Living With a Stoma: Diet & General Tips
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In the second instalment, we will be discussing about the diet and food most suited for patients with a stoma.
In general, gastrointestinal surgery can result in 2 types of stomas - an ileostomy or a colostomy. An ileostomy is a stoma located at the small intestine, while a colostomy is a stoma located at the large intestine.
We will be sharing separate dietary advice for each type of stoma followed by general advice for both.
Table of Contents (click to jump to the section!) 1. Patients with an Ileostomy 2. Patients with a Colostomy 3. General Advice for Both Stoma Types
Patients with an Ileostomy
Ileostomy output – what to expect
Your ileostomy output should become the consistency of “baby food” or “mashed potato” when you are eating and drinking to meet the needs of your body. This is because the large bowel usually reabsorbs the fluid from the small bowel (ileum) contents, so when your large bowel is being bypassed, this cannot take place. Thus, fluid is lost through your ileostomy. You therefore need to take in more fluid and “electrolytes” (salts) to make up for this loss.
What to drink
You will need to drink approximately 2 litres of fluids per day (even more if it is hot and humid), or if you are working out and sweating a lot. Discuss with your doctor if you have a medical condition that affects the amount of fluid you are allowed to drink eg. a heart condition or kidney disease.
Drinks you can have:
Sports drinks eg. Gatorade, 100 Plus (limit the amount, as these drinks are high in sugar)
Fruit juice (try to go for fruit juices with lower natural sugars like watermelon)
Tea and coffee, diet cordial (ordinary cordial is high in sugar)
Consume such food items to ensure adequate protein intake to build and repair muscle:
Meats such as beef, lamb, pork, chicken, and fish
Eggs and dairy products such as milk, cheese, and yogurt
Moreover, it is important to control your output by:
Eating smaller meals, but more often
Adding more salts or drinking electrolyte fluids
Do not take any slow release, enteric coated or sugar-coated tablets. The medication will not be absorbed as these tablets are meant to dissolve in the large intestine. If ingested, it will come into your pouch looking just like it did when you swallowed them and are therefore rendered ineffective.
Discuss any medications you are on with your doctor as they can advise you.
If you exhibit the following symptoms:
Generally feel unwell
Have a headache or feel dizzy
Experience a dry tongue
Have concentrated dark urine, or
Have muscle cramps
You may be dehydrated and missing some electrolytes. This is a sign for you to eat something high in salt and drink more fluids other than water.
Some examples of the diet to help with the electrolyte imbalance that you can take are:
Cup of soup or canned soup
Preserved foods eg. ham
Seek medical help if your symptoms do not improve. Additionally, seek early assistance from a health professional regarding the use of electrolyte replacement or sports drinks. If watery stoma output is the cause of the dehydration and it persists for 24 hours or more, do check in with your doctor.
Patients with a Colostomy
What should I eat?
It is not necessary to follow a special diet unless you have been advised to do so by your doctor for another specific medical condition. As much as possible, try to eat a diet containing a variety of items from all the food groups. This will ensure that your body receives all the essential nutrients (protein, carbohydrate, fat, vitamins and minerals) it needs.
Are there any food ostomates should avoid?
We are all different. Some ostomates can eat anything. Others have found, by experience, that it is best to avoid certain foods. If you have persistent problems, try keeping a food diary. You may find it helpful to figure out what food items may cause you discomfort.
Common concerns about eating
Beans, peas, onions, leeks, unripe banana, potato which is cooked then cooled (eg. potato salad and shepherd’s pie) contain a type of sugar and starch that can escape digestion and enter the colon, where they are fermented to produce gas. It may also help to avoid foods which are high in fibre or contain grains and seeds. Beer and fizzy drinks may also increase the amount of wind.
Very spicy foods can irritate the lining of the digestive system and cause frequent loose motions. These effects can be reduced by eating spicy dishes in small quantities with plenty of rice, pasta or potatoes. Pure fruit juices and some fruits and vegetables may also cause diarrhoea in some individuals.
Eating more foods containing fibre can help to prevent constipation. Try to increase the amount of fibre by choosing wholemeal (rather than white) bread or pasta, wholegrain cereals and more fruit and vegetables. It is best to make these changes gradually to avoid problems with wind. Fibre acts by absorbing water to make motions softer, so it is very important to drink plenty of fluids of at least six to eight glasses a day.
Often, it is not what you eat
The consistency of your stoma output does not only depend on the type of food you eat. Water is absorbed from undigested food as it passes along the colon. If a large section of the colon has been removed, then your stoma is likely to work more often and the output will be fairly liquid, or of a toothpaste consistency. If most of the colon is still intact, then motions will be more formed and less frequent. Do not assume that food is to blame for the way your stoma behaves.
Wind may be due to:
eating in a hurry
meals at irregular times
going for long periods without food
Diarrhoea may be the result of:
a stomach bug/flu
stress or an emotional upset
Constipation may be due to:
not drinking enough fluid
not getting enough exercise
some medicines e.g., certain painkillers or antidepressants
Call your doctor or go to the hospital if your stoma output is low, your stoma is not working, you have abdominal pain, or start having nausea and vomiting.
General Advice for Both Stoma Types
There should only be odour when emptying or changing your bag. This can be reduced by spraying a deodorant. If you detect odour while the bag is still in place, it might indicate a leakage or a faulty bag. Special drops, gels, capsules and sachets are available to neutralize any odour inside the bag.
Ballooning occurs when gas expelled through the colon collects inside the bag causing it to inflate. Most bags have a filter which allows this gas to escape. Occasionally the filter will block and the bag needs to be changed. If this happens to you regularly, it may be worth trying a different bag. When in the bath or shower, ensure the filter does not get wet and become ineffective; cover it with a sticky patch that is usually supplied with your box of stoma bags.
This occurs when, instead of dropping to the bottom of the bag, the motion collects around the stoma and may seep between the flange/ baseplate and the skin. This can happen because there is not enough air in the bag which causes the two sides stick together. It may help to cover the filter with a sticky patch to prevent gas escaping from the bag. Alternatively, you could place a small piece of crumpled tissue inside the bag to keep the sides apart. Lubricating the inside of the bag with baby oil or a special gel may help the motion to drop to the bottom of the bag. For further advice, speak to your stoma care nurse.
We hope that the above diet and general tips will be helpful if you have a stoma, or if you are a caregiver for a loved one with a stoma. There may be a lot of changes and getting used to, but with proper care and diet as well as communication between the doctors and nurses, taking care of a stoma is manageable. If you have any queries, feel free to leave them in the comments below and our friendly doctors and stoma care nurses will get back to you!
- Written by Seettha