The short answer
Colostomy, ileostomy, and urostomy each need a different routine. StatPearls reports stoma complications in 10% to 70% of patients, and calls ileostomy output above 1.5 L a day excessive.
StatPearls puts typical ileostomy output near 600 mL a day, with a usual range of 500 to 700 mL, and calls output above 1.5 L excessive because of dehydration risk.
StatPearls reports that 10% to 70% of people with a stoma develop a complication such as parastomal hernia, prolapse, retraction, stenosis, or ischemia.
StatPearls says the barrier opening should be no more than 1/16 to 1/8 inch larger than the stoma, and describes a healthy stoma as moist, pink to red, and above skin level.
NCI reports diarrhea rates as high as 50% to 80% with fluoropyrimidine- or irinotecan-containing regimens, and says people with colostomies should be assessed for constipation.
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The full explanation.
Which ostomy you have changes almost everything
The word covers three different operations, and the daily routine is not the same for any two of them.
A colostomy brings the colon to the skin. Output depends on which part of the colon was used. StatPearls describes ascending and transverse colostomies producing loose, oatmeal-like stool, descending colostomies producing a paste, and sigmoid colostomies producing stool that looks nearly normal.
An ileostomy brings the small bowel out, upstream of the colon. The colon reabsorbs water, so bypassing it means output stays liquid or pasty. Expect to empty the pouch 5 to 8 times a day.
A urostomy drains urine. A surgeon uses a short piece of intestine as a channel and attaches the ureters to it. Because it is built from bowel, some mucus in the urine is normal, and so is minor bleeding at the stoma.
Ask your surgeon in writing which one you have and whether it is permanent or meant to be reversed. That single answer drives supply orders, insurance codes, and diet.
What a healthy stoma looks like
Moist. Pink to red. Sitting above the skin line. That is the baseline you are comparing against every time you change the pouch.
Complications are common enough to plan for. StatPearls reports that 10 to 70 percent of patients develop a stoma complication, including parastomal hernia, prolapse, retraction below the skin, stenosis, which means the opening narrows, and ischemia, which means the blood supply is cut short.
Fitting the barrier is the whole game
Most skin problems trace back to one measurement. The opening you cut in the skin barrier should be no more than one sixteenth to one eighth of an inch larger than the stoma. Any wider and stool sits on skin. Any tighter and the barrier rubs the stoma.
Measure again every few weeks in the first months. Stomas shrink as swelling settles.
Press the barrier in place and hold it for 1 to 2 minutes. Body heat softens the adhesive and sets the seal. Plan to change the whole appliance every 5 to 7 days, and empty the pouch when it is about one third to one half full. A heavy pouch pulls the barrier off the skin.
For skin, MedlinePlus is specific. Wash with warm water and pat dry. Dab, do not scrub, and skip the soap. Skip alcohol-based products, which dry the skin, and oil-based products, which stop the pouch from sticking. If hair stops the pouch sticking, MedlinePlus suggests trimming scissors, an electric shaver, or laser hair removal, and says not to use a straight edge. Ask your ostomy nurse before shaving the area.
Output volume is the number that matters most
Write it down. A normal ileostomy puts out about 600 mL a day, usually somewhere in the 500 to 700 mL range, and roughly half that if you are not eating. StatPearls calls output above 1.5 L excessive and flags those patients as prone to dehydration.
MedlinePlus advises 6 to 8 cups of fluid daily, which is 1.5 to 2 L, and notes ileostomy raises dehydration risk. Ask your own team for your target, since a high-output stoma needs more, and plain water alone may not replace what you are losing.
Chemotherapy changes the math
This is where an ostomy stops being a stable routine. NCI reports diarrhea rates as high as 50 to 80 percent with fluoropyrimidines, the class that includes fluorouracil and capecitabine, and with irinotecan. Radiation to the abdomen, pelvis, or rectum can cause radiation enteritis, a bowel disorder that appears during or after treatment.
Two problems follow. First, an ileostomy already loses fluid, so added diarrhea moves you toward dehydration much faster than it would someone with an intact colon. Second, grading is harder to pin down. The scale NCI reproduces grades diarrhea by stools per day above baseline, with grade 3 set at an increase of 7 or more daily plus hospitalization indicated. It also grades ostomy output, but only as a mild, moderate or severe increase over your baseline, with no volume attached. So the grade depends on knowing your usual volume. Ask your oncology nurse to record millilitres per 24 hours and to write your personal call threshold in the chart.
