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We are working with Laura Clark, a registered dietitian with over 20 years experience in nutrition and dietetics. You can ask her a question and we will publish the most commonly asked questions on the 'you and your diet' pages.
In the initial stages after colostomy or ileostomy surgery, the output into your pouch will frequently be very loose and fluid, but this generally improves with time. In about six to eight weeks, your stoma will settle to a consistency that remains fairly constant. There are many foods that help thicken your output and our Secure StartSM advisors can help you with this.
Aim to drink six to eight glasses of fluid each day to make sure you don't get dehydrated. If you pass regular amounts of clear or pale, straw-coloured urine, you most likely have enough fluid in your system. If your urine becomes brown or dark yellow in colour, it's wise to drink more fluid to keep properly hydrated.
Once you are feeling better, and you have settled into more of a routine, you can start experimenting with your favourite foods. Generally most people can return to their pre-surgery diet with few, if any limitations.
Build a healthy eating style
All food and beverage choices matter - focus on variety, amount, and nutrition.
Grains
Any food made from wheat, rice, oats, cornmeal, barley or any other cereal grain is a grain product. This includes breads, breakfast cereal, and pasta. These are divided into whole grains and refined grains.
Whole grains contain the entire kernel. For example, oatmeal, brown rice, and whole meal flour are whole grains. Be sure to chew anything with seeds carefully and completely.
Refined grains have been milled to remove husks or fibre. These provide finer texture and include white flour, white rice, white bread, and pasta. A typical adult profile calls for three servings per day. One serving equals a slice of bread, half a cup of cooked cereal, half a cup of rice or pasta, or a cup of cold cereal.
Fruit and vegetables
Any vegetable or 100% vegetable juice counts as a member of this group. Vegetables may be eaten raw or cooked, fresh, frozen, canned, dried, whole, cut up, or mashed.
For vegetables, one serving equals about one cup. Depending on age, weight and gender, guidelines call for one to three cups of vegetables a day.
Any fruit or 100% fruit juice counts as part of this food group.
Fruit may be fresh, canned, frozen, dried, whole, cut up, or puréed. A serving of fruit equals one cup, and five servings per day are recommended. Fruit juice contains more sugars than just fruit; keep this in mind if you are watching your caloric intake. Overall, fresh whole fruit is a better choice.
Oils
Oils come from many different plants and fish. Examples are corn, olive, soybean, and sunflower oils.
Fats should be kept to a minimum. There are good fats and bad fats. Some fats contain high amounts of cholesterol, which can cause heart disease. Oils from plant sources do not contain any cholesterol. Fish oils are naturally good at reducing bad fats.
Oils include both solid fats and oils.
Solid fats are those that are solid at room temperature. Examples are butter, lard, margarine, and shortening.
Fats that are oils remain liquid at room temperature. Those that are mainly oils include mayonnaise and salad dressings. A number of foods with naturally occurring oils are nuts, olives, fish, and avocados.
Daily servings of fats and oils often come from the cooking processes, such as pan frying. A constant diet of deep fried food can be bad for you, but for most people there is no harm if it is done infrequently.
Dairy products
One of the primary benefits of dairy products is the calcium they contain.
Besides milk products, you can get the benefits of dairy through cheese, cottage cheese, yogurt, pudding made with milk, ice cream, and ice milk.
If you have lactose intolerance, there are milk alternative products available that are lactose free. Some cheeses and yogurts are lactose free as well. It’s always worth reading the packaging contents label to make sure.
You might consider soy milk and other soy products as dairy alternatives, but they may not contain the full array of nutrients that dairy products have.
Recommendations for dairy vary, but about three servings per day is optimal to maintain healthy bones and provide other essential nutrients. One serving equals a cup of milk, a pot of yogurt or a piece of cheese. With this many options, it is easy to get your daily intake.
Protein foods
All meat, poultry, fish, dried beans or peas, eggs, nuts, and seeds are considered part of this group. Protein is one of the most important nutrients supplied by this group.
Meat and poultry choices should be low-fat. Fish, nuts, and seeds contain healthy oils, so be sure to include them in your diet frequently.
If you have an ileostomy, be aware there have been occasions where a blockage occurs when nuts, popcorn, and other foods are eaten. Some people have been known to get a small blockage after only one nut. Be slow to introduce these into your diet. If you love eating nuts, make sure you chew them very well before swallowing. Another possibility is to choose nut spreads, such as peanut butter, cashew, or hazelnut spreads.
General recommendations for this food group would be five or six servings a day. A serving is approximately one egg, one tablespoon of peanut butter, a small handful of nuts or seeds, or 25 grams of meat.
Moderation - the key to healthy eating - is especially important with the oil group.
