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Nutrition and Your Ostomy

Amy Long Carrera, MS, RD, CNSC, CWCMS
Registered Dietitian Nutritionist | Shield HealthCare
12/17/14  12:17 AM PST
colostomy or ileostomy nutrition

In this article and the associated video, Shield HealthCare’s Corporate Registered Dietitian discusses nutrition after ostomy surgery and gives helpful diet tips.

Click the button below to watch our dietitian give nutrition tips for ostomates, and click on the links for more information and videos about ostomy nutrition:

Your Ileum and Colon

The ileum is the third and final segment of your small intestine. It is the most adaptable portion of your gastrointestinal tract. If other parts of your intestine are not working properly, the ileum can adapt to take over their functions over time.  Functions of the ileum include:

  • Absorbing sodium and other nutrients
  • Absorbing vitamin B12
  • Recycling bile salts
    • Bile salts are necessary to absorb fat and fat-soluble vitamins. The ileum absorbs used bile salts so your body can re-use them.
  • Slowing down transit time
    • If nutrients move too fast through your gastrointestinal tract, they are not absorbed well. The ileum acts as a brake when it senses that food is moving too quickly from the stomach to the small intestine.
  • Preventing reflux of colon contents, including bacteria, into the small intestine
    • The ileocecal valve is a one-way valve between the ileum and the colon. It closes when it senses too much pressure in the colon. It opens when it senses too much pressure in the ileum or when food leaves the stomach.

Your colon, or large intestine, provides many important functions, including:

  • Absorbing water, sodium and other minerals
  • Housing beneficial bacteria, which among other tasks, produce vitamins and ferment some carbohydrates into fuel for your intestine
  • Form stool and push it through to the end of the gastrointestinal tract

 

Your Diet After Surgery

Step 1: Clear Liquid Diet

Right after colostomy or ileostomy surgery your doctor will suggest a clear liquid diet. Consume only foods that you can see through and that are liquid at room temperature. This diet is fairly low in nutrients, so follow it for only three to four days unless your doctor tells you otherwise.

Clear liquids include:

  • Water and sports drinks
  • Tea and coffee without cream
  • Juice without pulp
  • Clear broth
  • Clear sodas
  • Popsicles without fruit chunks
  • Jell-O without fruit chunks

 

Step 2: Full Liquid Diet

The next step may be full liquids, which are easier to digest than solid foods while you recover. You can stay on full liquids a little bit longer than clear liquids as this diet provides more nutrients.

Full liquids include:

  • Clear liquids
  • Milk and cream (lactose-free if you are intolerant to lactose)
  • Ice cream and frozen yogurt
  • Kefir and buttermilk
  • Pudding and custard
  • Cream soups (strained to remove solid chunks)
  • Fruit nectar and juice with pulp
  • Oral nutrition supplements, such as Ensure®

 

Step 3: Low-Fiber Diet

After a few days, start to add solid foods that are low in fiber. These will be easier for you to digest than high-fiber foods.

Low-fiber foods include:

  • Clear and full liquids
  • White rice, pasta and bread
  • Potatoes without skin
  • Fresh fruit without skin
  • Canned or frozen fruit
  • Cooked vegetables
  • Cheese, yogurt, eggs
  • Baked, broiled or grilled fish, poultry or meat
  • Butter, margarine, mayonnaise, vegetable oil
  • Smooth nut butters

 

Step 4: Your Individual Diet

As you recover and heal after surgery (usually about two to three weeks afterward), gradually start to add fiber-containing foods to your diet. Use caution when trying new foods and keep track of what you eat and your symptoms. Certain foods may contribute to issues, such as gas, odor, diarrhea or constipation. If this happens, try the food again in a few days to see if your tolerance has improved.

TIP: Ask your doctor if you need a multivitamin and mineral supplement. If you limit or omit many foods from your diet, you may not be getting all of the nutrients you need.

Foods to Limit

 

Common Issues Recommended Foods Foods to Limit Notes
Gas Most cooked vegetables Broccoli, cabbage, Brussels sprouts, beans, peas, carbonated beverages, onions, garlic, leeks Eat smaller amounts more frequently. Long periods without eating can increase gas. Avoid smoking, chewing gum and drinking through a straw.
Odor Cranberry juice, buttermilk, yogurt, kefir, parsley Asparagus, alcohol, fish, eggs Try odor-eliminating drops or spray.
Hard stools / Constipation / Blockage Warm or hot beverages, fresh or cooked fruits, cooked vegetables Nuts and seeds, corn, coconut, raw celery or cabbage, raw apple peel, dried fruits may cause obstruction Increase fluid intake.
Watery stools/diarrhea Cheese, smooth nut butters, white rice, pasta, potatoes (without peel), bananas, applesauce may help to thicken stool. Prune juice and grape juice, alcohol, caffeine Choose lactose-free milk if you are lactose intolerant. If you have persistent watery stools, ask your doctor if you should consume an electrolyte drink.
Dehydration (more common w/ileostomy ) Isotonic  beverages, such as commercially available oral rehydration therapy drinks (Pedialyte®, CeraLyte®) or homemade (see recipes below) Hypotonic fluids (plain water, unsweetened iced tea, tea, coffee) and hypertonic fluids (sugary beverages i.e., regular soda, juices) Sip throughout the day.
Kidney stones (more common w/ileostomy) Low oxalate foods High oxalate foods: wheat bran, chocolate, nuts, beans, tofu, dark leafy greens, instant coffee, beer Drink 8-10 glasses of fluid daily.

 

Isotonic Beverage Recipes

Recipe #1: 6 ounces Pedialyte® (unflavored) + 2 ounces chicken broth

Recipe #2: 1 ½ cups regular Gatorade® or Powerade® + 1 ½ cups water + ¾ teaspoon salt

Recipe #3: ¾ cup apple/grape/cranberry juice + 3 ¼ cups water + ¾ teaspoon salt

Instructions: Mix ingredients together and sip throughout the day.

 

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Serving Medicare Ostomates Nationwide
My 89-year-old mother loves to swim but she has found that the pouch fills with water when she gets into the pool. What can we do to fix this?
Cathy
We recently had someone reach out to our Facebook community with a similar question, and several of our OstomyLife community members responded with their own advice.
 
Hopefully you and your mother will find their answers helpful ...


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