Medical Oncologist
CION Cancer Clinics
High output from an ileostomy: what it means and what to do | CION Cancer Clinics
High output from an ileostomy means the bag is filling faster than you can drink to replace it, and the body starts to run short of water and salt. It is most common in the first weeks after rectal surgery and in hot weather. This page explains the warning signs that need care the same day, why plain water makes it worse, and what your surgical team does to bring it down. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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The short answer
What counts as high output from an ileostomy?
High output means the bag is filling faster than you can drink to replace it. Most teams use a figure of around one and a half to two litres a day, but the practical sign is simpler: watery output, a bag that needs emptying every hour or two, and a person who feels weak, thirsty and light-headed.
Why an ileostomy does this and a colostomy does not
The large bowel is where most water and salt are soaked back into the body. An ileostomy sits before the large bowel, so everything that reaches it leaves the body still wet. In the first weeks after surgery the small bowel has not yet learnt to take over that job, which is why high output is most common early on.
Why it matters more here than in a cooler country
Most written advice on this comes from Britain. In Hyderabad in May, or in a village without a fan, a person with an ileostomy loses water through sweat as well, and the margin is much thinner. Treat a hot day as a reason to be more careful.
What this page cannot tell you
It cannot tell you whether your own output is high, because that needs a measured figure and a blood test for salts and kidney function. It gives you the signs to watch. The measuring and the treatment belong to your surgical team.
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Signs that need care the same day
Very little urine, or urine that is dark like tea. Dizziness on standing up. Cramps in the legs or hands. Output that is pure water and more than the person can drink back. Or the opposite: output that has stopped completely with a swollen tummy and vomiting, which may be a blockage. Go to the nearest emergency department and say the person has an ileostomy. Do not wait to see if it settles overnight, and do not try to fix it with plain water alone.
Not sure whether this applies to you?
Ask an oncologistWhy it happens
What pushes the output up?
The early weeks
The most common cause is simply that the stoma is new. The small bowel adapts over weeks and the output usually thickens on its own. Your team watches the trend rather than any one day's figure.
An infection or a tummy bug
A stomach upset that would give anyone loose motions turns into very high output with an ileostomy. Fever, vomiting or a sudden change after eating out should be mentioned to the team the same day.
Food and drink
Very sweet drinks, fruit juice, fizzy drinks and large volumes of plain water all pull fluid into the bowel and make output run. Spicy, oily food and caffeine can do the same.
Often blamed by families
- Coconut water and sugarcane juice
- Tea and coffee in large amounts
- Skipping meals, then eating a big one
Medicines and a partial blockage
Some antibiotics, metformin and medicines that speed the gut can raise output. A partial blockage can also cause watery output that squeezes past the obstruction. Bring every medicine box to the appointment.
At the clinic
What your team does about it
Measure it
You will be asked to record the volume in the bag each time you empty it, for a few days. A measuring jug from the kitchen is enough. Without a figure nobody can tell whether things are improving.
Check the blood
A blood test looks at sodium, potassium, magnesium and how the kidneys are coping. Low magnesium is common with high output and causes cramps and tiredness that families put down to the operation.
Change what goes in
Plain water is usually limited, which surprises people. In its place you are given a salty rehydration drink, and told to eat thickening foods and take smaller meals more often.
Slow the gut, if needed
Medicines such as loperamide, and sometimes codeine or a medicine that lowers stomach acid, may be prescribed to slow the flow. The timing and amount are set by your team; do not buy and take these on your own.
Day to day
What you can do at home to keep the output down
The single most useful habit is to sip a salty drink through the day and to keep plain water for a mouthful with tablets. That is the opposite of what most families do, and it is the reason a person who is drinking constantly can still be badly dehydrated.
Eat to thicken
Plain rice, curd rice, idli, ripe banana, boiled potato and toast all thicken output. Eat little and often, chew well, and avoid a large glass with a meal, which washes food through faster. Salt your food more than before, unless your team has said otherwise because of blood pressure or heart disease.
Time the medicines
If you have been prescribed loperamide, ask your team to write the timing down. If you are also on chemotherapy, tell the oncology team about the output, because some chemotherapy drugs loosen the bowel and the two plans need to talk to each other.
Who this advice does not suit
Someone with heart failure or kidney disease cannot simply drink more salt and fluid; their limits are set by the physician. Someone whose output has stopped, rather than increased, needs a different plan entirely. And someone with fever alongside high output needs to be seen, not managed at home.
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On your notes
Words your team will use, in plain language
- Output
- Everything that comes out of the stoma in a day, measured in millilitres or litres. The figure that matters most in this page.
