Leena Watts
An ileostomy is a surgical procedure that involves diverting the small intestine through an opening in the abdomen, known as a stoma. This procedure may be necessary in cases of bowel cancer, ulcerative colitis, or Crohn's disease. Following an ileostomy, individuals typically need to wear an external pouch to collect waste products, and dietary changes are often required to prevent issues such as diarrhoea, odour, dehydration, and nutritional deficiencies. In the initial weeks after surgery, a low-fibre diet is recommended, gradually introducing different foods back into the diet while monitoring their effects on output. This is because high-fibre foods can increase stool thickness and potentially cause blockages. Additionally, individuals should aim to eat small meals frequently, avoid large meals or snacks at night, and limit alcohol consumption to prevent dehydration and manage output.
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What You'll Learn
Preventing ileostomy blockage
After an ileostomy, dietary changes are often necessary to prevent blockages, manage side effects, and ensure adequate nutrition and hydration. Here are some guidelines to prevent ileostomy blockages:
Dietary Changes
- Start with a bland, low-fibre diet: Initially, it is recommended to consume bland, low-fibre foods. This includes avoiding fibrous skins and seeds, as they are not digested and can pass through the intestine unchanged, potentially causing blockages.
- Gradually reintroduce foods: When reintroducing high-fibre foods, do so slowly and one at a time. This way, you can identify any food intolerances that may have developed after surgery.
- Limit certain fruits: In the first 3 to 4 weeks after surgery, limit your banana intake to one small ripe banana per day. Eating too many bananas can cause an ileostomy blockage.
- Be cautious with fats: When consuming fats, start with small amounts as they may cause discomfort.
- Stay hydrated: Drink plenty of fluids, aiming for 8 to 10 glasses of liquids per day. Dehydration is a common issue after an ileostomy, and adequate fluid intake can help prevent blockages.
Lifestyle and Monitoring
- Eat small meals frequently: Instead of large meals, opt for 6 small meals throughout the day. Avoid eating large meals or snacks at night, as this can cause the ileostomy bag to fill up and require changing during sleep.
- Chew thoroughly and eat slowly: Take your time while eating, and chew your food well.
- Monitor liquid intake and output: Keep track of both your liquid intake and the output from your ileostomy. This information is crucial for managing your hydration status and identifying any potential issues.
- Stay mobile: Physical activity aids digestion and can help prevent and manage blockages.
- Recognise blockage symptoms: Be vigilant for signs of a blocked stoma, including slowed or stopped output, abdominal pain, cramping, and stomal swelling. If you suspect a blockage, contact your healthcare provider or stoma care nurse for advice.
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Managing side effects
After ileostomy surgery, people may experience side effects such as diarrhoea, odour, excessive weight loss, thin stool, dehydration, bloating, and gas. To manage these side effects, dietary changes are often required.
To prevent diarrhoea, it is recommended to try non-dairy milk, lactose-free cheese, or lactose-free yoghurt. Eggs should be introduced in small amounts, as they may cause a bad odour. Fish and nut butters should also be consumed in small amounts and may cause a bad odour. Some vegetables may cause gas or odour, so it is important to identify and limit these. Bananas should be limited to one small ripe banana per day to prevent ileostomy blockage. High-fibre foods should be reintroduced slowly and one at a time, ensuring adequate fluid intake.
Dehydration is a common side effect due to increased fluid loss through the ileostomy. To prevent dehydration, it is recommended to consume 8 to 10 glasses of liquids per day and monitor fluid intake and output. Alcohol should be limited as it contributes to dehydration.
Weight loss is another potential side effect, which can be managed by aiming for slow and steady weight loss through dietary changes and an exercise routine, as advised by a doctor.
To manage bloating and gas, it is important to limit high-fibre foods and introduce them slowly. A low-fibre diet is recommended initially after surgery to reduce bowel activity and allow the colon to rest and heal.
It is important to monitor side effects and consult a doctor or stoma care nurse for personalised advice and to ensure adequate nutrient intake.
