You have been provided with this leaflet as you may be losing a large amount of fluid and salts from your stoma or fistula.
The information contained in this leaflet will explain why this may be happening and the potential impact this can have on your wellbeing. It also gives advice to help you maintain your fluid balance and prevent dehydration.
Understanding a high output and the consequences
What is a stoma?
A stoma is a surgically created opening on the surface of the body, which is connected to your bowel to divert waste (faeces) out of your body.
What is a fistula?
A fistula is a small ‘tunnel’ or connection that develops naturally between 2 surfaces in your body. In this leaflet when we discuss a fistula, we are referring to an enterocutaneous fistula, which forms between the bowel and the skin, resulting in the content of the bowel leaking out onto the surface of the skin. These most commonly occur after bowel surgery, or in Crohn’s disease.
How will I know if my stoma/fistula has a high output?
A high output is usually anything more than 1500ml per day. This can be recognised by having to empty your appliance very regularly and having a watery output and dark yellow coloured urine.
What is the consequence of a high output stoma/fistula?
Losing large amounts of fluid from your stoma/fistula increases your risk of becoming dehydrated. Being dehydrated makes you feel very unwell and if left untreated can be dangerous and cause damage to your kidneys. Common signs of dehydration include:
- Feeling thirsty
- Passing less urine
- Urine that is dark yellow in colour
- Cramps
- Dizziness/feeling lightheaded
- Tiredness
- Headache
The following urine colour chart is a useful guide to help you know if you are dehydrated:
In addition to losing fluid, a high output washes out nutrients from your body, including salt, magnesium, selenium, zinc and copper. If your stoma/fistula output is high for a long period of time, you may also develop vitamin and mineral deficiencies. You may find that your body is unable to take all of the energy and nutrients you need from your food causing weight loss and malnutrition.
Tips for managing a high output stoma/fistula
What foods should I be eating?
We advise that to help reduce the output from your stoma/fistula you should follow a low fibre and low sugar diet.
What is fibre?
Fibre is a part of all plant-based foods, for example cereals, pulses, fruits and vegetables.
Fibre doesn’t break down fully during digestion and in a regular, healthy bowel will act to bulk out stool and assist in the movement of waste through the bowel.
Why do I need to restrict dietary fibre?
High fibre foods should be avoided as they are difficult to digest and can therefore increase your stoma/fistula output.
Also, these foods may get stuck and cause blockages or inflammation in your stoma/fistula.
Why do I need to restrict sugar in my diet?
Foods that contain a lot of sugar encourage fluid to be pulled from your body into your bowel.
This extra fluid will increase your stoma/fistula output and increase your risk of dehydration.
It is therefore advisable to avoid sugary foods.
What foods should I choose and avoid?
The following information provides more detailed dietary information
Food Group: Cereal
Foods you may include: low fibre breakfast cereals e.g. Cornflakes, Rice Krispies.
Foods high in fibre/sugar and should be avoided: wholemeal, high fibre breakfast cereals or those with nuts added e.g. muesli, bran flakes, Weetabix, puffed wheat, shredded wheat, Crunchy Nut cornflakes, Fruit and Fibre, porridge, granola, Coco pops, Frosties.
Food Group: Bread and flour
Foods you may include: bread made with white flour including pitta, naan bread, tortilla wraps, bagels, chapatti. Cream crackers, rice cakes, crumpets, pikelets, potato cakes.
Foods high in fibre/sugar and should be avoided: wholemeal, multigrain or granary bread. Seeded loaves, bread with fruit, fibre or nuts added, e.g. teacakes, fruit scones, fruit loaf. Wholewheat, cracked wheat or brown crackers.
Food Group: Potatoes
Foods you may include: Peeled and cooked potatoes, mashed, chipped or roasted (remove all skins).
Foods high in fibre/sugar and should be avoided: Potato skins, potato wedges.
Food Group: Rice, pasta and other
Foods you may include: White rice and tricolore pasta and spaghetti. White noodles, couscous, rice noodles.
Foods high in fibre/sugar and should be avoided: Wholewheat or brown pasta or noodles, brown rice or wild rice. Bulgar wheat, Quinoa.
Food Group: Cakes and biscuits
Foods you may include: Cakes made with white flour and no nuts, seeds or dried fruit added. Plain or cheese scones. Biscuits made with white flour, e.g. rich tea, custard creams, shortbread. Crumpets, white muffins, croissants, pancakes, brioche, rice cakes.
