An ileostomy is a surgical procedure that diverts the small intestine (ileum) through an opening in the abdominal wall, called a stoma, to collect waste in an external pouch. Since the large intestine is bypassed, fluid and electrolyte absorption are significantly impacted, necessitating specific dietary changes. Following proper nutrition therapy recommendations is essential for managing output, preventing complications, and maintaining overall health.
Initial Post-Operative Diet: Low Fiber and Frequent Meals
Immediately following ileostomy surgery, and for the first 6 to 8 weeks, a low-fiber (low-residue) diet is typically recommended. This helps minimize the volume and viscosity of stoma output while the bowel heals and swelling around the stoma decreases. The strategy focuses on easy-to-digest foods that are less likely to cause blockages or irritation.
- Small, frequent meals: Aim for five to six small meals throughout the day instead of three large ones. This aids digestion and improves nutrient absorption.
- Chew food well: Chewing thoroughly to an almost liquid consistency, like applesauce, is vital to prevent undigested food from causing a blockage.
- Introduce new foods gradually: When adding higher-fiber foods back into the diet, introduce one new item at a time in small quantities. This helps identify any foods that cause adverse reactions.
Long-Term Dietary Management and Reintroduction
As recovery progresses, most individuals can return to a varied diet. The goal is to eat a balanced, nutritious diet while being mindful of how different foods affect stoma output, gas, and odor. A food diary can be a helpful tool during this phase.
- Hydration is paramount: Ileostomy patients are at high risk for dehydration due to increased fluid and electrolyte loss. The focus should be on oral rehydration solutions (ORS) or low-sugar sports drinks rather than plain water alone, especially with high output.
- Salt intake: Increasing salt intake can help replace the sodium lost through the stoma. This can be done by salting food, consuming broth, or having salty snacks like pretzels.
- Foods for thickening output: Some foods can help thicken watery stoma output. Examples include bananas, applesauce, white rice, pasta, creamy peanut butter, and marshmallows.
Troubleshooting Common Issues
Nutrition therapy is also key for managing common ileostomy complications.
High Output
An output greater than 1,000 to 1,500 mL per day is considered high. Management includes:
- Fluid timing: Sip fluids throughout the day and avoid drinking large amounts with meals, as this can increase output.
- ORS: Prioritize oral rehydration solutions to replenish lost fluids and electrolytes.
- Low-sugar fluids: Limit sugary drinks, caffeine, and alcohol, as they can increase output.
Blockages
Certain hard-to-digest foods, or a failure to chew properly, can lead to a blockage. Symptoms include abdominal cramping, pain, bloating, and no or watery output.
- Foods to avoid initially: High-fiber or stringy foods like corn, mushrooms, celery, nuts, and large seeds should be avoided for the first several weeks post-surgery.
- What to do: If a blockage is suspected, stop eating solid foods and drink only fluids. A warm bath and massage can help. Contact a healthcare provider if symptoms persist.
Gas and Odor
Certain foods can increase gas and odor, though individual tolerance varies.
- Gas-producing foods: Onions, beans, broccoli, Brussels sprouts, and carbonated beverages are common culprits.
- Odor-producing foods: Foods like fish, eggs, asparagus, and garlic may cause more odor.
- Solutions: Parsley, buttermilk, and yogurt are known to help reduce odor. Chewing food slowly and avoiding drinking through straws can also minimize gas.
Low Fiber vs. Fiber Reintroduction: A Comparison
| Feature | Low Fiber Diet (Initial 6-8 Weeks) | Regular Diet with Reintroduced Fiber |
|---|---|---|
| Goal | Allow bowel to heal, reduce output, prevent blockage. | Restore a balanced diet, improve long-term nutrient absorption. |
| Carbohydrates | White bread, refined pasta, white rice, low-fiber cereals. | Whole grains, brown rice, whole wheat bread, as tolerated. |
| Fruits | Peeled, cooked, or canned fruits; ripe bananas, melons. | Introduce fresh fruits with skin and seeds gradually. |
| Vegetables | Well-cooked, peeled, and seeded vegetables; vegetable juices. | Add raw vegetables, leafy greens, and fibrous vegetables slowly. |
| Protein | Ground meats, fish, poultry, eggs, creamy nut butters. | Introduce tougher cuts of meat, nuts, and legumes gradually. |
| Consideration | Focus on small, frequent, and well-chewed meals. | Monitor individual tolerance, use a food diary. |
Conclusion
Nutrition therapy for an ileostomy is a multi-stage process involving an initial low-fiber diet followed by a gradual reintroduction of more varied foods. Key principles include prioritizing hydration with oral rehydration solutions, managing high output and potential blockages, and being mindful of gas and odor-producing foods. By working with a healthcare team, including a dietitian and stoma nurse, individuals with an ileostomy can successfully manage their nutritional needs and live an active, healthy life. Proper education and consistent monitoring are crucial for adapting to these changes and identifying any issues early.
Visit Ostomy Canada for additional resources on living with an ostomy.
