What is short bowel syndrome?
Short bowel syndrome occurs when a significant part of your small bowel is resected (removed through surgery) leaving you unable to digest and absorb all the nutrition and fluid you need to maintain health. This can lead to symptoms such as weight loss, diarrhoea and dehydration.
What is re-continuation surgery?
Re-continuation surgery is when part of the small bowel (jejunum) is surgically rejoined to the large bowel (colon).
Surgery will help to:
- slow down the movement of food and fluid through the bowel
- increase the time for nutrient and fluid absorption
- reduce symptoms such as bloating and diarrhoea
What should I eat following re-continuation surgery?
Initially following re-continuation surgery you may experience abdominal pain, bloating and diarrhoea. The following may help:
- eat small regular meals and snacks
- chew your food well
- choose soft foods
It is recommended you eat a balanced and varied diet that is:
- high in protein, carbohydrate and calcium
- low in fat, fibre and oxalate*
Protein is essential for growth and repair. Eating a protein rich diet will help your recovery after surgery. Protein rich foods include meat, fish, dairy products and eggs.
Carbohydrates (starchy foods) include bread, pasta, rice and noodles and are a major source of energy for the body. Eating carbohydrates will help you to maintain your weight and minimise symptoms.
Calcium is a mineral needed for bone health. After re-continuation surgery, absorption of calcium may be reduced. The richest sources of calcium are from dairy produce and fortified soya products. However, other sources include green leafy vegetables, some fruits and fortified cereal products.
Fat is a major energy source. However, following re-continuation surgery, high fat foods can cause diarrhoea and abdominal discomfort. Foods high in fat include full fat dairy products, pastry, fried foods and chocolate.
Fibre is a non-digestible component of foods, found in wholegrain cereals / flours, pulses, fruit and vegetables. Eating too much fibre can also lead to diarrhoea as well as bloating.
Oxalate* is found in plant foods and is produced by the body as a waste product of digestion. It normally binds to calcium and is passed out in the stool. Following re-continuation surgery, oxalate can be passed out in the urine, increasing the risk of developing kidney stones. If you are planning to consume an oxalate containing food, try to eat a food high in calcium alongside it to lower the risk of kidney stones.
Why do I need to follow this type of diet?
This diet will help to:
- maintain weight
- increase nutrient absorption
- maximise nutrient intake
- reduce symptoms
- aid recovery from surgery
- prevent the risk of developing kidney stones
The following table gives a guide to foods to limit and suitable alternatives to help in following a diet high in protein, carbohydrate, calcium and low in fat, fibre and oxalates.
| Type of food | Foods to limit | Suitable alternatives |
|---|---|---|
| Breads, cereals, grains |
Foods to limit
Brown, wholemeal granary bread, bagels or flour Brown rice Wholemeal pasta, noodles Pastry and pastries Rye bread |
Suitable alternatives
White flour or baked products eg bread, pasta, spaghetti, macaroni, crumpets, English muffins White rice Plain cous cous Noodles |
| Breakfast cereals |
Foods to limit
Porridge Wholegrain/ bran cereals such as Weetabix, all bran, muesli, cereals with nuts or dried fruit, shredded wheat, Shreddies Granola Chocolate puffed rice |
Suitable alternatives
Rice Krispies/ puffed rice Cornflakes/ frosted flakes Special K Sugar puffs Cheerios |
| Sweet and savoury snacks |
Foods to limit
Chocolate Digestives Bran biscuits Flapjacks Biscuits or cakes containing dried fruit, nuts or chocolate Crisps Cream crackers and Ryvita |
Suitable alternatives
Plain white crisp breads and plain crackers Plain biscuits such as rich tea. morning coffee, malted milk Sweets (not chocolate) Low fat snacks such as snack-a-jacks, baked crisps, wotsits, french fries |
| Meat, fish, pulses, nuts and seeds |
Foods to limit
Nuts* Beans (including baked beans)* Soy products* Tofu* Pulses Lentils Seeds Quorn Vegetarian Burgers* |
Suitable alternatives
Aim to eat one portion at each meal. Remove skin and visible fat from meat. Oven bake, grill, steam, poach, boil: Lean meats White fish (oily fish once/week) |
| Milk and dairy products |
Foods to limit
Full fat milk Cream Ice cream Full fat yoghurts Full fat cheese Full fat custard Crème fraiche Fromage frais |
Suitable alternatives
Skimmed or semi skimmed milk Low fat yoghurts Low fat cream/spreadable cheese/ cottage cheese Eggs (avoid fried or with full fat milk/ spreads) Low fat custard Low fat ice cream/ sorbet Low fat fromage frais |
| Puddings |
Foods to limit
Chocolate puddings Pastries Cakes Puddings containing unsuitable fruits |
Suitable alternatives
Tapioca Blancmange Puddings made with skimmed milk, frozen yoghurt Jelly |
| Fats and oils |
Foods to limit
Butter Lard Ghee Suet Dripping Hard margarines Palm/coconut oil |
Suitable alternatives
Choose lower fat spreads/ oil sprays and use sparingly |
| Fruits |
Foods to limit
