Understanding the Ileostomy Diet
An ileostomy is a surgically created opening, or stoma, that diverts the ileum (the last part of the small intestine) through the abdominal wall to allow waste to exit the body. Because the large intestine, which normally absorbs water and electrolytes, is bypassed, a person with an ileostomy loses more fluids and salts. A specialized diet is essential to manage stoma output, prevent dehydration, and avoid blockages. The dietary guidelines typically evolve in two phases: an initial, short-term low-fiber diet followed by a gradual transition to a more varied diet.
The Initial Low-Fiber Phase (First 6-8 Weeks)
In the weeks immediately following surgery, the bowel and stoma are swollen and sensitive. A low-fiber diet is crucial during this period to prevent painful blockages and promote healing. This involves limiting foods that are difficult to digest and can increase stool output.
Recommended Low-Fiber Foods:
- Refined Grains: White bread, white rice, white pasta, and low-fiber cereals like cornflakes and Rice Krispies.
- Soft Proteins: Ground or tender cooked poultry, fish, eggs, and smooth nut butters.
- Cooked, Peeled Fruits: Ripe bananas, applesauce, melons, and peeled, canned fruits like peaches.
- Cooked, Peeled Vegetables: Well-cooked carrots, peeled potatoes, and canned vegetables without skins or seeds.
- Dairy: Milk, cheese, and plain yogurt. For those with lactose intolerance, lactose-free options or non-dairy milks are recommended.
Foods to Limit or Avoid Initially:
- High-Fiber Foods: Whole grains, brown rice, whole wheat pasta, bran, and lentils.
- Tough, Stringy Foods: Celery, pineapple, tough cuts of meat, sausages with casings, coconut, and mushrooms.
- Raw Fruits and Vegetables: Avoid skins, seeds, and tough fibrous varieties.
- Nuts and Seeds: Can cause blockages if not chewed thoroughly.
- Spicy and Fried Foods: Can irritate the bowel and increase stool output.
Gradually Reintroducing Foods
After the initial recovery period of about 6 to 8 weeks, as stoma swelling subsides, you can begin to slowly reintroduce a wider range of foods. The key is to add new foods one at a time in small portions and chew them very well. This allows you to monitor your body's reaction and identify any foods that cause discomfort. Keeping a food diary is a helpful tool during this process. If a particular food causes issues, remove it from your diet for a few weeks before trying it again in an even smaller amount. Over time, most people can return to a varied and healthy diet, avoiding only the specific foods that cause problems.
Important Considerations for an Ileostomy Diet
Hydration and Electrolytes
Because the large intestine is no longer absorbing water, ileostomy patients are at an increased risk of dehydration.
Staying Hydrated:
- Aim for at least 8 to 10 cups (approximately 2 liters) of fluid daily.
- Oral rehydration solutions (ORS) are particularly effective for replacing lost fluids and electrolytes, especially with high stoma output.
- Limit fluid intake during meals to prevent food from being flushed through the digestive tract too quickly.
- Sip fluids throughout the day rather than drinking large quantities at once.
Electrolytes:
- Sodium and potassium are key electrolytes lost through an ileostomy.
- Increasing salt intake through cooking or consuming salty snacks can help.
- Good sources of potassium include potatoes without the skin, bananas, and tomato soup.
Managing Gas and Odor
Gas and odor are normal parts of digestion, but some foods can exacerbate them.
Foods that may increase gas: Broccoli, cabbage, beans, peas, onions, garlic, and carbonated beverages.
Foods that may cause odor: Fish, eggs, garlic, and onions.
Tips to reduce gas and odor:
- Chew food thoroughly and eat slowly.
- Avoid chewing gum and drinking through a straw, which can cause you to swallow air.
- Foods like yogurt, buttermilk, and parsley may help control odor.
Comparison of Ileostomy Diet Phases
| Feature | Immediate Post-Op (First 6-8 Weeks) | Established Ileostomy (After 6-8 Weeks) |
|---|---|---|
| Dietary Goal | Reduce strain on the bowel, promote healing, and prevent blockage. | Achieve a normal, balanced diet tailored to individual tolerance. |
| Fiber Intake | Limited to low-fiber (low-residue) foods. | Gradually reintroduce higher-fiber foods in small amounts. |
| Food Preparation | Emphasizes well-cooked, peeled, and pureed options. | Greater flexibility with preparation methods, including some raw foods. |
| Reintroduction Strategy | No new foods; stick to easily digestible options. | Add one new food at a time, chewing thoroughly, and monitoring for tolerance. |
| Key Focus | Low-fiber foods that thicken output and reduce irritation. | Variety, nutrient absorption, and long-term digestive comfort. |
Conclusion
While an ileostomy requires significant dietary adjustments, it does not mean a life of restricted eating. Initially, a low-fiber, bland diet is necessary to allow the bowel to heal and reduce the risk of blockages and high output. With careful reintroduction of foods and good chewing habits after the first 6-8 weeks, most individuals can enjoy a varied and nutritious diet. Prioritizing hydration and being mindful of how different foods affect your body are the cornerstones of managing an ileostomy successfully. Collaborating with a healthcare team, including an ostomy nurse or dietitian, can provide personalized guidance and ensure nutritional needs are met throughout the journey.
Visit the Crohn's & Colitis Foundation for additional resources on living with an ileostomy.
