Healthy eating with an ileostomy

What is an ileostomy?

An ileostomy is a surgical procedure which removes part of the small bowel (ileum), resulting in an opening between the small bowel and the outer abdominal wall. This opening is called a stoma or ileostomy. A stoma bag is attached to the opening providing an alternative channel for faeces to leave the body.

The main functions of the ileum are to absorb vitamin B12, bile salts and any remaining products of digestion that have not been absorbed further up the bowel. Ileostomy output is often determined by where on the ileum the stoma is situated/ how much of the ileum is removed and how much is left. The larger the resection, the looser the expected output.

What can I eat after my operation?

After abdominal surgery, most patients are not ready to eat a full diet straight away as it can take a while for the gut to recover from the trauma of surgery. Initially, people start off with sips of water and gradually build up volumes to test tolerance of all types of fluid, for example tea, juice or milk, before progressing to a low fibre diet. You may find having small, frequent meals easier initially before you are able to build back up to three meals a day. Your doctor should update you on when you are able to progress with your diet if not starting off with normal foods.

A staff nurse or dietitian will provide you with further information.

Will having an ileostomy affect my diet in the long term?

After an ileostomy, you will continue to digest and absorb nutrients as usual because this mostly takes place higher up in the small bowel which has not been operated on. This is why the majority of people with an ileostomy can eat a normal, well-balanced diet with an adequate fluid intake as based on the Eatwell Plate (see below).

What is included in a healthy balanced diet?

It is important to try and eat a well-balanced diet to aid recovery once you have progressed from the low fibre diet.

Starchy foods (carbohydrates)

Include one of the following at each meal; bread, breakfast cereals, pasta, rice, potatoes, noodles, crackers, crispbread or couscous.

Protein foods including meat, fish or alternatives

Aim for two portions per day of the following: meat, poultry, fish, eggs, lentils, tofu, beans (which are also good sources of protein and iron) or plant-based alternatives such as Quorn.

Dairy products

Dairy products such as milk, cheese or yoghurt are a good source of calcium, protein and energy, so aim for two to three portions a day. If you are avoiding dairy products, please check the labels to ensure that they are fortified with calcium and iodine.

Fruit and vegetables

Try to have at least five portions of fruit and vegetables every day (a portion is roughly what fits in the palm of one hand). Try to aim for a variety of colours to increase the range of nutrients that you are getting.

Fatty and sugary foods

These should be eaten in moderation but, if you have a poor appetite, they can be added to foods to provide more energy; mayonnaise, butter, cheese, oil, cream, sugar, chocolates, fizzy drinks and juice drinks.

Fluid

It is especially important for people with an ileostomy to drink plenty of fluids to avoid dehydration. Aim for at least 8 to 10 glasses (the equivalent of 1.5 to 2 litres/ 3 to 4 pints) of fluid per day; more during warm weather. Fluids such as tea and coffee may increase your output so keep these to a minimum if you are experiencing a high output. Sport drinks can be very useful as they replace essential salts and glucose.

Salt

Try to increase your salt intake to compensate for the increased losses through your stoma. Add salt to food and have salty drinks and snacks such as soups, Bovril or crisps.

General tips

• Eat regular meals as this helps to regulate ileostomy function.
• Eat slowly and chew foods well, especially high fibre foods, to aid digestion and passage through the stoma.
• If a particular food causes you an issue, try it again in a few weeks but in a smaller amount and gradually increase the portion size over a few weeks if tolerating well. Only avoid those that repeatedly cause problems to avoid a limited diet.
• Avoid drinking and eating at the same time, as this can cause wind.
• When you start to reintroduce, vegetables start with root vegetables prior to leafy greens to reduce wind.

What if I have a poor appetite?

Following surgery, some people find their appetite is poor and they don’t feel like eating very much. This is usually only temporary but the following tips can help to improve your appetite: :

• Initially, you may find it easier to have small, frequent meals with snacks between meals (little and often). Don’t worry if it isn’t ‘normal’ foods at ‘normal’ times.
• Be positive about what you do eat – every extra mouthful helps.
• Try not to get out of the habit of eating. You need to eat to stimulate your appetite. Try to relax and enjoy what you eat.
• A short walk before a meal or some fresh air may help give you an appetite. Experiment with different foods. You may find something new you like.
• Have convenience foods available in your home to make it easier to eat regularly.
• Accept offers from friends and relatives to help with cooking and shopping.
• If you have a freezer, try to prepare food in advance when you feel like cooking and store it for when you are not feeling so well.
• Sometimes the smell of food will be appetising, while at other times it may put you off. If this happens, try to keep away from the kitchen while food is being prepared, or eat cold foods, which often smell less.
• Avoid drinking with meals, as this may fill you up and spoil your appetite.

Which foods may affect my ileostomy output?

To begin with, you may find that your ileostomy output is quite loose and frequent. However, your bowel adapts over time to absorb more fluid and your output should thicken up. The way your body adapts, tolerates or responds to the surgery and certain foods or drinks is very individual. Although nothing you will want to eat will harm you, certain foods or drinks may upset you by making the stoma output looser or harder or by causing wind or odour. The following information is only a rough guide; different things upset different people, but it is important to try everything (more than once to be certain). It might be useful to keep a food and symptom diary to help you identify which foods or drinks you are not tolerating. If you think a food gives you symptoms, temporarily remove it from your diet and then try the food again after a few weeks.

Loose stools or diarrhoea

As well as certain foods (see below), diarrhoea can also be caused by stress or anxiety and is a side effect of medications such as antibiotics. If it persists for more than two days, seek medical advice from your GP.

Wind

Wind is produced as part of the normal process of digesting fibrous foods or due to any air swallowing during eating. In general, it helps to eat slowly, chewing food well in a relaxed environment, and not to overeat at mealtimes. Drinking through a straw, chewing gum or talking when eating may cause wind.

Odour

Some people are more prone to odour from their ileostomy than others. If you feel this is a problem, it might help to change your diet slightly.

Foods that may cause blockages

If you are including these foods within your diet, ensure that you are chewing them well.

• raw fruit skins
• nuts
• sweetcorn
• dried fruit
• popcorn
• mushrooms
• piths, pigs and stones
• coconut (including cakes and biscuits containing coconut)
• fibrous fruit and vegetables, for example celery or pineapple
• thick cut marmalade
• lentils

Contacts

If you have any questions, please ask your ward dietitian or colorectal specialist. Once you are discharged home, you can contact:

• your colorectal specialist nurse on 01223 217923 if you are experiencing increased stoma output, suspect a blockage, showing signs of dehydration or there are questions of concerns regarding your ileostomy.
• your dietitian on 01223 216655 if you are unintentionally losing weight or have further questions regarding your diet .

Further information

The Ileostomy and Internal Pouch Association (opens in a new tab) 0800 0184 724