I. Obstruction Obstruction is a potential problem for fistula patients. Incompletely absorbed food and medications are the most common causes of obstruction.
Signs of obstruction may include: 1. abdominal cramping; 2. bloating; 3. nausea and vomiting; 4. little or no gas entering the fistula bag; many obstructions resolve on their own. You can try lying down and then pressing your knees against your chest. While you are in the shower, rub your abdomen, especially near the stoma. Drink a cup of warm tea or broth.
If the obstruction does not resolve within 6 to 8 hours or you are vomiting, call your health care provider, trauma stoma nurse or local emergency room. The health care provider usually resolves the obstruction with intravenous medication or bowel rest, and may even do a stoma enema. A stoma enema is the irrigation of the stoma with a small amount of saline until the obstruction is resolved. The obstruction can also cause dehydration due to diarrhea and vomiting.
Second, dehydration One function of the colon is to absorb water and electrolytes, such as potassium and sodium, from food. When the colon is removed, the small intestine needs time to adapt.
The normal amount of stool excreted from the small intestine is about 1000ml per day. However, the amount of excretion from the small intestine increases after surgery. This also results in a bowel movement every hour or two, five to six times a day. A discharge greater than 1000ml of fluid a day can cause dehydration. Dehydration can occur when the amount of excretion increases and fluid replacement is insufficient.
The signs of dehydration are as follows: 1) Feeling tired; 2) Decreased urine volume; 3) Dark-colored urine; 4) Feeling thirsty; 5) Dry skin and mouth; Feeling dizzy when sitting or standing.
If you are showing signs of dehydration, increase the amount of fluid replacement to replace the water lost from your stool. Slowly drinking about 2,300 ml of fluid throughout the day may stop dehydration. Drinking more fluid or drinking large amounts of fluid at once can cause fluid to pass more quickly through the small intestine, causing higher elimination and loose stools. If dehydration persists for 1 hour, contact your health care provider or local emergency room.
III. Diarrhea Normal stoma drainage requires 4-6 evacuations during the day. The fistula bag is 1/3-1/2 full each time. A high stoma discharge means that you need to empty the stoma bag more times or that the bag is more than 1/3-1/2 full each time you empty it. If your stoma discharge is high, you need to: 1. slow down the passage of food and fluid through the small intestine to allow the small intestine to absorb more water and nutrients, which will help reduce the discharge Slow down bowel movements and eat foods that thicken the stool rather than those that thin it.
2. Limit fluid intake to no more than 120ml at meals, and take small sips of fluid constantly between meals.
Maintain your own fluid intake (2300ml of water or electrolyte drink) throughout the day 3. Replace lost electrolytes, sodium, and potassium (see the table at the back).
If, after trying the previous methods, you still have a lot of stoma discharge, then medications may help you manage the frequency and consistency of your stools. Antidiarrheal agents (loperamide, diphenoxylate) can reduce the volume of stool.
If high elimination is accompanied by nausea and vomiting as well as abdominal cramping, you may be obstructed and antidiarrheal medication should not be used at this time. If these symptoms do not resolve within 6-8 hours, contact your doctor.