A bowel resection, also known as a colectomy, involves the surgical removal of a diseased or obstructed section of the small intestine. Following this procedure, dietary adjustments are necessary to facilitate healing and minimize potential complications. This article provides comprehensive guidelines on post-operative dietary management after a small bowel resection.
Understanding Bowel Resection and Its Impact
Small bowel resection is surgery to remove a part of your small bowel. It is done when part of your small bowel is blocked or diseased. The small bowel, or small intestine, plays a crucial role in absorbing nutrients, liquids, vitamins, and minerals from ingested food and liquids. The small intestine absorbs carbohydrates, proteins, fats, vitamins, and minerals. It’s about 15 to 20 feet long and is divided into 3 sections: the duodenum, the jejunum, and the ileum. Each section has a specific role in how your body digests and absorbs nutrients.
The surgery can be performed laparoscopically, with a robot, or open surgery. If there is not enough healthy small intestine to reconnect, your surgeon makes an opening called a stoma through the skin of your belly. The small intestine is attached to the outer wall of your belly. Stool will go through the stoma into a drainage bag outside your body. This is called an ileostomy. The ileostomy may be either short-term or permanent.
When a portion of the bowel is removed, the remaining part adapts to compensate for the loss. This adaptation involves absorbing nutrients and liquids that would typically have been absorbed by the resected section. While this adaptation allows the body to maintain nutritional health, it may initially lead to challenges in nutrient absorption. It takes time for your remaining bowel to adapt after your surgery. This usually takes a few months, but everyone’s body heals differently.
Short Bowel Syndrome
Short bowel syndrome (SBS) 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.
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Initial Post-Operative Diet: Focus on Liquids and Soft Foods
Initially, patients are limited to consuming only liquids after bowel resection. After a few days, they may gradually start eating soft foods. Physicians often recommend starting with easily digestible foods such as cooked vegetables, bananas, avocados, mashed potatoes, and soft proteins. The intestines may still be swollen post-surgery, so soft foods are easier to pass through the affected areas.
You should be able to drink fluids soon after a bowel resection. A few days later, you can start to eat real food. Your doctor may tell you to start with soft foods like cooked vegetables, bananas, avocados, mashed potatoes, and tender proteins. Your intestines may be swollen after surgery, and these foods will travel through them more easily.
Foods to Avoid After Bowel Resection
High-Fiber Foods
Foods high in fiber, such as bread and whole-grain cereals, are difficult for the stomach to fully digest. These fibers travel to the large intestine for processing. Since the intestine is still in the healing process, overloading it can hinder recovery. Adopting a low-fiber diet for 4 to 6 weeks can benefit post-surgical recovery. A low-fiber diet (your doctor may call it “low-residue”) for 4 to 6 weeks can help.
Raw Produce
Raw fruits and vegetables are high in fiber and may have a crunchy texture (like carrots) or be stringy (like celery), making them hard to chew and digest thoroughly. Fruits with skins (such as apples) or seeds can also be challenging to digest. These types of foods can irritate the recovering intestine. It is recommended to avoid raw foods during the recovery phase and reintroduce them gradually once the patient has healed. 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.
Fatty and Greasy Foods
Post-surgery, patients often experience diarrhea due to the shortened large intestine, which gives digested food less time to form solid stools. Certain foods can exacerbate diarrhea, including:
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- Fatty meats
- Butter and cream
- Fried foods
- Rich, oily snacks
Diarrhea usually subsides within a few weeks, after which patients can slowly reintroduce these foods. It’s common to have diarrhea after a bowel resection. Because your large intestine is suddenly shorter, digested food doesn’t have as far to travel (or as much time to form into solid stools) before it leaves your body. Some things can make diarrhea worse:
- Fatty meats
- Butter and cream
- Fried foods
- Greasy snacks like potato chips
The diarrhea will usually go away after a few weeks. Then you can enjoy these foods again from time to time.