Foods and fluids which may help replace lost electrolytes
Sports drinks, bananas, broths (like chicken or beef bouillon), potatoes, tomatoes, crackers
Foods that may help to thicken loose output
Bananas, cheese, noodles (cooked), pretzels, white rice, white toast, marshmallows
Foods that can contribute to food blockage
Celery, corn, coconut, dried fruit, popcorn, chinese vegetables, nuts, mushrooms, grapes, raisins
Foods and fluids which increase intestinal wind
Beans, beer, carbonated beverages, broccoli, brussels sprouts, cabbage, onions, cucumbers
Foods which may increase output odour
Asparagus, broccoli, brussels sprouts, cabbage, cauliflower, eggs, fish, garlic, onions, some spices
Foods which can impact the colour of urine and stools
Beetroot, foods with food colourings, iron tablets, liquorice, tomato sauce, some medications
Wind
As your bowel begins to function after surgery, you will notice wind in your pouch. The amount of gas varies.
If you experienced excessive gas before your surgery, you will likely have similar problems after your surgery.
Gas can be caused by the foods you eat. It can also be the result of swallowing air. Drinking carbonated beverages, smoking, chewing gum, and chewing with your mouth open can all increase the amount of air you swallow.
If you are concerned about gas, you can use a pouch with a filter. The filter lets the gas out of the pouch, but not the odour. It also prevents gas from building up, so the pouch does not inflate like a balloon. Filters work best with a more formed discharge.
Diarrhoea
First, be sure that you are not unwell. If your stoma is too active, that is, if you need to empty your pouch once or twice every
hour, you may be losing far too much fluid.
If this suddenly occurs and it lasts 24 hours or more, you should seek medical attention.
If your stool changes to mostly fluid and there is a marked increase in the volume, you may have diarrhoea.
This could be related to food, medications, or an intestinal flu. During this time, you need to drink more fluids to prevent dehydration, avoid foods and beverages that cause loose stools, and empty your pouch more frequently. If this doesn’t resolve, contact your healthcare professional.
Foods known to increase stoma output are fibrous foods, raw fruit and vegetables, spicy foods, high fat foods, caffeine, nuts, and corn.
See the chart above for some other foods that can help thicken loose output.
Constipation
Just like a person without a stoma, constipation can be a common problem. A person with a colostomy, not ileostomy, is most likely to suffer from constipation. Increase the amount of water you drink if not on a fluid restriction diet. Foods that help naturally with constipation include:
Food blockage
If you have an ileostomy, cramping and abdominal pain along with watery diarrhoea or no stool output may indicate a food blockage or bowel
obstruction. This can occur when high fibre foods (such as raw vegetables, coconut, corn, nuts, dried fruit, and popcorn) have difficulty
passing through the intestine and exiting the stoma. Food blockage risk can be minimised by reducing high fibre foods, chewing foods
thoroughly, and increasing fluid intake. Your surgeon may recommend you eat only cooked (vs. raw) fruits and vegetables for about six
to eight weeks after surgery. This gives your body time to adjust to the changes in digestion.
If you have a colostomy, it might be constipation. This is of less concern but still should be monitored. There have been some foods in the past associated more frequently with blockages, but this does not necessarily mean it will always happen.
Note: If you have no output and have vomiting, it is important that you see your healthcare professional or phone 111.
*Applies to a faecal stoma
Try to develop a regular eating pattern
Create one that you can follow easily and does not restrict your lifestyle or the lives of those around you.
Take time to chew food thoroughly
Not only does slow eating help your stoma deal with what will eventually go through it, meal times will be more enjoyable and relaxing.
Try not to worry too much what could be good and bad for you
Moderation is the key.
Avoid eating a large meal later in the evening
This can make your pouch fill up more quickly overnight, and your
sleep will be interrupted as you need to empty it.
Avoid excessive amounts of alcohol
It can make you dehydrated and, depending on the type of stoma you have,
make you empty your pouch more frequently. Beer can contribute to larger amounts of gas as well.
Above all, food is an essential part of life, and it is an extremely pleasurable part of living. It provides a social and relaxed part of everyone's life. A stoma should not limit your enjoyment of sharing a meal with family and friends.
Your healthcare professional and your stoma care nurse will be very important resources for you in the days ahead.
You also have ongoing access to online information, or printed educational materials, at:
www.hollister.co.uk/en-gb/ostomycare/educationaltools
Ostomy support groups are also available to individuals who have had ostomy surgery. Here, you are able to interact with people who are facing many of the same challenges that you are. The ability to discuss issues with someone who understands what you are experiencing can be very beneficial.
Ileostomy Association
Freephone: 0800 018 4724
Email: info@iasupport.org
Web: https://.iasupport.org
Colostomy UK
Admin line: 0118 939 1537
24 hour Helpline: 0800 328 4257
Email: info@ColostomyUk.org
Web: www.colostomyuk.org
Urostomy Association
Tel: 01386 430140
Email: info@urostomyassociation.org.uk
Web: www.urostomyassociation.org.uk
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