Bowel surgery – unlike surgeries and treatments for most other cancers – does call for extra care and attention with the diet and ways of eating. For some of you the stoma will be permanent, for others, it will be a temporary measure. Regardless of your situation there are many things you can do to ensure you can eat a wide range of nutritious, energising foods. Although there are some differences in how and what can be eaten depending on whether you have a colostomy or an ileostomy eating healthily and enjoyably is achievable with both.
The main ‘rules’ for both types of stoma are:
Chew your food well – digestion starts in the mouth
Drink plenty of fluids, around between 1.5 and 2 litres a day
Include salt in the diet
When you are able to, eat enough fibre to lessen risk of constipation
Eat regular meals to get a regular bowel pattern (less likely to be inconvenienced)
Ileostomies are surgical openings at the small bowel to let faeces bypass the large bowel. The main food complaint of those with ileostomies is that, because of the narrowness of the ileum, some foods can get stuck. This may be less of a problem for those with colostomies but it can be an issue for anyone with a stoma. It is advised to eat small mouthfuls, especially of fibre containing foods and meats, and to chew until the food is almost liquid in the mouth. In addition, the first few two months after your operation the area will be swollen and more prone to blockage. You will probably have to restrict the type and amount of foods you eat. After this time the swelling will subside and you will be encouraged to get back to a normal diet, including fibre containing foods, but still being mindful of thorough chewing. When you are ready to start eating a more varied diet, it is a good idea to keep a food diary, adding one food at a time to see how you feel. If you add more than one it can be difficult to know what may be causing a problem, or in fact be fine to eat. Everyone is individual about how they react to foods after a stoma, so it is a case of experimenting and recording your reactions. Over time you should find that you can include most things that you like.
Colostomies are lower down than ileostomies and have an opening at the large bowel to let faeces bypass the rectum. One of the main issues with colostomies is flatulence. In a way flatulence is good, it means the stoma is working well, but it is of course unpleasant. Most people have to figure out with trial and error which foods cause them excess wind. Foods that previously caused wind will probably continue to do so. It tends to settle down somewhat once surgical swelling subsides but it will still be an issue for many. To help avoid wind you should also chew your food well and not talk while eating. This prevents trapped air from causing wind. Keeping a food diary can help you identify foods that cause you problems. It is a good idea to give a suspect food a few ‘tries’ before deciding to cut it out of your diet, especially if it is very nutritious. If most foods in a food group cause you problems discuss this with your GP who may refer you to a dietitian.
Foods That Can Cause Blockages
Because of swelling the following foods can cause difficulties just after either surgery, and may be more challenging for those living with an ileostomy. Those with either type of stoma should be encouraged to try small amounts of these foods a few months after surgery as any of them may be absolutely fine for you if thoroughly chewed in small amounts.
Celery, nuts, coconut, mushrooms, sweetcorn, cucumbers, oranges, apple and pear peelings, pak choi and other Chinese leaves, seeds, pineapple, pickles, olives, dried fruit, some of the sturdier leafy greens
Hi Odour Foods
These foods have their own smell when digested matter enters the stoma.
Broccoli, cabbage, asparagus, onions, garlic, peanut butter, strong cheese, cod liver oil, fish, seafood, some vitamins (B ones especially)
Odour Reducing Foods
Foods that neutralise odorous foods include: cranberry juice, tomato juice, parsley, fennel tea, buttermilk, yogurt
Gas Forming Foods
Any of these foods can cause flatulence but not all of them will for everyone. Try and introduce one of these foods at a time, using a food diary to track your reactions.
Excess fruit, excess dairy, excess wheat products, nuts, soy, Quorn, carbonated drinks, Champagne, other alcohol, beans, cucumbers, radishes, cabbages, onions, Brussels sprouts, cauliflower
Actions That Promote Wind
Lying down after meals
Swallowing large boluses of food
Using a straw with carbonated drinks
Chewing gum and smoking – gas forms with continued chewing and with the ‘style’ of breathing that occurs with smoking
Poorly fitting dentures (not an action of course!)
Foods to Help Constipation
Warm/hot drinks, coffee, fruit and freshly pressed/squeezed juices, vegetables, salad leaves
Foods to Help Diarrhoea
It is very important to replace lost fluids and electrolytes such as sodium and potassium, after a bout of diarrhoea. The colon normally absorbs water and electrolytes from the stool so when the bowel is gone you lose more water. With loose or watery stools it is even more important to keep a good fluid intake, including vegetable juice, strained soups, stock, sports drinks and coconut water (naturally high in potassium; Vita Coco recommended), as well as water. Tea and coffee may worsen diarrhoea.
Bananas, applesauce, white rice, white toast, peanut butter
Foods That May Cause Diarrhoea
Fresh fruit, fruit juices (especially prune, apple and grape), spicy foods, sugar, chocolate, caffeine, sugar substitutes such as Xylitol and mannitol (in gums and sweets)
Regular eating encourages regular bowel patterns: 4-6 small meals may work better for you than 3 normal sized ones. Some people find that having their main meal at lunch and a smaller meal at dinner reduces night output.
Certain substances in food can colour output and bile that can’t be reabsorbed can cause yellow or green stools, especially when you have diarrhoea or rapid bowel action. Beets, broccoli, asparagus, spinach and some meds that settle the tummy can colour or darken the stool.
Don’t use bulking agents unless instructed, but anti-diarrhoeal meds are okay.
Exercise is great for constipation and is of course vital to keeping weight in check.