A bowel obstruction, or blockage, can disrupt the normal passage of fluids, gas, and food through the intestines. In cases where the obstruction is severe, surgery may be necessary to relieve the blockage. This article provides comprehensive dietary guidelines for individuals recovering from intestinal obstruction surgery to support healing and prevent future complications.
Understanding Your Bowels
Your bowels, comprising the small and large intestines (colon), play a crucial role in absorbing nutrients from food and liquids. The small intestine, approximately 15 to 20 feet long, is divided into the duodenum, jejunum, and ileum, each responsible for specific aspects of nutrient digestion and absorption, including carbohydrates, proteins, fats, vitamins, and minerals. The colon, about 5 feet long, primarily absorbs water and minerals.
Bowel Resection and Its Effects
A bowel resection, also known as a colectomy, involves removing a diseased or obstructed portion of the large intestine. When a part of the bowel is removed, the remaining section adapts to compensate for the loss. It takes time for the remaining bowel to adapt after surgery, usually a few months, but everyone's body heals differently.
Short Bowel Syndrome
Short bowel syndrome is a set of symptoms that happen while your remaining bowel adapts after your surgery. You can reduce these symptoms by following the guidelines in this resource.
Initial Post-Operative Diet
Immediately following bowel resection, patients are typically restricted to a liquid-only diet. Clear fluids like water, tea, or broth are generally recommended right after surgery. This allows the digestive system to rest and begin the healing process. As tolerance improves, other fluids such as juices, milk, and nutritional drinks may be introduced.
Read also: The Hoxsey Diet
Transitioning to Solid Foods
When the healthcare team determines readiness, the gradual reintroduction of solid foods is recommended. It is advisable to start slowly with foods that are soft, low in fiber, and unlikely to cause constipation, nausea, or gas. Examples include:
- Smooth yogurt
- White bread, rice, and pastas
- Smooth soups (without beans)
- Mashed potatoes (without skins)
- Well-cooked vegetables
- Lean proteins such as eggs and fish
- Crackers
- Bananas, peeled apples, or pears (avoid citrus fruits, grapes, and berries)
Eating small meals spaced throughout the day is often beneficial. Reintroducing foods slowly helps monitor tolerance and prevents intestinal upset.
Foods to Limit or Avoid
Certain foods can irritate the digestive system or worsen post-surgical side effects. Here are specific recommendations:
High-Fiber Foods
Limit fiber intake, especially insoluble fiber found in whole-grain and bran products. Insoluble fiber doesn’t break down in water and your body can’t break it down, so it makes stool (poop) more bulky. Since the large intestine is healing, a low-fiber diet (sometimes called “low-residue” by doctors) for 4 to 6 weeks can aid recovery.
Raw Produce
Uncooked fruits and vegetables are high in fiber. They can be crunchy (like carrots) or stringy (like celery) and hard to chew into small pieces. They might have tough skins (like apples) or seeds that are hard to digest. All of this can irritate your large intestine as it heals. Avoid these foods for a few weeks as you recover, then slowly add them back into your diet.
Read also: Walnut Keto Guide
Fatty and Greasy Foods
It’s common to have diarrhea after a bowel resection. Fatty meats, butter and cream, fried foods and greasy snacks like potato chips can make diarrhea worse.
Spicy Foods and Coarse Seasonings
Spicy foods can irritate your digestive system and cause diarrhea or uncomfortable bloating -- especially as your intestine heals. Herbs and spices with rough textures -- like chopped rosemary, crushed peppercorns, or caraway seeds -- can also cause problems.
Beans and Dairy
There’s a type of sugar in beans that isn’t easy for your body to digest. So you might have gas or feel bloated after you eat them. You may also have trouble with lactose, a sugar found in milk and other dairy products. Gas is a normal part of digestion, but while you’re healing from bowel surgery it can be uncomfortable or even painful.
Caffeine and Sugary Drinks
Caffeine, which can be found in both coffee and soda, is a stimulant. That means it speeds up activity in your body -- including the intestines. Drinks made with sugar or artificial sweeteners can also bring on diarrhea. The bubbles in soda may cause gas and bloating. It’s important to stay hydrated after surgery, but water (or a special rehydration drink) is a smarter choice.
