Living with an ostomy comes with adjustments, and one of the most critical considerations is how medications interact with your altered digestive system. Your body may process medications differently depending on whether you have a colostomy, ileostomy, or urostomy. Some people may experience challenges with absorption, causing drugs or supplements to lose efficacy. Understanding these changes and your risk can help you manage your health more effectively while avoiding complications. Here, we'll go over everything you need to know about taking medications while living with an ostomy and some best practices to ensure your treatment goes well.
How Do Ostomies Affect Medication Absorption?
Although some ostomies may change how your body processes medications, not everyone who undergoes an ostomy surgery will face challenges. A colostomy, which diverts stool from the colon, generally does not affect medication absorption unless there is a digestion issue. This is because a colostomy only involves the bowel, whose primary responsibility is eliminating waste (i.e., fecal matter). A urostomy, which diverts urine rather than stool, does not impact medication absorption either, but certain medications may still affect urine output or stoma health.
However, an ileostomy can pose challenges. The small intestine plays a crucial role in absorbing nutrients and medications, so if a large portion is removed, some medications may pass through the digestive tract too quickly to be fully absorbed.
Different Types of Medications That May Be Affected
Since some types of ostomies change the length of your intestinal tract, the transit time of medications is shortened. However, this isn't always the case and depends on the circumstances of your surgery. Additionally, not all supplements and prescriptions are affected by this. To prioritize ostomy care, it's important to understand how your surgery may impact certain medications.
Extended-release (time-release) and enteric-coated tablets are designed to dissolve slowly as they travel through the digestive system. In people with an ileostomy, these medications may pass through the body too quickly, reducing their effectiveness. Ostomates who have undergone a colostomy or urostomy don't typically have issues taking these medications since the small intestine isn't affected. Many doctors instead recommend liquid medications and chewable tablets, as they dissolve quicker and are absorbed into the small intestine more efficiently.
You may also need to prepare for some changes in stoma output when taking antibiotics. Some antibiotics can disrupt gut bacteria and cause changes in stool consistency, while certain pain medications, particularly opioids, can lead to constipation or blockages. Your doctor or pharmacist can help you better understand what to expect so you can prepare accordingly.
Finally, all individuals with an ostomy should be cautious when using laxatives, as they can cause dehydration or electrolyte imbalances. Similarly, anti-diarrheal medications like loperamide may be necessary for controlling high-output stomas but should be used under medical supervision. Don't hesitate to ask your ostomy nurse or another healthcare professional if you have any questions.
Common Medication Concerns for People With an Ostomy
Ostomates often have medication concerns due to changes in their digestive or urinary system. Some key concerns include the following:
Dehydration
Some medications, such as diuretics and certain laxatives, increase fluid loss, which can be problematic for those with an ileostomy who are already at higher risk of dehydration. Your doctor will discuss the importance of maintaining adequate hydration with an ostomy, which is even more important when taking medications.
Vitamin and Nutrient Deficiencies
The middle of the small bowel is where most of the absorption of vitamins and nutrients are absorbed. These nutrients typically come from carbohydrates, fats, minerals, proteins, and vitamins but can also be from supplements and other medications. Depending on the type of stoma surgery you've undergone, your body may not have the same ability of long-term gradual absorption along the intestinal tract.
Some individuals may be deficient in nutrients due to a short bowel. The most common deficiency is with vitamins like B12, iron, and fat-soluble vitamins (A, D, E, and K). Your doctor will work with you to test your vitamin and nutrient levels and recommend any additional supplements that need to be taken orally.
Stoma Health
Certain drugs may increase the risk of bleeding from the stoma. Although minor bleeding is usually okay, excessive or persistent bleeding should be checked by your doctor. Individuals may also develop a reaction to medications that affect skin sensitivity, which can irritate the peristomal skin or stoma.
Some medications, including chemotherapy drugs and blood thinners, may cause irritation, swelling, or a change in the color of the stoma. If the stoma appears pale, darkened, or inflamed, it’s important to consult a healthcare provider.
Loose Stools
New ostomates may experience loose stool for several weeks after undergoing surgery. This is usually normal during the healing process, but if diarrhea persists, you may be tempted to take a medication like Imodium. However, before reaching for medication, it's important to consider your diet and give your body time to settle. Patients with an ileostomy might find that some foods increase the risk of gastrointestinal issues, and keeping a food diary can help reduce the risk of these types of problems.
Imodium should only be used if you experience chronic loose stools and are unable to control things with diet. Your doctor will help you determine when to start this. Another similar type of pill is Lomotil, which is only available by prescription. You should also be aware that if you happen to take Pepto Bismol, your feces will likely be black. This is a normal side effect, and there is nothing to be alarmed about.
Interactions With Ostomy-Related Conditions
Some medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can increase the risk of stomach irritation and ulcers, which may be problematic for those with certain digestive conditions that led to the ostomy in the first place. Regardless of if you're taking over-the-counter drugs, prescriptions, or supplements, it's always best to consult with your doctor. Potential side effects from certain medications may occur, and if you notice something causes problems, finding an alternative may be a better option.
Tips for Safe Medication Use With an Ostomy
Managing medications safely with an ostomy requires proactive strategies. Before starting or changing any medication, talk to your doctor about how it might be affected by your ostomy. A pharmacist can also recommend alternative formulations if needed.
Some doctors may recommend that ostomates empty contents of a medicine's capsule into applesauce or other food sources to maximize absorption. However, not all medications can be taken this way, and some may cause serious side effects. To make sure that you're staying safe with prescription drugs and vitamins, always talk to your doctor and follow their instructions.
Other tips to help with medication use include:
- Choosing liquid medications, dissolvable tablets, patches, or injections instead of things like enteric-coated tablets or extended-release capsules
- Keep an eye on your stoma output to check if any undissolved pills appear in the pouch
- Track medication intake and any side effects you experience
- Undergo tests with your doctor to evaluate the effectiveness of a new medication
Medication Tips When Traveling With an Ostomy
Living with an ostomy requires making some adjustments to life now and then, but that doesn't mean you can't do the things you love. If you're an avid traveler, the key is ensuring you have enough supplies and are prepared when away from home. Medication management is important to overall health, especially if you're treating inflammatory bowel diseases (IBD) like ulcerative colitis or Crohn's disease. So, if you're planning a trip, talk to your doctor about stoma care and how to avoid medication interruptions.
Ideally, your doctor should be able to prescribe you enough medication to cover the duration of your trip, plus a little extra just in case of a delay. If you're traveling internationally, it's recommended to check regulations for carrying prescription medication and ask your doctor about creating a backup plan for refills while you're gone.
You may also need a portable cooler or insulated pouch if your medications require refrigeration. Check the TSA regulations to confirm how to pack these types of bags accordingly.
To help ensure you've got everything you need to care for your stoma and keep your body healthy, partner with Byram Healthcare. We carry a wide range of high-quality ostomy products to help you navigate the changes after surgery. Contact us today to learn more.