Spicy Foods
Spicy foods can irritate the digestive system, causing discomfort such as diarrhea, bloating, or cramping - particularly while the intestines are healing. Physicians often recommend a bland diet for several weeks post-surgery. This includes avoiding not just spicy foods but also coarse herbs and seasonings like finely ground rosemary or crushed pepper, which can pose digestive challenges. Spicy foods can irritate your digestive system and cause diarrhea or uncomfortable bloating -- especially as your intestine heals. Your doctor may suggest a bland diet for a few weeks after surgery. And it isn’t just “hot” stuff you need to watch out for. Herbs and spices with rough textures -- like chopped rosemary, crushed peppercorns, or caraway seeds -- can also cause problems.
Beans and Dairy
Beans contain sugars that are difficult for the body to digest, potentially causing bloating and gas. Similarly, patients may develop sensitivity to lactose, a sugar found in dairy products. While gas is a normal part of digestion, it can cause discomfort or even pain during the healing phase. Limiting beans and dairy products can help alleviate these symptoms. 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, found in coffee and many sodas, is a stimulant that speeds up bodily functions, including digestion. Sugary or artificially sweetened beverages can also induce diarrhea in patients recovering from bowel resection surgery. Additionally, carbonated sodas may cause bloating and discomfort. Although staying hydrated is essential, it is crucial to make smart beverage choices post-surgery. Caffeine, which can be found in both these drinks, 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.
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Alcohol
Alcohol can irritate the intestines, leading to increased bowel movements. It is best to avoid alcohol until digestion normalizes. Furthermore, most physicians advise against consuming alcohol after any surgery, as it may interfere with pain medications and delay the healing process. 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.
General Dietary Guidelines for Recovery
Eat Small, Frequent Meals
When transitioning back to solid foods, patients may feel full more quickly than before surgery. To avoid discomfort, it is better to eat several small meals throughout the day rather than three large ones. This approach makes digestion easier and reduces bloating or gas. When you start to eat solid foods again, you may get full faster than before. Try to have several small meals throughout the day instead of three large ones. You’ll digest them easier, and they’ll be less likely to cause gas or bloating. Eat slowly and to chew each bite fully -- to a mashed-potato texture -- before you swallow. 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. Once your bowel has adapted, you can go back to having 3 meals a day.
Chew Food Thoroughly
Chew food thoroughly until it resembles mashed potatoes before swallowing. 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
The diet should be high in proteins, high in refined or low-fiber complex carbohydrates (starches), and moderate in fats. Examples of fatty foods are oils, butter, margarine, mayonnaise, gravies, cream sauces, and regular salad dressings. For example, it’s okay to have butter on toast or mayonnaise on a sandwich.
Limit Sugary Foods
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. 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.
Lactose Intolerance
If you’re lactose intolerant, follow a low-lactose diet. 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.
Limit High Oxalate Foods
Limit 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. Some foods have small amounts of oxalates and are safe to have in small portions. Spinach is usually well-tolerated but can cause kidney stones if you have fat malabsorption. If you have fat malabsorption, limit the amount of spinach you eat.
Fiber Considerations
After your surgery, you may find that fiber, especially insoluble fiber, is hard to digest. Insoluble fiber is found mainly in whole-grain and bran products. It doesn’t break down in water and your body can’t break it down, so it makes stool (poop) more bulky. Soluble fiber breaks down in water and can be broken down by your body. It also helps slow digestion. This usually makes it easier to tolerate. Psyllium (fiber supplement). Many foods have a mixture of both soluble and insoluble fibers. Legumes, such as chickpeas, lima beans, kidney beans, and lentils. Be careful; legumes may cause gas. You will probably have trouble digesting raw vegetables after your surgery. Start by eating small amounts (one half cup) of well-cooked vegetables. Be sure to chew them well.
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. You may need water-soluble forms of vitamins A, D, and E. You may need Vitamin B12, Calcium, and 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.
Fortified Milk Recipe
If you can eat or drink dairy products, this recipe can add calories and protein to your diet. Mix 1 quart (4 cups) of milk with 1⅓ cup of instant powdered milk (usually 1 envelope).
Food Diary
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.
Gradual Reintroduction of Normal Foods
As digestion improves, patients can start reintroducing 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. Once your digestion is better, you can start to go back to a normal diet. Add one new food a day, one serving at a time, so you can learn how your body reacts to each one. That’ll also help your intestines slowly adjust to digesting more high-fiber foods like fruits, vegetables, and whole grains.
