A Comprehensive Guide By
Gina Giebner –
The Rehab Dietitian

Undergoing a colostomy or ileostomy, a surgical procedure where a portion of the bowel (colon or ileum) is brought through the abdominal wall to create a stoma, can significantly impact dietary habits. Following surgery, it becomes crucial to adopt a thoughtful and gradual approach when reintroducing foods into the diet. This is essential for ensuring proper nutrition, minimising discomfort, and adapting to the changes in digestive function. If this process is managed correctly, many people can get back to their normal diet.

The Importance of Fibre

One crucial aspect of this recovery is the careful reintroduction of dietary fibre, which plays a pivotal role in maintaining digestive health and overall wellbeing.

Fibre is essential for digestive health, regular bowel movements, and the prevention of constipation. It also aids in weight management, helps control blood sugar levels, improves gut bacteria balance and supports heart health. Some people may need to adapt the fibre in their diet after bowel surgery.

Challenges After Stoma Formation

Adapting to life with a stoma involves adjusting not only to physical changes but also these new dietary considerations. After surgery, some individuals may experience a temporary reduction in appetite, changes in taste, or digestive discomfort. These factors can make it challenging to reintroduce fibre, as certain high-fibre foods may be difficult to digest.

How to get back to normal or near normal eating:
You may have been advised after your operation to follow a bland low fibre or low residue diet. However, once your stoma is working well, there is no need to stay on this diet.

Step by step reintroduction

Introduce one food at a time

Begin reintroducing foods one at a time to monitor how the digestive system responds. This allows for easy identification of any potential triggers or intolerances. Keeping a food symptom diary can be useful during this process.
Picture of a banana

Start slow

Begin by introducing small amounts of soluble fibre, which is easier to digest. Foods such as oats, bananas, peeled soft fruits and cooked vegetables are good choices. Gradually increase the fibre content as your body adapts. It may take several weeks to get back to your normal diet.

Include insoluble fibre step by step

Include insoluble fibre step by step Insoluble fibre adds bulk to the stool and can be introduced gradually as your digestive system adjusts. Foods like whole grains, raw vegetables and salad contain insoluble fibre (insoluble fibre also includes skins, pitch, pips and seed husks and stringy hard parts of foods)

Add small portions of one new thing in at a time (around a cupped handful of a new thing on the first day, then go for handful at each meal. Gradually increase the volume if you are tolerating it.

Aim for as much variety as you can. If you get a problem with anything in particular, stop for a bit but do retry again to make sure it was the food or drink, and not a coincidence.

If you are being over restrictive you may need to take a vitamin and mineral supplement due to your diet not being fully complete. It is best to seek support if you are following a restrictive diet for longer than a few weeks.

Keep a food symptom diary

Track your dietary choices and their impact on your digestive health. This can help you identify trigger foods, and make informed decisions about your diet.

Lady updating her food diary

Monitor stool/stoma output

Pay close attention to stool output and consistency. Gradually adding fibre-rich foods, like wholegrains, fruits, and vegetables, can help regulate bowel movements and prevent constipation/sluggish stoma action.

Stay hydrated

Adequate hydration is essential for maintaining digestive health as well as reducing fatigue. Consuming enough water helps soften stool and promotes regular bowel movements, preventing complications like constipation. Most adults need around 8-10 mugs/glasses a day. Try to keep most of your drink’s caffeine and fizz free.

Begin by introducing small amounts of soluble fibre, which is easier to digest. Foods such as oats, bananas, peeled soft fruits and cooked vegetables are good choices. Gradually increase the fibre content as your body adapts. It may take several weeks to get back to your normal diet.

Drinks for hydration

Lean proteins

Incorporate lean proteins like chicken, fish, eggs, and tofu. These are easily digestible and provide essential nutrients for overall health and recovery. High protein yoghurts like natural Greek yoghurts are particularly good for your bowel health (unless you have a lactose intolerance).

