Embarking on life with an ileostomy brings dietary adjustments. This guide introduces the ileostomy diet, offering advice to help you eat well with your stoma. Whether your stoma is temporary or permanent, understanding how to nourish your body is key. "Nourishing Life" provides easy-to-follow recipes for the unique dietary needs of ileostomy patients.
Understanding Ileostomy and Its Dietary Implications
An ileostomy is a surgical opening in the small bowel, allowing waste to bypass the large bowel. A primary concern for individuals with ileostomies is the potential for food to get stuck due to the narrowness of the ileum. While this can also affect those with colostomies, it's particularly relevant for ileostomies.
Initial Dietary Adjustments After Surgery
In the initial two months following surgery, the area around the stoma will be swollen, increasing the risk of blockage. During this period, restricting the types and amounts of food you eat is necessary. Once the swelling subsides, gradually reintroduce a normal diet, including fiber-containing foods, but always chew thoroughly.
The Importance of Chewing
It is advised to eat small mouthfuls, especially of fiber-containing foods and meats, and to chew until the food is almost liquid in the mouth.
Reintroducing Foods: The Food Diary Approach
When you're ready to expand your diet, keeping a food diary is invaluable. Introduce one food at a time to monitor your body's reaction. Adding multiple foods simultaneously can make it difficult to identify the cause of any issues. Individual reactions to foods vary after stoma surgery, making experimentation and careful recording essential. Over time, you should be able to include most foods you enjoy.
Read also: Post-Surgery Diet for Ileostomy
Colostomy Considerations: Managing Flatulence
Colostomies, positioned lower than ileostomies, involve an opening in the large bowel to bypass the rectum. A common issue with colostomies is flatulence. While flatulence indicates proper stoma function, it can be unpleasant. Identifying foods that cause excess wind often requires trial and error. Foods that previously caused wind will likely continue to do so. Although surgical swelling subsides over time, flatulence remains a concern for many.
Minimizing Flatulence
To reduce wind, chew your food well and avoid talking while eating to prevent trapped air. A food diary can help identify problematic foods. Give a suspect food a few tries before eliminating it from your diet, especially if it's nutritious.
Addressing Short Bowel Syndrome (SBS)
If more than 50 percent of your bowel has been removed, you may develop Short Bowel Syndrome (SBS), a malabsorptive condition. Symptoms include chronic diarrhea/high ostomy output, abdominal cramping, dehydration, heartburn, and abdominal bloating. If you've had extensive bowel surgery that could lead to SBS, follow your treatment team's advice.
Foods to Approach with Caution
Due to swelling, certain foods can cause difficulties immediately after surgery and may be challenging for those with an ileostomy. These foods can cause flatulence, though not universally.
Maintaining Hydration and Electrolyte Balance
Replacing lost fluids and electrolytes like sodium and potassium is crucial after diarrhea. The colon normally absorbs water and electrolytes from stool, so their loss is greater after bowel surgery. With loose stools, maintaining fluid intake with vegetable juice, strained soups, stock, sports drinks, and coconut water is vital.
Read also: Eating After Ileostomy Reversal
Establishing Regular Eating Patterns
Regular eating promotes regular bowel patterns. Consider 4-6 small meals instead of 3 larger ones. Certain food substances can color output, and unabsorbed bile can cause yellow or green stools, especially with diarrhea or rapid bowel action.
Dietary Guidelines for Healing
These guidelines are for the initial weeks after surgery to aid colon healing:
Eating Habits
- Eat small meals often, aiming for 6 small meals throughout the day instead of 3 large ones.
- Avoid eating too much in the evening.
Hydration
- Drink 8 to 10 (8-ounce) glasses (about 2 liters) of liquids daily to replace water lost through the ileostomy and prevent dehydration.
Food Choices
- Focus on bland, low-fiber foods.
- Introduce new foods one at a time.
A clinical dietitian nutritionist will discuss these guidelines before you leave the hospital.
Bland, Low-Fiber Foods
Bland foods are cooked, easy-to-digest, and not spicy, heavy, or fried.
Managing Food Intolerances
After surgery, you may develop food intolerances. Introduce foods one at a time and avoid those causing uncomfortable symptoms like diarrhea, bloating, gas, or odor for a few weeks before trying again. Reactions to food vary.
Read also: Managing Weight Loss with an Ileostomy
Reintroducing High-Fiber Foods
Your doctor will advise when to reintroduce high-fiber foods, usually about 2 weeks after surgery. Add them slowly, one at a time, while ensuring adequate liquid intake.
Monitoring Liquid Intake and Ostomy Output
Track your liquid intake and ostomy output, aiming for less than 1000 milliliters (about 34 ounces) of output per day. Use a log to record these measurements. Contact your doctor if your output is consistently high or watery.
Recognizing Dehydration
Contact your doctor immediately if you experience dehydration symptoms.
Fluid Intake Strategies
- Limit liquid intake to 4 ounces (½ cup) with meals.
- Avoid liquids for 1 hour before and 1 hour after meals.