High-Protein Diet after Small Bowel Resection in Mice
Short bowel syndrome (SBS) is a morbid clinical condition that results from massive small-bowel resection (SBR). After SBR, there is a dramatic weight loss in the acute postoperative period. A high-protein diet (HPD) results in greater weight gain and improved body composition in mice after SBR.
In patients with SBS, the gastrointestinal system is compromised since decreased mucosal surface area is associated with impaired absorption and digestion. Intestinal adaptation is a normal physiological compensatory response to massive SBR. The provision of an HPD may prevent the deterioration of lean mass and loss of protein stores.
Post-Surgery Care and Monitoring
Activity and Incision Care
It may take several weeks for you to get back to your normal activities. Ask your surgeon if there are activities you should not do. Start by taking short walks. Increase your activity slowly. Do not push yourself too hard. Your surgeon will prescribe pain medicines for you to take at home. If you are taking pain medicines 3 or 4 times a day, take them at the same times each day for 3 to 4 days. They regulate pain better this way. Ask your surgeon if you can take acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) to help with pain and to avoid taking narcotic pain medicine. Do not drive or use other heavy machines if you are taking narcotic pain medicines. These medicines may make you drowsy and slow your reaction time. Press a pillow over your incision when you need to cough or sneeze. This helps ease the pain. Ask your surgeon when you should begin taking your regular medicines again after surgery.
If your staples have been removed, you will probably have Steri-Strips (small pieces of tape) placed across your incision. These pieces of tape will fall off on their own. If your incision was closed with a dissolving suture, you may have had glue covering the incision. This glue will loosen and will come off on its own. Or, it can be peeled off after a few weeks. Ask your surgeon when you can shower or soak in a bathtub. It is OK if the tapes get wet. Do not soak or scrub them. Keep your wound dry at all other times. The tapes will fall off on their own after a week or two. If you have a dressing, your surgeon will tell you how often to change it and when you can stop using it. Follow instructions for cleaning your wound daily with soap and water. Look carefully for any changes to the wound as you do this. Pat your wound dry. Do not rub it dry. Ask your surgeon before putting any lotion, cream, or herbal remedy on your wound. Do not wear tight clothing that rubs against your wound while it is healing. Use a thin gauze pad over it to protect it if needed.
Ileostomy Care
If you have an ileostomy, follow care instructions from your surgeon. Talk to your surgeon if you have questions about ileostomy and your diet.
Dietary Adjustments
Eat small amounts of food several times a day. Avoid eating 3 big meals. Space out your small meals. Add new foods back into your diet slowly. Try to eat protein every day. Some foods may cause gas, loose stools, or constipation as you recover. Avoid foods that cause problems. If you become sick to your stomach or have diarrhea, contact your surgeon.
Managing Constipation
If you have hard stools: Try to get up and walk around more. Being more active can help. If you can, take less of the pain medicines your surgeon gave you. They can make you constipated. You may use stool softeners if your surgeon tells you it is OK. Ask your surgeon if you can take milk of magnesia or magnesium citrate. Do not take any laxatives without asking your surgeon first. Ask your surgeon if it is OK to eat foods that contain a lot of fiber or take an over-the-counter fiber product such as psyllium (Metamucil).
Returning to Work
Return to work only when you feel ready to. You may be ready when you can be active around the house for 8 hours and still feel OK when you wake up the next morning. You may want to start back part-time and on light duty at first. Your surgeon can write a letter to limit your work activities if you do heavy labor.
When to Contact Your Surgeon
Contact your surgeon if you have any of the following:
- Fever of 101°F (38.3°C) or higher, or fever that does not go away with acetaminophen (Tylenol)
- Swollen belly
- Feel sick to your stomach or you are throwing up a lot
- Not had a bowel movement 4 days after leaving the hospital
- Have been having bowel movements and they suddenly stop
- Black or tarry stools, or there is blood in your stools
- Belly pain that is getting worse, and pain medicines do not help
- Your ileostomy has stopped working for a day or two
- Changes in your incision, such as the edges are pulling apart, drainage or bleeding coming from it, redness, warmth, swelling, or worsening pain
- Shortness of breath or chest pain
- Swollen legs or pain in your calves