An example of lean a protein boiled egg in half

Precautions and tips:

1. Chew thoroughly

Chewing food thoroughly aids in digestion and reduces the risk of blockages. Take time to enjoy meals and practice mindful eating. We generally need to chew 15-30 times per mouthful. The aim is to avoid swallowing big hard lumps.

2. Follow a regular meal pattern through the day.

3. Observe portion sizes

Be mindful of portion sizes, especially when reintroducing new foods. Small, frequent meals can be easier on the digestive system.

4. Avoid heavy meals, alcohol and caffeine before bed

5. If you get excess WIND from your stoma remember that some foods ‘may’ increase wind. Keep a food symptom diary and test each food to see how you respond. It is never good to be overly restrictive especially with foods you enjoy. A varied balanced diet is important for your future health and wellbeing.

Note that tolerance to specific foods can vary from person to person. Here are some foods and drinks that may cause wind with a stoma:

Foods with may increase gas (not the same for everyone):

Cruciferous vegetables
– Broccoli, cauliflower, cabbage, Brussels sprouts, and kale can produce gas during digestion. It can depend on the amount and cooking methods.

Beans and lentils
– Legumes, such as beans and lentils, are known for causing gas.

Onions and Garlic
– These vegetables contain fructans, which can contribute to gas production. Try eating smaller amounts of these if gas is a problem

Carbonated drinks
– Carbonated drinks, including fizzy juice/drinks and sparkling water, can introduce air into the digestive system, leading to gas.

Artificial sweeteners
– Sugar alcohols like sorbitol and mannitol, often found in sugar-free products, can cause gas.

Chewing too much chewing gum can introduce swallowed air

Drinks with may increase gas:

Caffeinated beverages
– Coffee, tea, and certain energy drinks may stimulate the digestive system, leading to increased gas.

Alcohol
– Alcoholic drinks can cause bloating and gas in some people

Fruit juices
– Some fruit juices, especially those high in sorbitol, can contribute to gas.

High-sugar drinks
– High-sugar beverages, particularly those with added fructose, may cause gas.

Are there any foods that you shouldn’t eat with a stoma?

– The only foods people tend to get problems with is eating too many nuts at once. These may cause stoma blockages. Eating 1 nut in a chocolate is unlikely to cause a problem. Chewing well and drinking plenty will help. If you like nuts try having smooth nut butter or ground nuts instead.
– Otherwise aim to eat everything you normally would or work up to a healthy diet.

Often you can choose to eat differently when you are at home, where you can manage your stoma better. Alternatively, some people use medications like.

 

Are there any foods that you shouldn’t eat with a stoma?

– The only foods people tend to get problems with is eating too many nuts at once. These may cause stoma blockages. Eating 1 nut in a chocolate is unlikely to cause a problem. Chewing well and drinking plenty will help. If you like nuts try having smooth nut butter or ground nuts instead.

– Otherwise aim to eat everything you normally would or work up to a healthy diet.

Often you can choose to eat differently when you are at home, where you can manage your stoma better. Alternatively, some people use medications like Imodium (Loperamide) to increase their food variety. You should seek support from a health care professional, such as, your stoma nurse or a specialist dietitian, if you think this option may be right for you.

It can take several months for your stoma to settle, including your wind and odour symptoms. Starting chemotherapy/other cancer treatments, medication changes or starting antibiotics may alter your stoma function and further diet or medication management may be needed to prevent dehydration and unpleasant symptoms which may affect your treatment or wellbeing.

After your stoma reversal, you can get altered bowel habit or symptoms similar to IBS. It is worth seeking support from a specialist dietitian if this happens or discuss with your colorectal team.

It is also important to seek medical support if your stoma becomes over active or is blocking. 

To summarise

Reintroducing foods after a stoma may require patience and careful observation. By following a gradual and personalised approach, individuals can adapt their diet to promote optimal digestion, overall health, and well-being. Remember, every person’s journey is unique, and adjustments may be necessary based on individual responses and preferences.

Lady with a Stoma bag