- Drink sports drinks and oral rehydration solutions to replace fluid loss, especially with high ostomy output.
Foods to Limit or Avoid
- Dark roast coffee is preferable to light roast.
- Limit alcohol for the first 3 weeks after surgery, as it can cause fluid loss.
- Avoid sugary drinks like juice and soda. If you drink juice, dilute it with water.
- Avoid artificial sweeteners like sorbitol, mannitol, and xylitol.
Incorporating Electrolytes
Consume foods containing electrolytes like sodium and potassium to prevent dehydration. Limit banana consumption to one small ripe banana per day for the first 3 to 4 weeks after surgery.
Preventing Ileostomy Blockage
An ileostomy blockage, or bowel obstruction, can be caused by food, scar tissue, or intestinal twists.
Recognizing and Addressing Blockage Symptoms
If you experience no gas or bowel movements from your stoma for 6 hours along with cramps, pain, or nausea, contact your doctor immediately.
Immediate Steps for Cramps, Pain, or Nausea
- Follow these tips to help move food and gas through your intestine.
- Avoid laxatives, as they can worsen the problem.
- Avoid certain foods that may exacerbate the blockage.
Managing Common Problems
This section provides guidelines for dietary changes to manage common issues.
Diarrhea
Diarrhea involves loose or frequent bowel movements. Contact your doctor and drink 8 to 10 (8-ounce) glasses of liquids daily. Avoid certain foods and drinks. Increase consumption of specific foods.
Constipation
Constipation involves infrequent or hard bowel movements. Contact your doctor.
Gas and Odor
Gas and odor are common after surgery. Consult with your wound, ostomy, and continence (WOC) nurse. Avoid certain behaviors and foods, and increase consumption of others.
Additional Tips for Ileostomates
Many ileostomates find they can eat most foods by eating slowly, chewing thoroughly, and drinking plenty of fluids. If you're trying a new diet and feel deprived, you're less likely to stick to it.
General Dietary Recommendations
For about 6 weeks after surgery, dietary changes aid intestinal healing and prevent issues like odor, gas, diarrhea, or obstruction.
Initial Post-Surgery Diet
Start with clear liquids like clear juices, coffee or tea (without cream or milk), gelatin, and broth. Then, transition to low-fiber foods, limiting fiber to less than 8 grams daily.
Guidelines
- Choose grains with less than 2 grams of fiber per serving.
- Avoid high-fiber foods initially, as they are harder to digest.
- Drink at least 8 to 10 eight-ounce cups of liquid daily, adjusting for sweat and ostomy output.
- Consider oral rehydration solutions (ORS) for balanced fluid replacement.
- Drink liquids 30 minutes after meals instead of with meals.
- Take small bites and chew food well.
- Eat small amounts every 2 to 4 hours, with larger meals in the middle of the day.
- Avoid acidic, spicy, high-sugar, and high-fat foods.
- Avoid chewing gum, drinking with straws, smoking, and chewing tobacco.
- Take vitamin or mineral supplements as directed, with chewable or liquid forms preferred. Vitamin B12 supplements may be necessary.
Understanding Ileostomy Surgery
An ileostomy moves waste out of the body through a surgically created stoma when the colon or rectum isn't functioning correctly. The word ileostomy combines "ileum," the lowest part of the small intestine, and "stoma," meaning opening. During the procedure, the surgeon creates an opening in the belly wall and brings the end of the ileum through it, attaching it to the skin.
Managing Odor and Gas
A properly sealed pouch should prevent odor leaks. Certain foods can increase odor when emptying the pouch, including onions, garlic, broccoli, asparagus, cabbage, fish, certain cheeses, eggs, baked beans, Brussels sprouts, and alcohol.
Strategies to Minimize Odor
- Eat parsley, yogurt, and buttermilk.
- Keep ostomy devices clean.
- Use special odor eliminators in the ileostomy pouch.
Additional Tips
- Eat on a regular schedule.
- Eat slowly.
- Avoid swallowing air with food, chewing gum, or drinking through a straw.
- Avoid gas-producing foods like cucumbers, radishes, sweets, and melons.
- Avoid beer, soda, and other carbonated drinks.
- Try eating 5 or 6 small meals a day.
- Eat solid foods before drinking if your stomach is empty.
- Drink 6 to 8 cups (1.5 to 2 liters) of fluids daily.
- Chew your food well.
- Introduce new foods one at a time.
- Consider over-the-counter gas medicine.
- Maintain a healthy weight.
Addressing Specific Issues
When feeling nauseous, take small sips of water or tea and eat a soda cracker or saltine. Some red foods, like tomato juice and beets, can alter stool color.
When to Contact Your Healthcare Provider
Contact your provider if you experience:
- A swollen stoma larger than normal.
- A stoma pulling in below the skin level.
- Bleeding, color changes, or frequent leaks from the stoma.
- Skin rashes or sores around the stoma.
- Foul-smelling discharge from the stoma.
- Bulging skin around the stoma.
- Dehydration symptoms.
- Persistent diarrhea.
- Reduced stool production, belly swelling, or pain.