What to eat and drink when having an ileostomy and colostomy

In general, people with an ostomy can eat and drink what they want unless the surgeon or ostomy therapist has given counter-advice. But as before the surgery some food may be easier to digest than others – and right after surgery it may be helpful to pay some extra attention to the signals from your body.  

Right after surgery

New research shows that the quicker after surgery you eat real food the sooner the intestinal system will function again. And always Remember to chew your food thoroughly. 

During the first 2-4 weeks 

• Your body is still healing, and eating foods that are softer or easier to digest will allow your body to recover.
• You may feel a bit bloated, so try eating little and often at first. 
• Quite bland foods can be good for a start. 
• Chewing carefully is very important. 

Week 4-6 after ostomy surgery

• Often there is a reduction in appetite the first 4-6 weeks after an ostomy procedure. 
• It can be necessary to supplement the diet with protein and energy drinks. They can be bought at the pharmacy or made from scratch.

Is there something I cannot eat?

There’s no reason to restrict yourself from certain foods, but it’s good to know that different food will have different effects on the output from your stoma. If there’s a particular kind of food that you’re unsure about, just try a small amount. If there are no problems, then go for it!

Don’t be scared of trying new foods, but just be sensible. You will probably find that certain foods produce more gas than others, and even though they are not bad for you, you may want to cut down on these foods. The same applies to chewing gum.

It will only take a little trial-and-error to find a balanced diet that feels right for you. Some foods, especially high fibre foods, can cause a food blockage, where undigested parts of food block the bowel. Chewing well can help, but a food blockage can be serious. Read about food blockage here. 

How about fruit and vegetables?

You can still get your five-a-day! The skins of some fruits and vegetables are really tough, so it might be best to peel them to avoid any problems, especially potato skins and apple skins. And maybe you need to prepare your fruit and vegetables in new ways – try soups to get those vegetables in, or maybe try some fruit smoothies.

Allowing vegetables to soften a bit during cooking can also help, or try mashing some of those root vegetables. 

If an accident occurs

One bad experience should not lead to you never eating that one thing again. Only if it happens repetitively you should consider taking the food out of your diet. 

And remember; everyone has different reactions, so what works for one may not work for one other.

As other people at least 2 litres of liquid should be taken a day - this also to avoid obstipation. But you may wonder if you can still have your morning coffee, enjoy a glass of wine or drink carbonated drinks.

here are a few guidelines:

• Coffee and tee are fine, but as with anything else be aware of any reactions in your digestive system.
• Carbonated drinks in general can cause gas. 
• Beer can cause the output from the ostomy to become more liquid
• You can drink alcohol. Alcohol can cause dehydration, so make sure to drink enough water. 

For you having an ileostomy

Especially right after surgery, you may lose some fluid due to the relatively large amount of stool (750-1300 ml). Thus it’s recommended that you drink at least 2 litres of water per day plus the equivalent of what you lose via the stool. 

3-12 weeks after surgery, the small intestine gradually gets used to absorb more liquid and you may not have to compensate the same way as in the beginning. People with an ileostomy lose two to three times more liquid and salt than other people through the stool, so sprinkling a little salt on your food may be a good idea. 

It might feel like a big step at first, but there is no reason why you shouldn’t be able to enjoy a meal out in a restaurant. 

Be well-prepared

You can always contact the restaurant before you go so that you are prepared ahead of time, and a lot of the bigger restaurants have their menus online so you can always check the menu before you arrive at the restaurant.

Where to go?

A good idea is to start with a restaurant you know well and keep it simple when ordering. There is no need to be too cautious, just be practical. Order what you want, but be aware of how certain foods make you react. Also, don’t be afraid to ask the waiter what ingredients are used for the meals. 

If possible, you may want to order a type of food that you have already tried at home first so you know how you will be likely to react. As you slowly eat more and different foods, you will feel more confident when eating out as well. Even if you are used to having a drink at home, it could be best to 'start small'. For example, drink a small beer rather than a large one. This will help your body build up your tolerance to alcohol again and help reduce – or completely avoid – any reactions. 

Ballooning happens when there’s a build-up of gas in the stoma pouch, making it inflate like a balloon. Pouches have charcoal filters that help deal with wind by deodorizing and releasing it from the pouch. But if the filter capacity cannot handle the gas produced, or if it has become moist or blocked by solid output from the stoma, gas build-up can occur.

What can you do to prevent ballooning?

One of the main ways to prevent ballooning is to minimise the amount of gas your digestive system produces. Chewing food thoroughly really helps, as can limiting food and drinks that you know make you produce a lot of gas. These could be nuts, beans, carbonated drinks or sparkling wine.

What to do when you experience ballooning?

If ballooning does occur, you can release the gas from the pouch in the privacy of a toilet, if you use an open bag or use a two-piece system. Changing the pouch if the filter blocks can also help prevent ballooning. Finally, it may be worth trying another type of stoma pouch and filter type.

Pancaking happens when there is a vacuum in the stoma bag and the bag sticks together. This stops the output from dropping to the bottom of the bag and can block the filter. There is then a risk that the pouch will be pushed off the abdomen.

What can you do to prevent pancaking?

Blowing air into the pouch before putting it on will help stop a vacuum from occurring. In addition, a drop of oil or lubricant in the pouch will help the output to get to the bottom of the bag.

Like everyone else, you may have diarrhea once-in-a-while. But in general, a brief period of diarrhoea is not something to be worried about – it could be related to something you ate and will often take care of itself. 

However, three or more loose stools in a row are indeed a cause for concern, as you risk becoming dehydrated, and you should consult your ostomy care nurse.

If you have an ileostomy

If you have an ileostomy and experience diarrhea you will lose a lot of salt – around 1 tea spoon per litre of stool. Therefore, it is very important to sprinkle some extra salt on your meals.

Chewing carefully is very important to get a good start to the digestive process. This applies especially if you eat foods that are hard to digest (such as nuts). Some foods, especially high fiber foods, can cause a food blockage, where undigested parts of food block the bowel. Chewing well can help, but a food blockage can be serious.

How do I know I have a food blockage?

It can cause cramping; pain and watery stool, and your abdomen and ostomy may become swollen. If you think you have a food blockage, you should:

• Call your doctor or nurse or go to an emergency room. 
• Drink plenty of water
• Avoid solid foods for 24 hours and stick to soups instead

Preventing a blockage is easier than treating one, so chew your food thoroughly and be sensible with your food options, and you should be able to have a normal, healthy diet.