Diet and nutrition are a very important part of having an ileostomy. Knowing what you can and can’t eat is very confusing straight after surgery, but your Stoma Care Nurse will help support you with this and there is also plenty of information about diet with an ileostomy out there for you to read.
What is an ileostomy?
An ileostomy is where the small intestine is diverted through an opening in the abdomen (stoma). They are formed to either temporarily or permanently stop digestive waste passing through the full length of the small intestine or colon. There are a number of reasons why this may be necessary, including bowel cancer, ulcerative colitis and Crohn’s disease.
What to eat following ileostomy surgery
In the first few weeks after your stoma surgery, you will usually be advised to follow a low fibre diet. This is because a high fibre diet may increase the thickness of your stools and could potentially cause a temporary ileostomy blockage. Fibre also makes your bowel active which you don’t need in the first few days and weeks, you need quite the opposite: to give the bowel time to rest and heal.
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. You may find that after surgery, you want to stick with foods you could tolerate well prior to surgery.
Follow our guidance for the foods to avoid which could cause a loose output or have the potential to block your stoma, as these are important.
What causes a loose stoma 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. Having a loose or watery output can happen occasionally with an ileostomy and there are some tricks to help thicken your output so that it is more manageable and doesn’t cause any leaks, which can lead to sore skin and misery.
If we look at diet, the most common reasons for causing diarrhoea or a loose output are usually:
- too many green vegetables or beans
- fruit juices or fruit itself,
- spicy foods
Foods which naturally thicken your stoma output
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. By doing this it often stops your mid-morning coffee flying through you at top speed!
Examples of thickening foods:
- Starchy foods such as white bread, pasta and mashed potatoes
- Marshmallows or jelly babies
- Ripe bananas
- Apple sauce/stewed apple
- Rice cakes
- Banana bread
- Peanut butter (smooth)
- Sponge cakes
- Rice puddings
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. If you are using a drainable pouch, remember when you drain your pouch, you may need to pop another one through the drainage end of the pouch.
It may be wise to speak with your stoma care nurse about anti-diarrhoea medications such as Imodium/loperamide capsules. This medicine can help slow the output down and have a thickening action too. These can also be used in liquid or melt form, so that it can be broken down by the small intestine more effectively than the capsules. Your stoma nurse will guide you in how much is safe to use and when to take these.
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. Contact your stoma nurse if the diarrhoea continues after 24hours and she will provide you with advice. Here are some tips on dehydration and what to look out for.
The signs of dehydration are:
- Dry mouth
- Increased thirst
- Decrease in urine output
Tips to avoid dehydration:
- Aim to drink 8 glasses of fluid per day
- Avoid salty food such as Bovril
- Full sugar drinks (stir these to let them go flat)
- Drink electrolyte packed sports drinks
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. Here are some examples but it is good to have a full comprehensive list to keep with you.
Foods not to eat with an ileostomy:
- fruits and raw vegetables with skins on (ie apples/cucumber),
- seeds and nuts,
- dried fruit,
- fibrous fruits and vegetables such as Chinese vegetables
As part of a well-balanced diet, it is important to increase your calories, fat and protein to aid your bodies healing process. Here are some calorific foods following your stoma surgery:
- Full fat milk and cheese
- Double cream (add this to soups, mashed potato, and puddings)
- Snack on biscuits and cakes
- Foods’s high in protein each day such as fish, tender meat and eggs
- Drink regularly to keep well hydrated.
Dieting and weight loss with an ileostomy
Losing weight with an ileostomy involves consuming fewer calories than we burn in a day, which can be difficult for a patient with an ileostomy, and you must be careful that you get enough vitamins and minerals. If you are wanting to lose weight it might be worth looking at eating less saturated fats and processed foods, red meat, and sugary foods… and increase your fruit and vegetables instead.
Make sure the foods you are eating are compatible with your stoma, suddenly introducing large amounts of vegetables and fruit can cause your output to become more liquid which may not be ideal. Think about adding in those fruits such as ripe bananas which can help thicken your output. The high fibre content of some diets may help you feel fuller longer, but it can make your stoma more active than usual.
If you like the outdoors, walking is a good choice of exercise for ostomates. If you want to take up exercise and have just had surgery, check with your surgeon that it is safe to go ahead. Start slowly and regularly and it will help getting the balance of diet and exercise right.
For more ileostomy diet and nutrition information, visit our advice centre.