An ileostomy reversal is a surgical procedure that restores bowel continuity after a temporary ileostomy. This article provides detailed information on dietary adjustments following ileostomy reversal, aiming to support recovery and manage potential complications.
Understanding Ostomy Reversal
What is an Ostomy Reversal?
An ostomy reversal is a surgical procedure performed to reverse a colostomy or ileostomy. These procedures are initially performed to divert stool away from a diseased or injured section of the bowel, allowing it time to heal. The surgeon creates a colostomy or ileostomy by dividing the bowel and redirecting either the large intestine (colon) or small intestine (ileum) through an opening in the abdomen called a stoma. An ostomy reversal reconnects the bowel and closes the stoma, allowing for normal bowel function through the anus.
Why is Ostomy Reversal Performed?
Ostomy reversal is typically an elective procedure chosen by individuals who wish to return to their pre-ostomy bowel function. The primary motivation is to eliminate the need for an ostomy bag and stoma care, alleviating both the practical and psychological burdens associated with living with an ostomy, such as skin irritation and leakage.
Candidacy and Timing for Reversal
The decision to proceed with an ostomy reversal depends on several factors, including the patient's overall health, the condition of the remaining bowel, and the functionality of the anal sphincter muscles. Key criteria include:
- Sufficient length of intact rectum
- Adequate anal sphincter control
- Absence of active bowel disease
- Overall good health to withstand surgery
The timing of the reversal is carefully considered, with the optimal window typically being between 3 and 12 months after the initial stoma surgery. The procedure is generally avoided during chemotherapy.
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Surgical Approach and Immediate Post-Operative Care
The surgery can be performed laparoscopically (via keyhole surgery) or as an open surgery, depending on the individual case. The initial 24 hours post-surgery usually involve a liquid-only diet to allow the bowel to rest. After 1-2 days, a soft diet is introduced. Early mobilization is encouraged to stimulate bowel activity and aid recovery.
Initial Post-Reversal Diet
First 24 Hours
Stick to liquids only to allow the bowel to rest.
After 1-2 Days
Start on a soft diet.
Dietary Recommendations Following Ileostomy Reversal
General Guidelines
Following ostomy reversal surgery, dietary adjustments are crucial to facilitate healing and manage bowel function. Common recommendations include:
- Small, Frequent Meals: Eating small, low-fiber meals can ease digestion and reduce discomfort.
- Hydration: Drink plenty of fluids (around 8 glasses per day) to prevent constipation.
- Gradual Introduction of Foods: Slowly increase the quantity and variety of foods over time to assess tolerance.
Foods to Include
- Firming Foods: Mashed potatoes, bananas, jelly sweets, and marshmallows can help firm up loose stools.
- Protein-Rich Foods: Incorporate protein at every meal to aid wound healing.
Foods to Limit or Avoid
- Diarrhea-Inducing Foods: Fizzy drinks, alcohol, caffeine, high-fiber vegetables, spicy foods, and fatty foods can cause diarrhea.
- Gas-Inducing Foods: Some vegetables may cause gas or a bad odor for some people, avoid them.
- Hard-to-Digest Foods: Avoid coffee, fried foods, or spicy foods.
- Sugary Drinks: Avoid sugary drinks, such as juice and soda. If you want to drink juice, choose 100% fruit juice and dilute it (mix it with water) to reduce the sugar.
- Artificial Sweeteners: Don’t have artificial sweeteners, such as sorbitol, mannitol, and xylitol.
Managing Specific Issues
- Wind and Cramps: Fennel or peppermint tea can help ease pain and trapped wind.
Detailed Dietary Guidelines for Healing
Eating and Drinking Recommendations
- Follow these guidelines for the first few weeks after your surgery
- Eat small meals often. Try to have 6 small meals throughout the day instead of 3 large ones.
- Don’t eat too much in the evening.
- Drink 8 to 10 (8-ounce) glasses (about 2 liters) of liquids every day. This will help you replace the water lost through your ileostomy and keep you from becoming dehydrated (losing more fluid from your body than usual).
- Eat mostly bland, low-fiber foods.
- When you add foods back into your diet, introduce them 1 at a time.
- Before you’re discharged (released) from the hospital, a clinical dietitian nutritionist will talk with you about these guidelines.
- It’s best to eat mostly bland, low-fiber foods for the first few weeks after your surgery.
- Bland foods are cooked, easy-to-digest foods that aren’t spicy, heavy, or fried.
