Why is my stoma so active at night?

Having a very active stoma at night can be very inconvenient, frustrating & sometimes feel never-ending. Most of the time, your stoma going into overdrive at night could be explained by a few reasons, so give this blog post a read and see if you’ve thought of any of the following.

However, as always, if you are concerned or are at danger of becoming dehydrated (which can easily be caused by an overactive stoma), please consult a medical professional. The following points are from my experiences only & things I’ve learnt since having my stoma formed in 2011.

What are you eating before bed?

Food is something that affects different people who have had stoma surgery in different ways, so it is hard to give a concrete rule as there is no “one size fits all” approach to try with it. If I eat anything more than a light snack after 7/8pm, I definitely notice a difference in how active my stoma is throughout the night. You will find what works for you with trial and error, as I did, but a lot of people suggest to stop eating at least a few hours before bed, so maybe stopping after your evening meal would be a good place to start.

There are, however, guidelines as to what foods can cause looser output, which consequently can lead to your stoma bag filling up quicker and needing more empties on a night. You can read up on what actually loosens your output in a blog post I wrote on how to thicken up your ileostomy output.

Eating regularly also helps get your bowel into a better pattern at knowing when to expect food and side effects from having a more inconsistent eating routine such as wind and runny output often reduce if you get used to snacking more light & often.

Are you struggling with “ballooning”?

Ballooning is a term used to describe your ileostomy bag filling up with air, often to the point where it resembles a mini balloon, hence the term! Having a more active stoma at night can definitely be a cause of this and ballooning is often made worse by gas-producing foods.

Again, what affects one person may not affect another and visa versa, but generally some foods that are known to produce more gas when we eat them are:

  • Onions
  • Dairy
  • Certain spices
  • Alcohol (especially fizzy alcohol such as beer)
  • Garlic
  • Cucumber

A good tip to try help you what could be causing ballooning and your stoma being more active would be to keep a food diary for a week or two and see if you can spot any patterns when you limit or don’t eat certain foods.

Are you taking medication?

Some medication can cause ileostomy output to be looser as they can have laxative side effects. Steroid withdrawal is often known to send the bowel into overdrive. A good way to counteract laxative effects caused by regular medication you need to take can be to take tablets such as Immodium (Loperamide) to slow the gut down. It’s always best to ask your doctor before starting this, but I have taken Immodium myself when needed since early days post-surgery. I have the instant melts which absorb on my tongue, so they are absorbed more quickly and effectively.

Have you had extensive surgery or have any other health conditions?

Stomas can be overactive more constantly (known as a ‘high output stoma’) if you have had extensive surgery such as bowel resections or have health conditions such as Inflammatory Bowel Disease (IBD), dysmotility disorders, fistulas & short bowel syndrome. Flare-ups of IBD can cause very loose output in people who have stomas, just as it can do with people who have not had stoma surgery. High output stomas are a separate topic completely and require more long-term management and medical intervention.

Viruses and things such as tummy bugs can also cause your output to suddenly accelerate.

Have you tried wearing a bigger stoma bag at night?

Because I had to get used to dilating my stoma, I got used to changing my bag twice daily. Now, I have carried that forward and wear a maxi bag to bed and a midi size in the day. Wearing the maxi bag to bed gives me a bigger output allowance before I have to empty my bag and also gives me more peace of mind because I do not worry about waking up in time as much to avoid an exploding stoma bag and leaks from ballooning lifting it off my stomach.

Do you wear loose nightwear?

Wearing loose fitted nightwear can also be another way to help give your bag more room to expand with air and output in the night. I have found that wearing a tighter fit nightshirt has made my bag leak in the past so now I always ensure that my bag is out of my nightwear and in no way restricted by a waistband or clothing.

How about setting an alarm?

If you are really worried about not waking up on time to empty your bag, so much so where it’s detrimental to how much sleep you are getting, why not try setting an alarm for half way through the night? It’s not ideal but mentally it might make you feel able to relax more knowing that your alarm will wake you up. If this isn’t practical, for example if you don’t want to wake your partner up, try putting your phone on vibrate and leaving it on the side of the bed not far from you.

If in doubt, ask for help

As I said at the beginning of this post, it’s always best to ask for medical advice if you are concerned. It’s also super important to stay hydrated with a stoma, especially if you are losing more output than normal. Especially in hot weather, I drink rehydration solutions to help keep on top of this. Having a stoma can be very overwhelming and there is no such thing as a stupid question as you are navigating your stoma journey. Support groups online are also a great way to get tips and share tips on everything in the stoma world.

Until next time,