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Diet after stoma surgery

Published 2nd April 2019 by Sorin Tudorut

Eat well and enjoy your food

Eating well is a big part of living life on your own terms. The good news is having a stoma should not stand in the way of enjoying good food!

Contrary to belief, there are no set dietary rules for people living with a stoma. It may just take a bit of time to find out what works for you. However, a balanced and nutritional diet should include the following:

  • Fresh fruit and vegetables
  • Protein (meat, fish, cheese, eggs and pulses)
  • Carbohydrates
  • A reduced alcohol intake
  • Reduced saturated (animal) fats
  • Low salt and sugar

Remember that during the first 2 months following the surgery, your body is working hard to heal itself and this will require you to take in enough protein to help with tissue repair, and calories to help with increased metabolism during the healing process. Eggs, fish and lean meat are a good source to consider. Once your bowel is in recovery and you have the “OK” from your healthcare team, you can eat what you like, when you like.

Here are some general guidelines:

  • Eat regularly
  • Drink plenty of fluids
  • To avoid blockages, chew your food well
  • Ask your stoma nurse or a dietician if you need to take vitamins
  • After surgery, try new foods one at a time, in small quantities. If there is a problem (such as gas), you can make simple adjustments that work for you.
  • Most importantly, enjoy your food!

Diet troubleshooting

Diarrhoea

Take note of your usual output consistency which for bowel stomas will be either ‘porridge like’ or semi-formed. If you notice an increase in frequency, a watery consistency where your pouch is filling more than usual and/ or a change in the colour from brown to green it is important to keep well hydrated. If the diarrhoea doesn’t settle or has an offensive smell and you feel unwell, please consult your GP who may send a stool sample off for testing.

Eating regular meals or a smaller portion more frequently can help with absorption in the bowel.

There are certain food groups that can help to thicken loose output, foods that are high in starch (soluble fibre) such as potatoes, white bread, rice, pasta, noodles & cereals. Foods containing caffeine, sugar or chilli can have laxative effects as these are bowel stimulants. This is very individual so try different things and see what works for you.

However, depending on how much bowel is left after your surgery you may experience a watery output due to the limited amount of bowel to provide absorbency. If you have been told it’s a high output stoma, your Stoma Care Nurse or GP will help you manage this, possibly with anti-diarrhoea medication & hydration drinks.

Constipation (not relevant for ileostomy)

Constipation can affect people with a urostomy since part of your bowel has been removed during your surgery and also people with a colostomy. If you notice that your stool is hard or ‘pellet like’ and you haven’t passed a motion for a while (24-48 hours depending on your usual frequency) you may be constipated.

Tips to help avoid constipation

  • Ensure that you are keeping well hydrated
  • Eat small regular meals
  • Try to move around & keep active (if possible)

If necessary, your GP or Stoma Nurse may prescribe a mild laxative. Some people experience constipation if they have a slow transit time and will benefit from foods high in fibre and may need some mild laxatives to help.

If you are prone to constipation but notice a very watery / loose output with your colostomy pouch filling up frequently but feel slightly bloated, you may have ‘over flow’. This occurs when the bowel is full of constipated motion and only liquid manages to get through.

This would need to be managed as constipation NOT diarrhoea. It is important to seek advice if you think that this is happening to you.

‘Pancaking’ occurs when the output accumulates at the top of the colostomy pouch & appears quite thick and sticky. If this is a problem for you after following the advice above you may want to try and make sure there is air in the pouch on application or adding lubricating oil into the top of the pouch, avoiding the filter. There’s also a technique called bridging where small pieces of foam are inserted into the top of the pouch, this is a customisation offered by Amcare.

WATCH OUT!

Some medications & painkillers sometimes increase the risk of constipation. You may want to contact your Stoma Care Nurse or GP to review your medications.

Blockages (primarily for those with ileostomy)

Certain foods are known to be more difficult to digest such as those containing insoluble fibre like nuts, grains, fruit & vegetables (particularly their skins). You may see them passing through into your bag. These foods shouldn’t be excluded from your diet but you may want to cook them more thoroughly & most importantly chew them thoroughly. Chewing is the first stage of digestion; it is vital in releasing the nutrients but also aiding digestion.

Immediately after bowel surgery your bowel may be swollen which narrows the passageway, in addition to this, people who have had any kind of abdominal surgery can have adhesions or scar tissue which can possible cause narrowing or kinking of the bowel. If you notice that your bag hasn’t filled for a while and you feel bloated, nauseous or vomit you may have a blockage in your bowel. You may need to contact your Stoma Care Nurse or GP if the symptoms persist will settle as your body heals.

Wind

Wind or gas in the bowel is quite normal and is all part of the digestive process but you may find it more noticeable when wearing a pouch. Some people naturally produce more gas than others and some foods are known to cause an increase in gas. As everyone is individual it is advisable to have an awareness of any foods which affect you.

If you chew your food slowly and try not to ingest too much air when eating this may help reduce excess gas. It may also help to take fluids before and after eating rather than during a meal. You may notice ‘ballooning’ of the pouch when you have excess gas for the filter to release. Two-piece products can allow the gas to be released without having to remove the pouch. If you need advice on two-piece pouch systems available, contact our product specialist team who will be happy to help.