like rings, paste, wafer flanges and barrier strips only stick to clean, dry, dust and oily free skin. Alcohols used get trapped under things and cause allergic reactions. Antibacterial liquid soap works best to kill infection and clean the skin of oils, drys out wounds to allow bonding. As long as nothing else added to it at factory, why I prefer to use antibacterial dish soap free of any aloes or skin lubricants.
6: If you use paste, consider using no-sting paste free of alcohol. Premix some paste with stoma powder to get it to activate and spread a 1/2" thin ring around stoma focusing on wounds first using a flat stick to press it down. If it doesn't stick then remove, and discard off stick using toilet paper. Blow dry and try again. Then about 1/3" away from stoma, put two thick rings of paste, score the tops and sprinkle in a little stoma powder, mix and cover any powder with paste or it interferes with bonding to skin and wafers.
7: If you use a ring, stretch to the size of your stoma and any gaps you press the ring flatter and closer to the stoma to cover the skin. Rings are good for flat areas and good clear skin. Paste is better for unevenness, wounds, dips or graneolumas on the skin.
8: With a wafer hole cut to be just a hair bigger than your stoma (cut an oval if your stoma is oval) press the wafer on and ensure paste or the wafer does NOT cover the stoma or it will clog. You can test fit the wafer and make reference marks on the edge of the flange and ones skin to line up later with. Some weaken their wafer horizontally so it flexes some for bending so it's not so stiff, like for belly folds.
9: Diet and quantity control is important for those with an Ileostomy.
Signs of a clogged stoma.
No output or only watery output under pressure for a few hours after eating. Could be caused by a covered stoma by improper application of an appliance, typically hole is cut too small or not lined up correctly or paste covering the stoma. Also could be caused by eating hard food. Remove appliance if necessary and wait in shower washing output away. If badly clogged a severe pain will appear and a trip to the ER is necessary.
Unfortunately very high and frequent output will ensue after clearing for quite some time which will likely making putting on a replacement appliance difficult. Use stool thickening tactics (below). If going to an ER, bring your own otosmy gear and a change of clothes as hospital likely doesn't carry or doesn't know how.
What is "pancaking?"
Pancaking occurs when a vacuum in the bag (likely do to a clogged filter) or super thick stool blocks stool from depositing to the bottom of the bag. Thus can force bag off and cause leaks. Controlling what one eats and by mixing and consuming stool thickening and stool softening foods at the same time in your mouth to get a balance. For instance eating toast mixed with tea in your mouth so the dry bread is soaked and the tea causes more runny stool. To resolve a pancaking issue is to go dump, then flush the bag with two drops of antibacterial dish soap and water, then add fresh water and seal up, go lay on your back and get the water up near your stoma and gently massage the pancaked output loose. Do not squeeze the bag or try to dislodge pancaking output by pressure as that can cause the wafer to detach as well.
To resolve pancaking caused by a vacuum, after the bag is washed and clean, insert a tongue depressor or flat stick into the bag from the bottom and push the two clinging plastic pieces apart. Then seal the end and roll the air up towards the top of the bag so there is a ballon of air around the stoma.
What is "ballooning?"
Ballooning occurs when foods eaten produce too much gas and the filter gets clogged (likely due to laying down) and thus forces bag off and causes leaks. You can "burp" the bag of excess gas while dumping or just opening it up a little and pressing the gas portion out. But the best control method is diet control.
These two conditions can cause premature bag replacement and leaks which burn the skin. It's better to replace the appliance if there is any continuous stinging pain, don't just live with it. Keep an eye on your otosmy supply and have ample reserves.
I've found that caffeine, in coffee, tea and even chocolate causes diarrhea and can assist in controlling flow so stool is more liquid..however coffee makes output very acidic making burns far worse. Dried Chinese Crispy Noodles, Cheerios or applesauce (peeled apples) are the exact opposite, a stool thickening food. By mixing these with other foods one can manipulate their stool output and counter the issues above. Also the severe thickening helps in cases where one has severe diarrhea and unable to reattach a new bag due to high flow.
Eating Guide
Partially copied from my nutritionists guide. Ileostomy Nutrition Therapy from the Academy of Nutrition and Dietetics. (This handout may be duplicated for client education.)
My recommendation is to see a nutritionist for the full guide as not all can be pasted here
I've added my own observations to further clarify
Chew all foods well to the consistency of paste.
Foods That May Cause Blockage (very bad avoid!)
Apples, unpeeled (unpeeled and applesauce are excellent thickeners, don't eat the skins or the core, chew well)
Bean sprouts, Cabbage
Casing on sausage (inside fine if no tough parts, avoid swallowing if a chunk is felt) Also sausage like meats like pepperoni and salami contain indigestible bits.
