An ileostomy is a surgical procedure that reroutes waste out of the body through a surgically created opening in the abdomen called a stoma. This becomes necessary when the colon or rectum isn't functioning correctly. The term "ileostomy" originates from "ileum," the lowest section of the small intestine, and "stoma," meaning opening. In an ileostomy, a surgeon creates an opening in the abdominal wall, bringing the end of the ileum through it and attaching it to the skin. After this surgery, managing diet and nutrition becomes crucial, especially if the goal is to gain weight.
Understanding Ileostomy and Its Impact on Nutrient Absorption
Having an ileostomy means that stool doesn't follow the typical intestinal route. This impacts stool consistency and how the body absorbs vital vitamins and minerals. As a result, healthcare professionals often recommend a specialized diet post-ileostomy.
With an ileostomy, food material bypasses the colon, where nutrient absorption typically occurs in a person without the procedure. This can make individuals more susceptible to nutritional deficiencies. In such instances, a doctor might suggest taking nutritional supplements, preferably in liquid or chewable (but non-gummy) form to ensure proper breakdown and absorption. Examples include chewable multivitamins and liquid or chewable calcium supplements like calcium citrate.
Common Nutrient Deficiencies
Nutrient deficiencies of particular concern in people who have had an ileostomy can include:
- Calcium
- Magnesium
- Iron
- B Vitamins
- Folic Acid
- Fat-soluble vitamins, including vitamins A, D, and E
General Dietary Guidelines After Ileostomy
In the initial weeks post-surgery, a low-fiber diet is usually recommended to prevent potential ileostomy blockages caused by thicker stools. However, about six weeks after surgery, the intestine adapts, and a more normal diet can be gradually reintroduced.
Read also: Post-Surgery Diet for Ileostomy
Following surgery, your ileostomy diet after 6 weeks should be relatively back to normal. Your intestine adapts and functions better with time after surgery. At this stage you can slowly re-introduce fruits and fibre back into your diet and monitor their effects on your output. Try to remember that when you have an ileostomy, your output should be a porridge consistency as it does not go through the large bowel (colon) anymore. The good news is that there are plenty of foods which are starchy and have a natural thickening effect, to help with the loose output you maybe experiencing. So, make sure these are very much a part of your diet too. Often people snack on these in between their meals, such as a handful of jelly babies, a rice cake or a chunk of banana to keep their output that little bit thicker.
Initial Post-Operative Diet
Immediately following the ileostomy, while still in the hospital, a clear liquid diet is initiated, gradually progressing to other foods based on medical advice.
General Well-being Tips
There are also some general well-being tips that can help a person who has had an ileostomy feel better overall. These include:
- Eating several small meals at regular intervals on a daily basis: Eating at routine times can help a person better identify when they may need to change their ileostomy bag.
- Chewing food thoroughly: Doing this will make digestion easier.
- Not eating large meals or snacks at night: Eating a large meal could cause the ileostomy bag to become over-full and require changing during sleeping hours.
- Limiting alcohol intake: Alcohol can contribute to dehydration, bloating, and gas.
Addressing Weight Loss and Promoting Weight Gain
Losing weight after having an ileostomy involves consuming fewer calories than one burns in a day. However, cutting back on dietary intake can be difficult for a person who has had an ileostomy, as they have to be careful to ensure that they get enough vitamins and minerals.
Strategies for Weight Gain
To gain weight healthily with an ileostomy, consider the following:
Read also: Eating After Ileostomy Reversal
Increase Calorie Intake: Focus on consuming more carbohydrates, protein, and dairy products. These macronutrients are essential for building and repairing tissues.
Nutrient-Dense Foods: Emphasize foods rich in calories and nutrients to address potential deficiencies.
Frequent Small Meals: Try eating 5 or 6 small meals a day to prevent feeling too full and ensure consistent nutrient absorption.
Oral Nutritional Supplements: Consider high-calorie drinks like Boost or Ensure to supplement nutrient intake. Oral nutritional supplements can provide calorie-rich nutrition for those who experience weight loss after having an ileostomy. Some examples of these supplements include:
- Boost
- Carnation Instant Breakfast
- Ensure
- Glucerna, for those with diabetes
- Kate Farms Nutrition Shake
- Orgain Nutrition Shakes
These shakes and drinks have calories and nutrients for easier consumption. However, a person should consult a nutritionist regarding how much they should consume and how often.
Read also: Managing Weight Loss with an Ileostomy
Thickening Agents: Consider thickening output with Welchol or fiber pills/drinks to aid in weight gain. In addition to diet, you may want to use some thickening agents which you can pop directly into your pouch. These come in different forms, either a small sachet or a capsule. They sit at the bottom of the pouch and help solidify the liquid output into a gel, therefore making the output easier to drain and also help with leakage.