Foods high in fibre/sugar and should be avoided: Cakes made with wholemeal flour or with added nuts, seeds or dried fruit. Fruit scones, Christmas cake, mince pies. Wholewheat biscuits e.g. digestives, Hob Nobs, cereal bars, fig rolls, flapjack.
Food Group: Fuit
Foods you may include: Fruit with all pips, pith and skin removed e.g. banana, apple, pear, peach, mango, melon, lychees, tinned fruit, avocado. Smooth fruit juice (no more than 150ml twice a day).
Foods high in fibre/sugar and should be avoided: Fruit with skin, pips or seeds that remain attached, e.g. raspberries, strawberries, blueberries, blackberries, blackcurrants, passion fruit, kiwi fruit, pomegranate. Coconut, all dried fruits, figs and prunes. Pineapple, oranges, tangerines, satsumas.
Food Group: Vegetables
Foods you may include: Root vegetables that are peeled and well-cooked, with stringy or tough bits removed: turnip, carrot, butternut squash, sweet potato, parsnip, swede, pumpkin. Skinned and deseeded: tomatoes, courgette, marrow, cucumber, aubergine, roasted pepper. Tomato puree or passata. Well-cooked florets of cauliflower and broccoli (stalks removed). Garlic puree, onion salt, finely chopped herbs.
Foods high in fibre/sugar and should be avoided: Vegetable skins. Cabbage, curly kale, celery, fennel, leaks, okra, peppers, spinach, sprouts, sweetcorn, yam, cassava, onions, avocado, asparagus, mushrooms, rhubarb, pak choi, bean sprouts, Brussel sprouts. Peas, mange tout, sugar snap peas, sweetcorn, baked beans, broad beans, string or French beans. Salad vegetables, e.g. lettuce, beetroot, olives.
Food Group: Meat, fish and protein alternatives
Foods you may include: meat, poultry, ham, bacon, sausages, fish, eggs, tofu. Sausage rolls, meat pies.
Foods high in fibre/sugar and should be avoided: Quorn, beans (including baked beans), pulses, lentils, nuts, seeds. Pies or pastries made with wholemeal flour.
Food Group: Milk and dairy products
Foods you may include: Milk (fresh, evaporated or condensed), cream, crème fraiche. Cheese, cottage cheese, cream cheese, cheese spreads. Smooth, low sugar yoghurt (no bits), plain yoghurt, fromage frais. Ice cream (small portion).
Foods high in fibre/sugar and should be avoided: Muesli or nut yoghurts, yoghurts with whole fruit.
Food Group: Miscellaneous
Foods you may include: Plain or milk chocolate (50g). Crisps. Very thin spread of shredless marmalade or seedless jam. Very thin spread of lemon curd or honey. Marmite, smooth nut butter. Condiments e.g. tomato sauce, brown sauce, soy sauce, mayonnaise, stock cubes.
Foods high in fibre/sugar and should be avoided: Any chocolate containing fruit, nuts or seeds added. Popcorn. Marmalade with shreds, or jam with seeds. Crunchy nut butter. Treacle, syrup. Boiled or gum sweets, jelly babies, toffee, fudge, wine gums, mints, marshmallows. Fizzy and sugary drinks.
Is there anything else that I need to change in my diet?
The following dietary tips can also help to reduce your stoma/ fistula output:
- Sprinkle salt on your meals to help replace the salts lost through your stoma/fistula
- Use salt in your cooking
- Snack on salty foods e.g. crisps, cheese and biscuits, salty biscuits
- Eat slowly and chew your food well
- Avoid having drinks with your meals, leave a 30-minute gap
- Try to limit spices in your foods, plainer options may be better tolerated. Instead, use herbs, garlic puree or onion salt to add flavour
- Starchy carbohydrates may help to thicken up your output – make sure they are low fibre choices. For example, white bread; white rice or pasta; potatoes (without skins); chapatti
- Smaller, more frequent meals may be better tolerated. For example, 6 small snack meals may be better tolerated than a 3-course meal
It is important to continue to maintain a good balance in your diet, despite the restrictions that you have been advised on. This is to prevent any vitamin or mineral deficiencies and to prevent weight loss.
You may be advised to take a vitamin/mineral tablet on a daily basis. This will be decided by your medical team and dietitian.
Please tell us if you are taking over the counter vitamins and minerals or herbal remedies.
Do I need to change what I drink?
The amount and type of fluids you drink can have a big impact on your stoma/fistula output.
Drinks that contain sugar and those that are fizzy will increase the output as they encourage fluid to be pulled from your body into your bowel.
This extra fluid will increase your stoma/fistula output and increase your risk of dehydration.