Alcohol
Alcohol can stimulate your intestines and cause more frequent bowel movements. Avoid it until your digestion is back to normal. Plus, most doctors say not to drink alcohol after any type of surgery. It can interfere with your pain meds and slow the healing process.
Read also: Weight Loss with Low-FODMAP
High oxalate foods
If you have fat malabsorption (trouble absorbing fats from foods), you may develop kidney stones. Limit eating foods that are high in oxalates, such as spinach & rhubarb.
General Dietary Recommendations
Eat Small, Frequent Meals
Eat 6 to 8 small meals a day Eat small, frequent meals to put less stress on your shortened bowel. Small meals help control your symptoms and are easier for your body to digest and absorb. Eat slowly and chew your food well. Once your bowel has adapted, you can go back to having 3 meals a day.
Chew Food Thoroughly
Chew foods well to help break down food. This makes it easier for your body to absorb. It will also help stop foods from causing a blockage as they pass through your intestine.
Limit Liquids During Meals
Only drink ½ cup (4 ounces) of liquids during each meal Drink large amounts of liquids with meals. This helps push your food through your bowel more quickly. This means that you may not digest or absorb enough nutrients.
Macronutrient Balance
High in proteins. High in refined or low-fiber complex carbohydrates (starches). Moderate in fats. Examples of fatty foods are: Oils, Butter, Margarine, Mayonnaise, Gravies, Cream sauces, Regular salad dressings. For example, it’s okay to have butter on toast or mayonnaise on a sandwich. Low in sugary foods. Examples of sugary foods are: Sugar (cookies, cakes, candies, chocolate, soda, instant teas, fruit drinks), Corn syrup, Molasses, Honey, Pancake syrup. You can use artificial sweeteners like Splenda® or Sweet N’ Low®. However, limit your intake of sugar-free candies or cough drops that contain sugar alcohols. Sugar alcohols include sorbitol, xylitol, mannitol, and isomalt.
Stay Hydrated
Choose drinks that don’t have a lot of sugar. This will keep you from getting dehydrated. Examples include water, coffee, tea, milk, or juices diluted with water.
Address Lactose Intolerance
Lactose is a sugar that’s found in dairy products. It can cause symptoms such as gas, cramps, and diarrhea. These symptoms usually start within the first 30 minutes of eating or drinking dairy. Sometimes, having part of your bowel removed can make you lactose intolerant. To see if you can tolerate lactose, drink one half cup (4 ounces) of milk. If you have any symptoms, try lactose-free dairy products, such as Lactaid® milk or almond, rice, or soy milk. You can also use Lactaid® tablets or Lactaid® drops before you eat dairy items to help you digest them. Some foods have less lactose than others. If you can’t drink dairy milk, try cultured yogurt and aged cheeses. These include hard cheeses such as cheddar and Swiss. If you can eat those, try soft cheeses, such as cream cheese and cottage cheese. If you still have symptoms, try to avoid all dairy products for 1 to 2 months before trying them again.
Vitamin and Mineral Supplementation
You’re probably not eating some of the foods you did before your surgery. You may choose to take one multivitamin each day. This can help you get all of the vitamins and minerals you need. The multivitamin should have the recommended daily allowance (RDA) for vitamins and minerals. You may also need more of certain vitamins or minerals. Ask your doctor or clinical dietitian-nutritionist what to take. Vitamins A, D, and E. You may need water-soluble forms of vitamins A, D, and E. Vitamin B12. Calcium. Potassium. If you’re having a lot of diarrhea, your potassium levels may go down. Ask your doctor or clinical dietitian-nutritionist if you should eat foods that are high in potassium. These include oranges, potatoes, tomatoes, and bananas. Don’t take potassium supplements without talking to your doctor first.
Oral Rehydration Solutions
If you’re having a lot of diarrhea, your doctor or clinical dietitian-nutritionist may recommend you drink an oral rehydration solution. This will give you back the liquid, sodium, and potassium lost with your bowel movements. You can buy an oral rehydration solution, such as Hydralyte®, from your local pharmacy. This isn’t the same as sports drinks, such as Gatorade®, which don’t have the same amount of nutrients. You do not need a prescription for an oral rehydration solution.