- Oral rehydration solution
- A drink with salt and sugar in a set balance so the small bowel can absorb it. Plain water without salt is absorbed poorly by an ileostomy.
- Electrolytes
- Sodium, potassium and magnesium in the blood. High output drains all three, and each shows up as a different symptom.
- Hypotonic and isotonic
- Hypotonic drinks, like water and juice, pull salt into the bowel. Isotonic drinks match the body's own balance and are absorbed.
- Anti-motility medicine
- A medicine that slows the bowel so more water can be absorbed. Loperamide is the usual first choice.
Commonly believed
Four things families tell us, and what is actually true
"He is drinking four litres of water a day, so he cannot be dehydrated."
He can, and often is. Plain water pulls salt into the small bowel and leaves through the stoma, taking the salt with it. The more plain water goes in, the more comes out. A salty drink in smaller sips is what actually stays in the body.
"Coconut water is the healthiest thing to give."
Coconut water is high in potassium and sugar and low in sodium, which is the salt an ileostomy loses most. It is not a rehydration drink for a stoma. A proper oral rehydration solution is, and it is far cheaper.
"Loperamide is dangerous, so we stopped it."
Loperamide slows the bowel and is one of the main tools for high output. Stopping it, or changing the timing, without telling the team can put someone back in hospital. If you are worried about a medicine, ask before you change anything.
"If she stops eating, the output will stop."
The bowel makes several litres of its own juices a day whether or not food is eaten. Fasting lowers output only a little and starves a person who is trying to heal. Thickening food, eaten little and often, does far more.
Questions we are asked
Common questions about high output
How do I measure the output at home?
Empty the bag into a plastic measuring jug kept only for this, note the amount and the time, then flush it. Add the figures up at the end of each day, for as long as your team asks. A photo of the page on your phone is fine to bring.
Which drink should I actually be sipping?
An oral rehydration solution from the chemist, made up exactly as the packet says, or a salty drink your dietitian has written out for you. Sip it through the day rather than drinking a glass at once. Buttermilk with salt is a reasonable everyday option for many people; ask your team.
Will the output settle on its own?
Often, yes, over the weeks after surgery as the small bowel adapts. But it settles faster and more safely when it is measured and managed, and some people need medicines for as long as the stoma is in place. Nobody can tell you in advance which group you are in.
Can high output damage the kidneys?
Yes. Repeated dehydration is hard on the kidneys, and it is one of the commonest reasons people with a new ileostomy are readmitted to hospital. That is why the team checks kidney function on the blood test, and why the signs in the amber box above are treated as urgent.
Does chemotherapy make this worse?
Some chemotherapy drugs used after rectal surgery loosen the bowel, and with an ileostomy that shows up as higher output. Tell both the surgical and the oncology team what the bag is doing. The chemotherapy plan is not usually changed, but the fluid and medicine plan around it often is.
Should we go back to the hospital where the surgery was done?
For anything urgent, go to the nearest emergency department and say the person has an ileostomy. For everything else, the stoma nurse or surgical team who know your case should be your first call. Keep their numbers on your phone.
Can we fast during Ramzan or for a festival?
With a new ileostomy or a history of high output, a day without fluid is risky, especially in summer. Talk to your team and, if you wish, a religious adviser before deciding. Many people are advised not to fast in the first months and to consider it again once the stoma has been reversed.
Will the ileostomy still be reversed if the output has been high?
High output on its own does not stop a reversal. If anything it is one more reason the team will want to close the stoma once the join has healed and any chemotherapy has finished. Your surgeon sets the timing.
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Dr. C. Raghavendra Reddy
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Dr. Owais Mohammed
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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Dr. Vajja Sandeep Kumar
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Sources
- NHS — Ileostomy: complications
- NHS — Ileostomy: living with
- American Cancer Society — Ostomies
- Macmillan Cancer Support — Bowel cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Dehydration and Salt With an IleostomyWhat to drink, what to avoid, and why plain water is not enoughThe Temporary Ileostomy After Rectal SurgeryWhy the stoma was made and how long it usually staysLife With an Ileostomy: How It Differs From a ColostomyWhy an ileostomy is the wet stomaComplications and Red FlagsThe other signs after surgery that cannot waitIleostomy Reversal: Timing and What to ExpectWhen the stoma is closed and what changes
Talk to us
Is the bag filling too fast?
Call the helpline and tell us how much is coming out and how the person feels. A surgical oncologist or stoma nurse will tell you whether it can wait for clinic or needs to be seen today.