See our video on our website:
Suggested drinks to choose:
- Water
- No added sugar squash/cordial
- Sugar free flavoured still water
- Decaffeinated tea or coffee (caffeine is a stimulant to the gut and can increase stoma/fistula output). Avoid adding sugar
- Pure fruit juice - no more than 150ml twice a day due to the sugar content
- Salted drinks e.g. Bovril or Oxo
It may be helpful to avoid drinking for 30 minutes before and after a meal to help to reduce your output.
Also limit alcoholic drinks as these can increase your output and thus worsen any dehydration.
What if I am on a fluid restriction?
You may be asked to limit your total intake of fluids each day as the more you drink, the more fluid you will lose from your stoma/ fistula. Not only do you lose fluid but also salts and magnesium.
For every 1 litre of output this equates to almost 2 tsp of salt being lost from your body and this is why you feel thirsty when you have a high output.
The temptation is to drink even more when you feel thirsty, but this will only result in more salts being lost, hence your doctor may need to prescribe extra intravenous fluids or if you are on intravenous feeding your parenteral nutrition will need to be reviewed.
Please remember that liquid foods e.g. soup, ice cream, jelly, ice lollies will count towards your fluid allowance.
Further advice on this will be given to you by your healthcare professional if necessary.
Do I need to take an oral rehydration solution?
Your healthcare professional may advise you to take an oral rehydration solution (for example double strength Dioralyte).
These drinks contain salt and cause fluid to move from inside your gut into the rest of your body, thus rehydrating you.
Further advice on this will be given to you by your healthcare professional if necessary, you can also see our videos on our website:
If I am losing weight, what can I do to fortify my diet?
Having a high output stoma/fistula and being on dietary restrictions can mean that some people lose weight unintentionally.
Here are some tips to help, but always speak to your dietitian if you are concerned:
- Choose full fat dairy products e.g. milk, cheese, yoghurts and cream
- Have high energy snacks in between meals e.g. crisps, biscuits, cakes, crackers and cheese, plain scones with seedless jam and cream
- Be sure to have protein with each meal e.g. meat, poultry, eggs, fish and cheese
- Add extra energy and protein to the foods you are already having e.g. add cream to your soup; add butter and cheese to potatoes/vegetables
- Add 2tbsp of dried skimmed milk powder to half a pint of milk to add additional protein and calcium
- Have a starchy food with each meal e.g. potatoes, white pasta, white rice, white bread and low fibre cereals
- Choose high energy desserts e.g. sponge/cake with custard or cream
Meal ideas
Breakfast:
- Rice Krispies with full fat or semi-skimmed milk
- Or white bread/toast with salted butter
- Or fried/scrambled/poached egg on white toast
- Or sandwich with grilled sausage/bacon/turkey rasher
Lunch:
- Sandwich with white bread/bagel/pitta/tortilla wrap and protein filling e.g. cheese, cooked meat, egg, tuna, salmon
- Or puréed/smooth soup with a white bread roll
- Or jacket potato (no skin) with butter and cheese, tuna mayonnaise
- Or pasta with passata and cheese, tuna, meat, and low fibre vegetables.
Evening Meal:
- Potatoes (no skin) or pasta or rice with protein source, e.g. chicken, fish, cheese, egg, red meat and low fibre vegetables (cooked and peeled root vegetables and broccoli/cauliflower with no stalks)
- Or Shepherd’s pie/lasagna/meat pie
- Or cheese omelette with diced and peeled potatoes
- Or cheese and tomato pizza
- Or MILD curry curry and rice/chapatti
- Or roast meat/poultry, potatoes, mashed carrot/swede, broccoli (no stalks) with gravy and Yorkshire pudding
Dessert:
- Sponge and custard
- Or yoghurt
- Or low fibre fruit
- Or cheese and crackers
Snack/Supper ideas:
- Crumpet with butter
- Or Cheese and crackers
- Or crisps
- Or plain biscuits
- Or yoghurt with low fibre fruit
- Or cake or plain scone
- Or toast and butter
Fluids:
- Water, no added sugar squash, tea/coffee
For further information or advice, please contact your dietitian:
Name:
Tel:
Contact details:
Intestinal Failure Unit - 0161 206 2845
Further information
Intestinal Failure Unit: intestinal failure unit (www.northerncarealliance.nhs.uk).
PINNT Patients on Intravenous and Nasogastric Nutrition Treatment (www.pinnt.com)
Date of Review: February 2026
Date of Next Review: February 2028
Ref No: PI_SU_1463 (Salford)