Consult a Professional: Consult a nutritionist or dietitian for personalized advice on gaining weight.
Food Choices to Aid Weight Gain
- Carbohydrates: Pasta, rice, and other starchy foods can help increase calorie intake.
- Proteins: Include lean meats, poultry, fish, eggs, and dairy products to support muscle growth and repair.
- Dairy: Milkshake drinks can be a good way to increase dairy consumption and aid in weight gain.
- Bananas: Often people snack on these in between their meals, such as a handful of jelly babies, a rice cake or a chunk of banana to keep their output that little bit thicker.
Managing Common Ileostomy-Related Issues
High Output
If experiencing a high output stoma, consider the following:
- Medical Advice: Seek medical advice on managing high output stoma and consider medications like Lomotil or Cholestyramine Packet to slow down output.
- Imodium: Take Imodium before eating to manage high output stoma and consult a healthcare professional for appropriate dosage.
- Solid Foods Before Liquids: Eat some solid foods before you drink anything if your stomach is empty. This may help decrease gurgling sounds.
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.
Dehydration
Drink 6 to 8 cups (1.5 to 2 liters) of fluids every day. You can get dehydrated more easily if you have an ileostomy, so talk to your provider about the right amount of fluid for you.
If you have any of the following signs of dehydration, call your doctor’s office right away.
- Dry mouth
- Urinating less often
- Feeling lightheaded or weak
Diarrhea
If diarrhea continues after 24 hours, contact your stoma nurse for advice. Be careful that you don’t dehydrate when you have a loose output/diarrhoea. When we lose too much water, our bodies may become out of balance and dehydrate.
Foods That May Cause Problems
People who have had an ileostomy can most often eat a normal diet. But some foods may cause problems. Foods that may be fine for some people may cause trouble for others. Foods that caused you problems before the ileostomy may continue to cause problems.
Certain undigested foods can cause blockages if you have an ileostomy, so it’s good to know which these are so you can avoid them where possible. As a general rule, people should try to avoid fibrous skins and seeds after having an ileostomy. The body does not digest these, so they move through the intestine unchanged. As a result, they can potentially affect a person’s ileostomy.
Odor Control
Your pouch should be sealed well enough to prevent any odor from leaking. You may notice more odor when you empty your pouch after you eat certain foods. Some of these foods are onions, garlic, broccoli, asparagus, cabbage, fish, certain cheeses, eggs, baked beans, Brussels sprouts, and alcohol. Doing these things may keep down the odor:
- Eating parsley, yogurt, and buttermilk.
- Keeping your ostomy devices clean.
- Using special odor eliminators that are put into the ileostomy pouch. Ask your health care provider about this.
Gas Control
Control gas, if it is a problem:
- Eat on a regular schedule.
- Eat slowly.
- Try not to swallow any air with your food.
- Do not chew gum or drink through a straw. Both will make you swallow air.
- Do not eat gas producing foods such as cucumbers, radishes, sweets, or melons.
- Do not drink beer or soda, or other carbonated drinks.
Additional Considerations
- Chew Food Well: Chew your food well.
- Introduce New Foods Slowly: It is OK to try new foods, but try only one at a time. That way, if you have any trouble, you will know which food caused the problem.
- Over-the-Counter Medications: Over-the-counter gas medicine can also help if you have too much gas.
- Weight Management: Try not to gain weight unless you are underweight because of your surgery or any other illness. Excess weight is not healthy for you, and it may change how your ostomy works or fits.
- Red Foods: Some red foods may make you think you are bleeding. Tomato juice, cherry-flavored drinks, and cherry gelatin may make your stool reddish. Red peppers, beets, and pimientos may show up as small red pieces in your stool or make your stool look red. If you have eaten these, it is most likely OK if your stools look red. But, call your provider if the redness does not go away.
When to Contact Your Healthcare Provider
Contact your provider if:
- Your stoma is swollen and is more than a half inch (1 centimeter) larger than normal.
- Your stoma is pulling in, below the skin level.
- Your stoma is bleeding more than normal.
- Your stoma has turned purple, black, or white.
- Your stoma is leaking often.
- You have to change the appliance every day or two.
- Your stoma does not seem to fit as well as it did before.
- You have a skin rash, or the skin around your stoma is raw.
- You have a discharge from the stoma that smells bad.
- The skin around your stoma is bulging out.
- You have any kind of sore on the skin around your stoma.
- You have any signs of being dehydrated (there is not enough water in your body). Some signs are dry mouth, urinating less often, and feeling lightheaded or weak.
- You have diarrhea that is not going away.
- You are producing less stool than usual or have belly swelling or pain.