Blackberries* Blueberries* Citrus Peel* Gooseberries* Oranges/tangerines/mandarins* Dried eg prunes, apricots, figs* Kiwi* Mango* Raspberries Banana |
Suitable alternatives
Remove skins, seeds, piths, pips Maximum two to three portions per day: Apples, fresh apricots, cherries, grapefruit, grapes, lemon, melon, nectarines, papaya, passion fruit, peaches, pear, pineapple, strawberries |
| Vegetables and potatoes |
Foods to limit
Aubergine* Beetroot* Leeks* Rhubarb* Spinach* Carrots* Celery* Green beans* Sweet potatoes* Tomatoes* Chips* Potatoes (no skin)* Peas Sweet corn All raw vegetables Broccoli, Brussels sprouts, cabbage, cauliflower, celery, onions, sauerkraut, turnips, baby marrow |
Suitable alternatives
Cooked vegetables Remove skins, seeds, stalks Maximum two to three a day: Asparagus Avocado Cucumber Lettuce Peppers |
| Miscellaneous |
Foods to limit
Chocolate* Peanut butter* Soups with unsuitable vegetables |
Suitable alternatives
Jams, marmalade Honey, syrup, treacle Low fat dressings and sauces – try herbs, spices, tomato juice, vinegar, lemon juice |
| Soups |
Foods to limit
Soups made with cream, and full cream milk, or soups containing fat Soups containing pulses, lentils, beans, mixed vegetables |
Suitable alternatives
Fat free consommé and bouillon, soups made from skimmed milk and fat free broths containing pasta or noodles |
| Fluids/ Drinks |
Foods to limit
Strong black tea*/ coffee Cocoa / chocolate drinks* Fruit juices containing unsuitable fruits* ‘Diet’ drinks Draft beer* Soy milk* |
Suitable alternatives
Water, squash Milky weak tea or coffee Add sugar to hot drinks Bovril Skimmed or semi skimmed milk in small quantities Fruit juices (apple, pineapple, grape, grapefruit, cranberry, lemon/lime juice) |
* These foods are high in oxalate
Suggested meal plan
Breakfast ideas
- Cornflakes or a puffed rice cereal with semi skimmed milk and sugar.
- White bread/toast with low fat spread and jam / marmalade / honey / marmite.
- Grilled lean, back bacon and scrambled eggs made with semi skimmed milk and low fat spread.
- Boiled egg with white bread soldiers and low fat spread.
- Low fat yoghurt with suitable fruit.
- Smoothie.
Lunch and main meal ideas
- White bread sandwich or flour wrap – Tuna in brine / chicken (no skin) / egg with low fat mayonnaise, ham and low fat cheese / cheese spread.
- Consomme soup / broth with white bread.
- Jacket potato (no skin) with low fat spread and cheese, meat/turkey bolognese.
- White fish baked / poached / steamed with boiled potatoes and low fibre vegetables.
- Pasta with tomato sauce, suitable vegetables and tuna (in brine) / chicken (no skin) / lean minced meat.
- Meat and potato pie with gravy, mashed potato and suitable vegetables.
- Stir fry (chicken / prawns / suitable vegetables) with noodles, sweet chilli sauce.
Dessert ideas
- suitable fruits
- jelly
- low fat custard
- low fat yoghurt / custard ice cream
- plain cakes or biscuits
- puffed rice or cornflake cereal bars
Snack ideas
- low fat crisps
- plain, salted or sweet popcorn
- plain cakes or biscuits
- soup and roll
- crackers and low fat spread / cheese
- crumpet / white toast with low fat spread and jam / marmalade / honey
- milky drinks
- smoothies made with suitable fruits yoghurt / milk
Do I need to supplement my diet?
If you are finding it difficult to maintain your weight while following this diet, your dietitian may recommend some nutritional supplements that are high in energy and protein and contain vitamins and minerals. These are available on prescription on the ward or from your GP on request by your dietitian.
As your absorption of nutrients may be reduced, your doctor or dietitian may also prescribe a vitamin or mineral supplement such as calcium, iron, magnesium, zinc or vitamin B12.
What about fluid and salt?
Replacing salt
Replace salt by including more in your diet:
- add salt to cooking (for example potatoes, rice, pasta and vegetables)
- add salt to food at the table
- flavour foods with garlic or celery salt
- add sauces such as tomato ketchup and brown sauce to meals
Replacing fluid
Signs of dehydration include:
- thirst
- reduced volume of urine
- dark coloured urine
- tiredness
- muscle cramps
- dry skin
- dizziness
To help avoid dehydration and reduce diarrhoea, it is best to:
- Drink fluids high in salt such as Bovril and soup.
- Try milk and milky drinks
- Limit drinks containing caffeine and those low in salt, for example water, tea, cola, coffee, squash.
You may need to drink an oral rehydration solution such as Dioralyte® or an electrolyte mix. Your dietitian or doctor will advise you further about this.
Where can I find more information?
Please contact your dietitian if you require further advice:
Dietitian. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contact number: 01223 216 655
Contact email. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(An email consent form must be completed to enable Addenbrooke's staff to contact patients by email).
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Smoking is not allowed anywhere on the hospital campus. For advice and support in quitting, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169.
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