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Stoma re-feeding or recycling

What is stoma re-feeding?

Stoma re-feeding (also known as recycling) is the process of collecting stool (poo) from your baby’s functioning stoma (ileostomy or jejunostomy) and returning it back to your baby via their mucous fistula (non-functioning stoma). This may sound a little scary but ordinarily our poo would travel the whole length of our bowel. In children with stomas, this process is cut short. By re-feeding the stool we can mimic our bowels natural process.

Who benefits from stoma re-feeding?

  • Infants with short bowel.
  • Infants with high stoma losses limiting the amount of milk they can have.
  • Infants with poor weight gain.
  • Infants with jaundice due to TPN.
  • Infants with electrolyte imbalance (salts, sugars and potassium).

How does stoma re-feeding help?

Re-feeding the stool from the ileostomy or jejunostomy into the lower bowel allows the nutrients (salts, sugars and potassium) in the stool to be absorbed. It also stimulates the growth of the lower bowel and helps it adapt to processing stool as it normally would.

This is highly beneficial for when your baby is ready to have their stoma closed. If stoma re-feeding is successful, your baby will be able to have more milk feeds and the amount of TPN and other IV fluids will be reduced.

How are stoma losses re-fed?

Your baby will either have a stoma bag on their ileostomy or jejunostomy, or a tube inserted into their stoma and another tube passed into their mucous fistula.

Every 2 to 3 hours we will collect the stool from the stoma bag or drainage bag, and either slowly push the stool into the mucous fistula using a syringe or by using the stool collected in a syringe and attaching it to a tube that will then slowly infuse via a pump into the mucous fistula. The stool will travel through the lower end of the bowel to the rectum.

To begin with, the amount of stool re-fed will be 1 to 2mls per hour. If this is tolerated and your baby starts to poo into their nappy, the amount of stool re-fed will be increased. We may do a test before re-feeding called a ‘contrast’ to check there are no blockages in the lower bowel.

What are the risks?

There are possible risks and complications to stoma re-feeding. Your baby will be monitored closely and stoma re-feeding will be paused or stopped, with any of the following signs:

  • Trauma caused by passing the tube into the mucous fistula resulting in bleeding or perforation.
  • Leakage of the stoma losses from the stoma bag or mucous fistula tube. This can make the skin sore surrounding the stoma bag and we are unable to assess amount of stool being lost or infused.
  • Infection or blockage. This can result in abdominal swelling, redness, vomiting, temperature and discomfort.
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Please note this is a generic information sheet relating to care at Sheffield Children’s. The details in this resource may not necessarily reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If you have specific questions about how this resource relates to your child, please ask your doctor.

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