What you need to know about healthy eating with a stoma
The purpose of this information is to provide people with stomas guidance on what constitutes a healthy diet after stoma surgery and any important factors to take into consideration regarding stoma management and general wellbeing. If you would like more information about diet or any other Ostomy Lifestyle subject, call our Helpline on 0800 731 4264 you can also e-mail firstname.lastname@example.org. The following information can be downloaded as a pdf file. Once you have read the information, let us know how helpful it was by clicking here to complete a short survey.
Information about diet and healthy eating is often conflicting and difficult to interpret. Add to this a medical condition such as having a stoma and many people feel confused about what they should and shouldn’t be eating. The following information is general advice for people with stomas from 2-3 weeks after your operation, if your health care team has given you different advice due to a specific problem you have, it is important to check with them before you change your diet.
Most people with stomas do not need to change their diets and should follow a normal healthy eating pattern like the rest of the population. If you have recently had your surgery or have been unwell, ensuring that you get all the essential nutrients from your diet is even more important and putting unnecessary restrictions on your diet could slow down your recovery and healing.
A balanced diet is made up of:
- Starchy foods such as potatoes, rice & grains, bread and pasta, for energy. Try different varieties, including wholemeal vs refined/white rice and pasta, to see which are most helpful for your stoma management.
- Fruit and vegetables provide a wide range of vitamins and minerals and both soluble and insoluble fibre. Soluble fibre is found in the flesh of fruit & veg and can help lower cholesterol as well as make stool thicker, softer and easier to pass (helpful for those with a colostomy or ileostomy who wish to thicken their output). Insoluble fibre is found in the skins of fruit & veg and helps move waste through your bowel, so can help with constipation (helpful for those with a colostomy who experience pancaking and anyone who experiences constipation). If you have a colostomy or ileostomy, immediately after surgery foods containing insoluble fibre may make your stoma behave unpredictably, so you may wish to avoid or limit your intake of them. As your bowel adjusts you can re-introduce them and see how they affect you.
- Protein rich foods for growth and healing. Protein comes from meat, fish, eggs, soya and pulses and it is the substance we use to heal wounds and regain muscle.
- To promote general wellbeing, fatty foods should be limited. However, if you are recovering from surgery or have a small appetite and need to gain weight, including more of these foods in the short term is a good idea.
The vast majority of people with a urostomy (a stoma that passes urine) find that their food intake is unaffected by having a stoma, however some food and medications can make urine discoloured or smelly (e.g. beetroot can make your urine pink and antibiotics and asparagus can make it smell strange). There are some specific recommendations for those with a urostomy in the ‘Fluid Intake’ section. The following information applies to those with a colostomy or ileostomy (stoma that pass faeces).
The impact of food and drink on your stoma is hard to predict as diet is very individual. Evidence from our surveys suggests that foods can affect people in different ways after stoma surgery. While many people find that they can eat just the same diet as before their surgery, some find there are things that can have an adverse effect on the activity of their stoma. They may then choose to avoid those foods, or include them in their diets and be prepared for the effects.
Many people report that a good way to ascertain which foods and drinks are suitable for you is to keep a food diary so that patterns between diet and stoma output can be identified. (Available to download here or by contacting the office). You can then base your diet on what you have observed to be agreeable in terms of your stoma output. There may be a certain degree of trial and error, especially in the first few months after your stoma is formed when the bowel is swollen. This swelling (or oedema) is the reason your stoma looked puffy initially and can cause problems digesting food that would otherwise not occur, so it sometimes worth trying a food again later on before deciding whether to eliminate from your diet completely.
Importance of chewing
It sounds very obvious, but it is vitally important to chew food thoroughly when eating. Chewing is the first stage of digestion and in doing this we make more nutrients available from our food. Foods that contain cellulose such as nuts, grain, fruit & vegetables (particularly the skins) cannot be completely broken down in the digestive system. So, you may notice these coming through your stoma looking the way they did when you ate them. Immediately after bowel surgery, your bowel is swollen and this narrows the passageway for food to pass along. In addition to this, people who have had any kind of abdominal surgery can have adhesions (which may be thought of as fibrous scar tissue). These can lead to sections of the bowel becoming narrow or kinked. So, it is especially important to chew these foods thoroughly, especially in the first few months, to ensure everything can move through easily. Cooking these kinds of foods for longer can also make them easier to digest. There is no need to eliminate these foods from your diet, indeed, they are an important food group to include, so long as you follow these guidelines.
It is essential for everyone to drink enough to keep their kidneys healthy and flush out the chemicals that build up in the blood. You should aim to drink enough throughout the day that your urine is a light straw colour. The following information is for the specific stoma types but does not take into account other medical conditions. If you have been given different information from your healthcare team please check with them before making any changes.
People with urostomies should aim to drink between 2-3 litres of fluid per day. This will help to prevent infections. Anecdotally, it is suggested that drinking a glass of cranberry juice per day can also reduce infections.
If you have a colostomy, your fluid intake can remain as normal unless you are experiencing constipation or pancaking. If you have this problem, increasing your fluid intake can be really helpful.
People with ileostomies, particularly if the stoma is formed higher up in the bowel, can have more difficulties with their fluid intake. This is because it is the role of the large bowel to absorb water (and salt) and for people with ileostomies this is no longer being used. The small bowel will, with time, adapt to absorb more water and more salt, however careful attention should be paid to ensure that you are drinking an adequate, varied fluid intake (e.g. water, juice, cordial, herbal/fruit teas, etc) to maintain kidney health. Remember, you are aiming for light straw coloured urine.
For those who are more active it is even more important to pay attention to your fluid intake. Fluids lost through sweating contain electrolytes, so it is important to replace those with specialist sports drinks.
Everyone should bear in mind that alcohol is a dehydrating fluid in the most part and caffeinated drinks such as tea and coffee cause you to lose more fluid in your urine. The majority of your fluid intake should therefore be from fluids such as water and fruit cordials.
Salt is important for nerve and muscle function and is found naturally in most food and drink. There are risks associated with both having too much and too little salt in our diets. Too much salt can lead to high blood pressure, which can make you more likely to develop heart disease, or have a stroke, while too little salt can cause headaches, cramps and fatigue. While there is some evidence that people with ileostomies can lose between 35-90mmol of sodium per day (equivalent to up to a teaspoon of table salt) because this would normally be absorbed in the large intestine, each person with an ileostomy will differ in terms of the amount they lose. There is also evidence that the small bowel of someone who has an ileostomy adapts over time to compensate for absorption issues. But, in the first few weeks after surgery you may need to add salt to your food and have additional salty snacks. There is conflicting information about long-term addition of salt to diet but evidence shows that most people have adequate salt in their diet to make up for what is lost through their ileostomy and there is no need to add more.
Prolonged, watery output from a colostomy or ileostomy can cause dehydration (loss of water and salt) which can be treated by drinking rehydration solutions available from a pharmacy. It is not sufficient to drink plain water in these cases. If you are concerned about your salt levels you can request a blood test from your GP.
A little of what you fancy….
Of course, every now and again you will want to enjoy a treat like cake or ice cream and there is no reason why you can’t indulge once in a while! Healthy eating is about moderation and after stoma surgery it is also about trial and error. Take your time to explore how different foods affect your stoma, chew your meals, maintain a varied fluid intake and, most importantly, enjoy your food!
Researched and written by Sophie Medlin, Lecturer in Dietetics at Plymouth University and Helen Bracey, Helpline Services Manager at Ostomy Lifestyle