What is the normal output range for ostomies (output from an artificial opening in the body, such as an ileostomy or colostomy)?

Normal Output for Ostomies

Normal ostomy output varies by type: colostomy output is typically formed stool occurring once daily, while ileostomy output is liquid, requiring emptying 3-4 times daily with a normal volume of less than 1.5 L/day. 1

Types of Ostomies and Their Normal Output

Colostomy

• Most common type of enteral stoma, created from a portion of the colon 1
• Output is typically formed stool with bowel movements occurring once daily 1
• Easier to manage than ileostomy output due to its consistency 1
• Colostomy appliances usually require changing once every 6-7 days 1

Ileostomy

• Constructed from terminal ileum close to the ileocecal valve 1
• Produces liquid effluent that generally requires emptying 3-4 times daily 1
• Normal output is less than 1.5 L/day; outputs greater than this are considered high 1, 2
• Appliance wafer typically needs changing every 4 days on average 1
• More prone to causing dehydration and skin excoriation than colostomies 1

High Output Concerns

Definition and Causes

• High ostomy output (HOO) is defined as output greater than fluid intake, typically >1.5 L/day 1, 2
• Early HOO occurs within 3 weeks of stoma formation 1, 3
• HOO is common with ileostomies (occurring in up to 31% of small bowel stomas) but rare with colostomies 4, 2

Clinical Implications

• When output exceeds 2000 mL/24h, patients are at high risk for dehydration, electrolyte depletion (particularly sodium and magnesium), and malnutrition 1, 3
• Patients with ileostomies more frequently present with high-output stomas resulting in dehydration compared to those with colostomies 5
• Renal impairment is a common complication of late high-output stomas 3

Management Considerations

Monitoring Output

• Regular assessment of stoma output volume is essential for early detection of abnormalities 1
• Laboratory monitoring should include serum electrolytes (sodium, potassium, magnesium) 1
• A random urinary sodium <20 mmol/L suggests sodium depletion 1

Prevention of Complications

• Patients with impaired renal function should avoid ileostomies when possible due to higher risk of dehydration 4, 5
• Colostomies have higher rates of stoma retraction (21.6% vs 9.4% for ileostomies) but lower rates of high output 4
• Proper hydration and electrolyte balance are crucial to prevent renal failure in patients with high-output stomas 1

Treatment of High Output

• Restriction of hypotonic/hypertonic fluids to <1000 mL daily 1
• Remaining fluid requirements should be met with isotonic glucose-saline solution 1
• Medications to reduce output may include:
  • Bulking agents (psyllium fiber, guar gum) 1
  • Antimotility agents (loperamide, diphenoxylate and atropine, codeine) 1
  • Antisecretory agents (proton pump inhibitors, H2 antagonists) 1

By understanding normal ostomy output parameters and monitoring for deviations, healthcare providers can promptly identify and address complications that may affect patient morbidity and mortality.