Many people are surprised to learn that it is still possible to experience constipation after having a colostomy. Although your bowel now empties through a stoma, the large bowel continues to function much the same way as it did before surgery. If stool moves more slowly through the bowel, it can become harder, drier and more difficult to pass.
Understanding the signs of constipation and knowing what steps to take can help keep your colostomy working comfortably and regularly.
The symptoms are often similar to those experienced before surgery and may include:
- Hard, dry stool in your pouch
- Reduced stoma output
- Less frequent bowel movements than normal for you
- Abdominal discomfort or bloating
- A feeling that your bowel is not emptying properly
Because everyone’s stoma output pattern is different, it is important to become familiar with what is normal for your own body.
What causes constipation with a Colostomy?
Many of the causes of constipation are the same as before you had a stoma. These include:
- Certain medications
- Not drinking enough fluids
- A diet low in fibre
- Reduced physical activity
- Changes in routine or travel
- Illness or dehydration
If constipation develops gradually, reviewing your usual eating, drinking and activity habits can often help identify the cause.
How to relieve constipation with a Colostomy
1. Increase Your Fluid Intake
One of the most effective ways to manage constipation is to ensure you are drinking enough fluids.
Aim for approximately 1.5 to 2 litres of fluid per day, unless you have been advised otherwise by your healthcare team.
Some hydration choices include:
- Water
- Cordial
- Fruit juice
- Oral hydration drinks if recommended
Try not to rely too heavily on caffeinated drinks such as tea and coffee, as excessive caffeine can contribute to dehydration in some people.
2. Eat foods that naturally stimulate bowel function
Certain foods may help encourage regular bowel activity and soften stools, particularly fresh fruit and vegetables or prunes and prune juice.
Introducing these foods gradually may help improve bowel regularity without causing excessive wind or discomfort.
3. Stay active
Regular movement helps stimulate bowel function by encouraging stool to move through the digestive tract. Even gentle activities can make a difference, try walking and stretching as a starting point.
If you are recovering from surgery, follow the activity recommendations provided by your healthcare team.
4. Increase fibre gradually
For many people with a colostomy, increasing dietary fibre can help relieve constipation, introduce/increase this gradually. Some good fibre sources are fruit and vegetables, legumes and wholemeal or wholegrain based foods.
It’s essential to ensure your fibre increase is accompanied by adequate fluid intake. Adding large amounts of fibre without enough fluids can sometimes worsen constipation.
Could your medication be causing constipation?
Some medications can slow bowel function and contribute to constipation. It’s important to check with your GP or pharmacist about your medications. Some pharmacies in Australia also offer a MedsCheck review which is something to consider if you are taking 5 or more medications together. Types of medications that may contribute to constipation are some pain medications, iron supplements and certain antidepressants.
If you think a medication may be affecting your stoma output, speak with your GP before making any changes to your treatment.
When to consider a laxative?
If dietary and lifestyle changes do not improve your symptoms, a gentle laxative may sometimes be recommended to help soften stool and make it easier to pass through your colostomy.
There are different types of laxatives designed to act in different ways, and not all laxatives are suitable with a stoma, so it is important to seek advice and gain appropriate recommendation based on your medical history.
When should I seek medical advice?
As mentioned above, if you are considering a laxative or a change in medication you must speak with your GP or STN. Importantly if you have ongoing constipation despite self-care