Examples of Bland, Low-Fiber Foods
- Grains: Refined cereals (such as Cream of Wheat® or Rice Krispies®), White bread, White rice, Plain crackers (such as saltines)
- Protein: Eggs (start with a small amount), Fish (start with small amounts), Poultry (chicken or turkey without skin), Smooth nut butters (start with small amounts)
- Vegetables: Well-cooked vegetables without skin or seeds (such as carrots, green beans, or spinach), Vegetable juice without pulp
- Fruits: Applesauce, Peeled ripe bananas (no more than 1 small ripe banana per day), Fruit juice without pulp
- Dairy: Milk, Yogurt, Cheese
- Fats: Butter, Oil
If you have questions about foods not listed in these tables, call 212-639-7312 to talk with an outpatient clinical dietitian nutritionist.
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Food Intolerances
After your surgery, you may have some food intolerances that you didn’t have before surgery. A food intolerance is when eating a certain type of food causes uncomfortable symptoms, such as diarrhea, bloating, gas, or bad odor.
When you add foods back into your diet, introduce them 1 at a time. If a certain food causes uncomfortable symptoms, don’t eat it for a few weeks. Then try it again. No 2 people will react the same way to food.
Your first follow-up appointment will be about 2 weeks after your surgery. At this appointment, your doctor will tell you if you can start adding high-fiber foods back into your diet. When you start adding high-fiber foods back into your diet, do it slowly. Only add 1 food at a time. Make sure you’re also drinking enough liquids.
Managing Fluid and Electrolyte Balance
When you have an ileostomy, you lose much more salt, potassium, and water than usual. Throughout each day, keep track of your liquid intake (how much liquid you drink). You should also keep track of your ostomy output (how much liquid comes out of your ileostomy). Record your liquid intake and ostomy output. You can use the table in the resource Liquid Intake and Ostomy Output Log. Call your doctor’s office if your output is more than 1000 milliliters (about 34 ounces) per day or is watery.
Signs of Dehydration:
- Feeling dizzy or lightheaded
- Feeling very thirsty
- Having dark urine
- Urinating less often than usual
If you have any of the following signs of dehydration, call your doctor’s office right away.
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Tips to Stay Hydrated:
- Don’t drink more than 4 ounces (½ cup) of liquids with meals.
- Don’t drink any liquids for 1 hour before and 1 hour after meals.
- It’s important to keep drinking lots of liquids, even if your bowel movements are watery.
- Drink sports drinks (such as Gatorade or Powerade) and oral rehydration solutions (such as Pedialyte). These drinks will help replace your fluid loss quickly, especially if your ostomy output is high. A high output is more than 1000 milliliters (about 34 ounces) per day.
- Put all ingredients into a cup with a lid.
- Limit or avoid the following foods and drinks.
- If you drink coffee, choose a dark roast instead of a light roast.
- Limit the amount of alcohol you drink for the first 3 weeks after your surgery. Alcohol can cause you to lose more fluid.
- Eat foods that contain electrolytes. Electrolytes, such as sodium and potassium, can help prevent dehydration.
Foods to Prevent Ileostomy Blockage
Don’t eat more than 1 small ripe banana per day for the first 3 to 4 weeks after your surgery. An ileostomy blockage (also called a bowel obstruction) is when your intestine is partly or fully blocked. It can be caused by food, scar tissue, or a twist in your intestine.
Signs of Ileostomy Blockage:
- No gas or bowel movements coming from your stoma for 6 hours
- Cramps
- Pain
- Nausea (feeling like you’re going to throw up)
If there’s no gas or bowel movements coming from your stoma for 6 hours and you have cramps, pain, nausea (feeling like you’re going to throw up), or all 3, call your doctor’s office right away.
Tips to help move food and gas through your intestine:
- Drink warm liquids.
- Lie on your back and pull your knees up to your chest.
- Rock back and forth.
- Take a warm bath or shower.
- Massage your abdomen.
Don’t take a laxative (medication to help you have a bowel movement). This can make the problem worse.
Don’t eat the following foods:
- Celery
- Coconut
- Corn
- Dried fruit
- Mushrooms
- Nuts
- Popcorn
- Raw fruits and vegetables with seeds or skin
Managing Diarrhea
Diarrhea is having loose or watery bowel movements, having more bowel movements than what’s normal for you, or both.
Call your doctor’s office if you have diarrhea for more than 24 hours.
Tips to manage diarrhea:
- Drink 8 to 10 (8-ounce) glasses (about 2 liters) of liquids throughout the day.
Don’t eat the following foods and drinks:
- Alcohol
- Caffeine
- Dairy products
- Fried foods
- Fruit juices
- High-fat foods
- Raw fruits and vegetables
- Spicy foods
- Sugary drinks
Eat more of the following foods:
- Applesauce
- Bananas
- Cheese
- Noodles
- Oatmeal
- Pretzels
- Rice
- Tapioca
- Toast
- Yogurt
Managing Constipation
Constipation is having fewer than 3 bowel movements per week, having hard bowel movements, having a hard time passing bowel movements, or all 3.