Colostomies swing the other way. NCI notes that patients with colostomies should be assessed for constipation, looking at diet, fluids, activity, and opioid use. Opioid pain medicine after cancer surgery is a frequent culprit.
Pills that stop working
An ileostomy shortens the road a tablet travels. MedlinePlus states that medicines with a special enteric coating are not absorbed properly, and that liquid forms are preferred. It also warns that birth control pills may not be absorbed reliably. Bring every bottle, including antinausea and pain medicines, to your pharmacist and ask which need a different form.
Food, gas, and blockage
Introduce new foods one at a time. Eat 5 or 6 small meals on a schedule, chew well, and skip gum and straws, which push air into the pouch.
MedlinePlus names foods that drive odor: onions, garlic, broccoli, asparagus, cabbage, fish, some cheeses, eggs, baked beans, Brussels sprouts, and alcohol. Parsley, yogurt, and buttermilk help. Gas producers include cucumbers, radishes, sweets, melons, beer, and carbonated drinks.
Blockage is the one that lands people in the emergency department. Warning signs are sudden cramping, a swollen stoma, nausea, and thin watery output. Nuts, seeds, corn, popcorn, and raw pineapple are the classic offenders. Hot tea may help move things. Call if nothing comes out of the stoma for 4 to 6 hours.
Call the same day for any of these
- Stoma turns purple, black, gray, or white
- Stoma swells more than half an inch beyond its usual size, or pulls below skin level
- No output for 4 to 6 hours with cramping or nausea
- Dry mouth, much less urine, or lightheadedness when standing
- Ileostomy output above 1.5 L in 24 hours
- Bleeding beyond a light smear, or foul-smelling drainage
- Temperature of 100.5 degrees Fahrenheit — 38 °C is 100.4 °F; act at 100.4 °F — or higher during chemotherapy, which is CDC's fever threshold for possible infection
- Skin around the stoma is raw, blistered, or bleeding
Ask for a referral to a wound, ostomy, and continence nurse, often listed as a WOC nurse. This is their specialty, and a single fitting visit fixes most chronic leaks.
Sources
- https://medlineplus.gov/ency/patientinstructions/000071.htm
- https://medlineplus.gov/ency/patientinstructions/000070.htm
- https://medlineplus.gov/ency/patientinstructions/000074.htm
- https://medlineplus.gov/ency/patientinstructions/000477.htm
- https://www.ncbi.nlm.nih.gov/books/NBK565910/
- https://www.ncbi.nlm.nih.gov/books/NBK560503/
- https://www.cancer.gov/about-cancer/treatment/side-effects/constipation/gi-complications-hp-pdq
- https://www.cancer.gov/about-cancer/treatment/side-effects/infection
Words to know
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Common questions
How much ileostomy output is too much?
StatPearls describes typical ileostomy output as about 600 mL a day, usually in the 500 to 700 mL range, and about half that when you are not eating. It calls output above 1.5 L a day excessive and says those patients may be prone to dehydration. Ask your own team what number should prompt a call.
Why does chemotherapy matter more when you have an ileostomy?
NCI reports diarrhea rates as high as 50% to 80% with regimens containing fluoropyrimidines or irinotecan. An ileostomy already loses fluid because the colon is bypassed, so added diarrhea moves you toward dehydration faster. NCI's grading scale counts both stools per day and increase in ostomy output over your baseline, so your team needs to know your usual volume.
Do my medicines still work the same way?
Not always. MedlinePlus says medicines with a special enteric coating are not absorbed well after an ileostomy, that liquid forms may work better, and that birth control pills may not be absorbed reliably. Bring every bottle to your pharmacist.
What is an emergency with a stoma?
MedlinePlus says to contact your provider right away if nothing comes from an ileostomy for longer than 4 to 6 hours, which can mean a blockage, and to call if the stoma turns purple, black, or white, pulls below skin level, or bleeds more than usual.
Questions to ask your doctor
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Sources last checked: 2026-07-21 what this meansLast updated: 2026-08-20Next planned review: 2028-07-21
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How this page was created
Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes. We do not employ clinicians and do not intend to — our work is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and checked line by line against the sources listed on it. That confirms the sources support what the page says. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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