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Dehydration and nutrition
To prevent dehydration, it is recommended that people with an ileostomy drink 8 to 10 (8-ounce) glasses (about 2 liters) of non-caffeinated, non-alcoholic beverages every day. It is also important to monitor output (how much liquid comes out of the ileostomy) and to record both input and output. If output is greater than 1000ml per day, it is advised to contact a doctor, who may recommend a fiber supplement or medication. Other signs of dehydration include dark-coloured urine, loss of appetite, abdominal cramping, drowsiness, and fatigue. To replace lost sodium and potassium, it is recommended to eat foods such as canned soups and vegetables, broths, salted snacks, processed meats and cheeses, and sports drinks.
Nutritional deficiencies can also occur after ileostomy surgery because food material no longer passes through the colon for nutrient absorption. To prevent this, a person may need to take nutritional supplements, as recommended by their doctor. It is also important to eat nutritious foods and introduce new foods slowly, one at a time, to identify any food intolerances that may have developed after surgery. Common food intolerances after ileostomy surgery include dairy, eggs, fish, and certain vegetables, which can cause diarrhea, bloating, gas, or bad odour. In general, it is recommended to eat mostly bland, low-fiber foods for the first few weeks after surgery.
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Food intolerances
After ileostomy surgery, some people may develop food intolerances that they didn't have before the operation. Food intolerance is characterised by uncomfortable symptoms such as diarrhoea, bloating, gas, or bad odours. These intolerances may disappear as the colon heals, but it is important to manage them effectively to prevent discomfort and inconvenience.
To identify food intolerances, it is recommended to introduce new foods one at a time. If a particular food causes unpleasant symptoms, it should be avoided for a few weeks before trying it again. This gradual reintroduction allows for the identification of specific triggers and helps manage any discomfort. It is also important to be cautious with high-fibre foods and fats, as they may cause an ileostomy blockage or discomfort. For example, eating too many bananas can lead to a blockage, so it is advised to limit consumption to one small ripe banana per day during the initial recovery period.
Additionally, some specific foods are known to cause unpleasant symptoms in individuals with ileostomies. For instance, eggs, fish, and nut butters may cause bad odours when the pouch is opened. Similarly, some vegetables can lead to gas or unpleasant odours. It is important to identify and limit the consumption of these trigger foods to manage symptoms effectively.
Dealing with food intolerances after ileostomy surgery can be challenging, but there are strategies to manage them. Firstly, it is recommended to eat small meals frequently throughout the day instead of large meals, as this helps limit bowel movements and prevents overfilling the ileostomy bag during sleep. Secondly, drinking plenty of liquids is crucial to replace the water lost through the ileostomy and prevent dehydration. Finally, a bland, low-fibre diet is often suggested to reduce the likelihood of triggering unpleasant symptoms.
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Weight loss
To avoid excessive weight loss, it is important to consume enough calories, vitamins, and minerals. This can be challenging, as many people with an ileostomy experience a decrease in appetite and may need to limit their intake of high-fibre foods, which can affect how many nutrients they are getting.
To aid weight loss, doctors may recommend nutritional supplements. It is also important to eat nutritious foods and drink plenty of water. A well-balanced diet that is rich in calories, fat, and protein can help the body heal after surgery.
In the first few weeks after surgery, it is recommended to follow a low-fibre diet, as high-fibre foods can increase stool thickness and cause temporary ileostomy blockages. Fibre also stimulates the bowel, when what is needed is rest and healing. During this time, it is common to start with a bland diet and gradually reintroduce different foods, one at a time, to identify any new intolerances.
After six weeks, the diet should be relatively back to normal, and it is safe to slowly reintroduce fruits and fibre, monitoring their effects on output.
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Frequently asked questions
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 from passing through the full length of the small intestine or colon.
In the first few weeks after ileostomy 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. You should also avoid eating large meals or snacks at night, as this could cause the ileostomy bag to become overfull.
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. As a general rule, people should try to avoid fibrous skins and seeds.
After having an ileostomy, you lose much more salt, potassium, and water than usual, which can lead to dehydration. Contact your stoma nurse if the diarrhoea continues after 24 hours.
Aim for slow, steady weight loss by making dietary changes and incorporating an exercise routine as advised by your doctor.