Call your doctor’s office if you’re constipated for more than 2 to 3 days.
Tips to manage constipation:
- Drink warm liquids, especially in the morning.
- Drink prune juice.
Don’t do these things:
- Don’t take an antidiarrheal medication (medication to treat diarrhea), such as loperamide (Imodium®).
- Don’t use a laxative or enema (liquid inserted into your rectum to soften your stool) without talking with your doctor.
Eat less of the following foods:
- Cheese
- Meat
Eat more of the following foods:
- Fruits and vegetables
- Whole-grain breads*
- Whole-grain cereals*
Managing Gas and Odor
For the first few weeks after your surgery, it’s common to have gas in your pouch and a bad odor when you open your pouch. If you’re having problems with gas or odor, talk with your wound, ostomy, and continence (WOC) nurse.
Tips to manage Gas and Odor:
- Eat smaller meals.
- Eat slowly and chew your food well.
- Avoid using straws, chewing gum, and drinking carbonated beverages. These can cause you to swallow more air, which leads to gas.
Don’t do these things:
- Don’t skip meals.
- Don’t chew gum.
Eat less of the following foods:
- Beans
- Broccoli
- Brussels sprouts
- Cabbage
- Carbonated beverages
- Cauliflower
- Corn
- Cucumbers
- Dried peas
- Eggs
- Fish
- Garlic
- Mushrooms
- Nuts
- Onions
- Peppers
- Spicy foods
Eat more of the following foods:
- Buttermilk
- Cranberry juice
- Parsley
- Yogurt
Long-Term Dietary Adjustments
Gradual Increase in Fiber Intake
After the initial recovery period, gradually reintroduce fiber into the diet. This helps regulate bowel movements and promote overall digestive health.
Monitoring Bowel Function
Pay close attention to bowel habits and stool consistency. Adjust fiber intake accordingly to achieve a healthy balance.
Addressing Lower Anterior Resection Syndrome (LARS)
LARS is a common side effect following ostomy reversal, characterized by symptoms such as increased stool frequency, urgency, incontinence, and abdominal pain. Dietary adjustments can help manage these symptoms:
- Fiber Management: Adjusting the amount and type of fiber in the diet can help improve symptoms.
- Hydration: Staying well-hydrated is crucial for regular bowel function. Aim to drink 8 to 10 glasses of water a day to keep things moving.
Additional Recovery Tips
Wound Care
Keep the surgical wound clean and dry to prevent infection. Follow the wound care instructions provided by your surgeon.
Activity and Exercise
- Early Mobilization: Regular short walks can help regain energy and promote bowel activity.
- Avoid Heavy Lifting: Avoid heavy lifting for around 6-8 weeks post-surgery.
- Driving: You can drive again once you are confident that you can do an emergency stop.
- Realistic Goals: Giving yourself some realistic goals is a good way of getting active again.
- Seek advice: At this point, it’s important to seek advice from your stoma nurse about how much exercise you should undertake every week as well as the intensity and types.
Pelvic Floor Physical Therapy
Pelvic floor exercises can help strengthen the pelvic floor muscles, which may be weakened due to inactivity during the ostomy period.
Skin Protection
Use unfragranced wet wipes to clean up after each bowel movement to protect the skin around the anus.
Potential Complications and Management
Common Side Effects and Risks
- Lower Anterior Resection Syndrome (LARS): Increased frequency/urgency of stools, incontinence, clustering, constipation, uncomfortable gas, abdominal pain.
- Scar Tissue: Scar tissue from surgical healing can cause difficulties with healing and bowel function.
- Hernias: A hernia happens when part of your bowel pokes through the cut made for your stoma.
- Nerve Damage: Nerve damage can happen. It can affect your bowel function, your ability to pee, or your ability to have sex.
Managing Complications
- Medications: Immodium can help with diarrhea, and Metamucil or Miralax can help with constipation.
- Sitz Baths: Soaking in warm water can reduce discomfort during bowel movements.
- Skin Protectants: Applying petroleum jelly or zinc oxide cream to the anal area after bowel movements can provide relief.
- Pelvic Floor Therapy: Can help re-train the pelvic floor muscles to have a bowel movement.
When to Contact Your Doctor
Contact your care team if you experience any worrying symptoms, such as:
- Increased pain, redness, or swelling around the wound
- Discharge of pus or fluid from the wound
- Signs of infection
- Persistent diarrhea or constipation
- Symptoms of dehydration
Psychological and Emotional Support
Addressing Anxiety
It is normal to feel anxious about bowel function after ostomy reversal. Support groups and counseling can provide emotional support and coping strategies.
Positive Outlook
Focus on the positive aspects of the reversal, such as regaining bowel control and eliminating the need for an ostomy bag.