Understanding Constipation and Stoma Output

Constipation is a common digestive complaint, but can you suffer from constipation when you have an ostomy?

Before we discuss constipation with a stoma, lets first understand constipation is in a regular bowel.

What Is Constipation?

In general terms, constipation refers to infrequent, difficult, or incomplete bowel movements. Common signs include:

• Passing stools less often than usual, but what’s usual I hear you saying? It can vary quite a bit, but each person will come to know what’s their ‘normal. Generally, this would be between 3 times per day to 3 times per week.
• Straining during bowel movements
• A feeling of incomplete emptying
• Hard, dry, or lumpy stools. If you’ve ever heard of the ‘Bristol Stool Chart’ that would be a score of 1 or 2.

Causes of Constipation - Some of the most common causes include:

• Low fibre intake
  Fibre helps bulk up stool and keep it moving. The bowels actually ripple (imagine a tennis ball inside a sock being squeezed down, this squeezing causes the ‘ripple’ effect and is what moves food along. Having more fibre makes for a larger more bulky ‘ball’ for the bowels to squeeze against. Conversely,  a low-fibre diet provides no ‘bulk’ and so can slow things down.
• Dehydration
  Not drinking enough fluids can make stools harder and more difficult to pass.
• Medications
  Common culprits include painkillers (especially opioids), antacids, iron supplements, and certain blood pressure medications.
• Lack of physical activity
  Movement helps stimulate bowel function.
• Emotional stress or anxiety
  The gut and brain are closely linked, and stress can slow bowel movements.
• Changes in routine or diet
  Travel, illness, or surgery (such as stoma formation) can disrupt normal bowel patterns.

Constipation with an Ostomy

For people without a stoma, constipation typically affects the colon and rectum. However, for people with a stoma, the experience of constipation and changes in output vary significantly based on where the stoma is located in the digestive tract.

The type of stoma you have plays a big role in how constipation may present—or if it’s even likely.

1. Ileostomy (Small Intestine Output)

• Location: End of the small intestine (ileum)
• Normal Output: Loose to semi-formed, often more liquid
• Constipation Risk:
  True constipation is rare with an ileostomy because the colon—where water is absorbed—is bypassed, so all the fluid is still present
  However, blockages (bowel obstructions) can mimic constipation. Signs include:
  • Sudden reduction or stop in output
  • Cramping abdominal pain
  • Nausea or vomiting
  • Swollen abdomen
• If you have an ileostomy and your output slows significantly or stops, it’s more likely to be a mechanical blockage, not typical constipation. Seek medical advice promptly or try some of these tips offered by Hanna @ Gut My Life Back

 Colostomy (Colon/Large Intestine Output) – Ascending, Transverse, or Descending

The location of your colostomy within the colon affects the consistency of your stool—and your likelihood of experiencing constipation.

• Ascending Colostomy (Right Side):
  Output is generally liquid to semi-liquid. Constipation is less common, but dehydration can reduce output.
• Transverse Colostomy (Across the Upper Abdomen):
  Output tends to be mushy or pasty. Constipation may occur but is less frequent than with a descending colostomy.
• Descending or Sigmoid Colostomy (Left Side):
  Output is usually more formed and solid, similar to a typical bowel movement.
  This is where constipation is most likely to occur, as the stool spends more time in the colon, allowing more water absorption.

Constipation and a Stoma: How Can You Tell?

Recognizing constipation when you have a stoma may look different from traditional symptoms. Watch for:

• A noticeable reduction in output
• Increased straining to pass output (if you irrigate your colostomy, this may show up during irrigation)
• Harder, drier output from the stoma
• Abdominal bloating or discomfort
• Feeling sluggish or nauseous

For ileostomates, watch for lack of output altogether, which could signal a blockage.