Chinese vegetables (stir fried crunchy, too hard, need very soft veggies with no skins)
Coconut, Coleslaw, Celery (avoid)
Corn (grits also, corn anything doesn't seem to dissolve in stomach)
Cucumbers (skins bad, inside chewed up good seems okay, no seeds)
Dried fruit, raisins
Grapes, blueberries etc. (skins and seeds the problem.)
Green peppers (red, yellow also) pureed or very very small seems okay in small amounts
Mushrooms (doesn't dissolve in stomach) pureed or very very small seems okay in small amounts
Nuts (totally avoid)
Peas (mushy interior okay, like pea soup, skins a problem)
Pickles (skins a problem, inside if chewed up good seems okay, seeds not)
Pineapple (liquid okay, mushy parts fine, hard parts not, rather risky as parts of mushy may not digest)
Popcorn (totally avoid)
Relishes and olives
Salad greens (diarrhea nightmare too)
Seeds and nuts (avoid)
Spinach (doesn't digest, pureed perhaps)
Tough, fibrous meats (for example, steak on grill, well done, tough parts especially, over grilled chicken or dry pork chops. Juicy grilled or pan fried chicken, shredded pork in juices, medium rare steaks, hamburger better.
Vegetable and fruit skins, (any avoid)
Whole grains (no grits, rolled oats oatmeal seems to be okay, oat cereal is an excellent thickener)
Foods That May Cause Gas or Odor
Alcohol, Apples, Asparagus (stink), Bananas, Beer, Broccoli (clog hazard)
Brussels sprouts (clog hazard)
Cabbage (clog hazard)
Carbonated beverages
Cauliflower, Cheese, some types
Corn (clog hazard), Cucumber
Dairy products
Dried beans and peas (clog hazard)
Eggs (don't digest in stomach)
Fatty foods, Grapes
Fish (cooked salmon in small portions may not, nor stink, same for raw tuna)
Green pepper (red and yellow also, clog hazzard)
Melons, Onions (clog hazard)
Peanuts (clog hazard) Prunes
Radishes, Turnips
Soda and sipping using straws, (drink from glass instead)
Seafood (oh God does it stink!)
If your having pancaking issues a small amount of something above (like having a soda during a meal) could introduce some air into your diet and thus into the bag. Also by avoiding too much thickening foods by themselves which often contribute to pancaking.
Foods That May Help Relieve Gas and Odor
Buttermilk, Cranberry juice, Parsley
Yogurt with active cultures (Greek yogurt)
Foods That May Cause Diarrhea (looser or more frequent stool)
Alcohol (including beer)
Apricots (and stone fruits)
Beans, baked or legumes
Bran, Broccoli, Brussels sprouts
Cabbage, Caffeinated drinks
Chocolate
Corn (in my experience corn anything doesn't digest in stomach, just passed through and out, kernels/popcorn will clog)
Deep Fried meats, fish, poultry (KFC, supermarket rotisserie chicken very bad, and anything soaked in brine)
Fruit juice: apple, grape, orange (small amount okay)
Fruit: fresh, canned, or dried (small amount okay)
Glucose-free foods containing mannitol or, sorbitol
Gum, sugar free, Licorice
High-fat foods, High-sugar foods
High salt foods (KFC, supermarket rotisserie chicken)
High seasoned foods (like blackened)
Milk and dairy foods (small amounts okay)
Nuts or seeds (bad, clog hazard)
Peaches (stone fruit, one rarely okay)
Peas, Plums (stone fruit)
Prune juice or prunes
Soup, Spicy foods
Sugar-free substitutes
Tomatoes, Turnip greens/green leafy
Vegetables, raw
Wheat/whole grains, Wine
Rice (very soft 1/4 cup in mixed in food okay), refried beans (1/4 cup okay) pasta (one cup max).
Any foods soaked in brine or deep fried (rotisserie chicken, Kentucky fried chicken etc)
Solent nutritional meals
Foods That May Help Thicken Stool
Applesauce (unpeeled apples, no cores)
Bananas, Barley (when OK to have fiber)
Cheese (processed cheese food a clog problem, use real cheese)
Dried Chinese Crispy Noodles (severe thickening, mix with other food that causes diarrhea)
Marshmallows
Oatmeal (when OK to have fiber)
Pasta (sauces may increases symptoms) (in my experience more than a cup of pasta causes diarrhea)
Peanut butter, creamy only, nuts clog (may make skin greasy)
Potatoes, no skin (skin clogs, more than a cup may cause diarrhea)
Pretzels (salty may cause more flow water consumption)
Metamucil, mix or crackers (mix in cup of water and drink before it gells up)
