Ostomy Care: Too Much Output

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This is not a substitute for direct care by YOUR doctor. Confirm with your doctor before doing any of the following.

• These drugs slow down the intestinal tract which will help with absorption of fluid and reduce the number of bowel movements you are having each day.  They also serve to reduce the amount of output from colostomies and ileostomies.
• We typically send a patient home with instructions to adjust the drug dose based on the number of bowel movements or amount of ostomy output.  Some days you may require the maximum dose and others you may not take any drug at all.
• The maximum dose of each drug is 8 capsules/tablets per day of either medication  They are taken at 4 defined times throughout the day—30 minutes prior to meals ( 3 doses) and at bedtime (1 dose).  The maximum you should take is 2 tablets or capsules at any given dosing time.  The maximum dose regimen would therefore be 2 tabs 30 mins prior to breakfast, lunch, and dinner, and 2 tabs at bedtime.
• You may take both Imodium AND Lomotil at the maximum dose if your doctor tells you to do so.
• We generally start at 1 or 2 tabs per day and slowly titrate based on number of bowel movements or amount of ostomy output. For instance, if you START out at 1 tab 30 mins prior to lunch and find that this is not enough, you can add an additional tab 30 mins prior to supper.  If this is not enough, you would add a tab 30 mins prior to breakfast.  If you find yourself waking at night to have bowel movements or empty an ostomy appliance, you could take a tab at bedtime.  Add additional doses one day at a time, as a sudden increase in medication may completely shut the intestine down, resulting in nausea and vomiting.
• Increase or decrease the dose based on stool consistency. It should be soft, pudding consistency if you have in ileostomy. For a colostomy it can range from soft pudding, to ripe banana in firmness.
• If you suddenly develop abdominal distention, nausea, and/or vomiting, stop the medication completely, and do not resume it until you start having bowel movements or ostomy output again. If you have no ostomy output of stool or flatus in 24 hours please call the clinic.
• Most individuals will find a regimen that they will take on most days and will only require infrequent and minor dose changes.
• A good antimotiliy drug regimen should result in 4-7 bowel movements per day in J-pouch patients or 800 cc or less of ostomy output per day.