Liquid Nutritional Supplements
If you’re losing weight, a high-calorie liquid nutritional supplement may be helpful. However, depending on your surgery, some supplements may not be right for you. This is mainly because they have a high sugar content. Your doctor or clinical dietitian-nutritionist may recommend a special supplement for you. These supplements are low in sugar and has ingredients that are “pre-digested.” This makes them easier to absorb. They may also recommend medium chain triglycerides (MCT). This is a type of fat that’s easy to digest for extra calories. Always ask your doctor or clinical dietitian-nutritionist before taking a supplement.
Monitoring Progress
Keeping a food diary is a helpful way to find out what foods are best for you. If you have an ileostomy or colostomy, it’s also helpful to record your output from your stoma. Measure the amount of stool in your bag for 1 week. Measure it each time you change or empty the bag. Then, if it’s about the same each day, measure it once a month for 1 or 2 days.
Long-Term Dietary Considerations
Once digestion improves, patients can gradually reintroduce regular foods. Add one new type of food each day to monitor how the body reacts. This gradual process also allows the intestines to adjust to digesting higher-fiber foods, such as fruits, vegetables, and whole grains.
Preventing Future Obstructions
Bowel blockage (obstruction) may be prevented by doing several things. Try eating smaller meals more often throughout the day. Chew your food very well. Try to chew each bite until it is liquid. Avoid high-fiber foods and raw fruits and vegetables. Drinking plenty of water may help. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink. Your doctor may ask that you drink high-calorie liquid formulas if your symptoms require them. Try to get at least 30 minutes of physical activity on most days of the week.
Foods to Limit or Avoid after Bowel Obstruction
- Bezoars often form when we eat a lot of foods containing tannins such as unripe mangoes, guava, soaked persimmons, and foods high in fiber such as bamboo shoots… Therefore, to prevent bowel obstruction, it is necessary to limit the consumption of these foods.
- Limit foods high in fiber such as old vegetables, grains, legumes, and nuts.
- Limit high-fat foods, fried foods, fast food, processed foods… which can cause indigestion and make the digestive system work harder to digest food.
- Limit tough and hard foods such as offal, tendons, and gristle… which will create a nucleus for other foods to clump together.
- Avoid eating fruits, and foods with a lot of resin, and tannins, especially on an empty stomach or when eating with high-protein foods.
- Limit dried fruits and vegetables.
- Limit red meat.
- Avoid alcohol, carbonated drinks, or other stimulants.
Physical Activity
Your surgeon may recommend that you limit exercise and strenuous activity during your bowel surgery recovery, and you will likely feel tired and weak for the first couple of months after surgery. Resting is good, but inactivity after bowel surgery can increase the likelihood of complications. When you’re ready, walking is a great form of exercise to ease back into your usual levels of physical activity. You can start by walking for short distances a couple of times a day and gradually increase the amount of walking as you recover. Your healthcare team can help answer any questions you may have about when you can start becoming physically active again after surgery and offer additional tips for low-stress exercises.
Potential Complications
Most people generally do well after bowel obstruction surgery, but any surgery carries a risk of complications. Some of the potential complications after bowel surgery include:
- formation of scar tissue in the intestines, which could lead to future obstructions
- opening of the surgical edges within the bowels, leading to leakage of the intestinal contents
- temporary paralysis of the bowels
- other surgical complications, such as damage to nearby organs, blood clots, or infections
- weakened blood flow, which can lead to tissue damage, removal of more of the bowel, and even death
Other complications may develop over the long term after bowel surgery. In particular, colorectal surgeries, which involve the lower intestine, can lead to urogenital complications affecting urinary, sexual, and bowel health.
When to Seek Medical Attention
Most complications from bowel surgery are mild, but some can be serious. You may need urgent medical care if you have:
- vomiting or nausea
- fever or chills
- blood in the stool
- a swollen or tender belly
- pain that won’t go away (or gets worse)
- chronic diarrhea
- little or no passage of gas or stool
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