Nutritional Advice for Ostomates

Introduction

 

Eating nutritious food will help you heal while recovering after your ostomy surgery and improve your overall health. Individuals may become malnourished after years of living with a chronic medical condition. After surgery, you will be placed on a liquid diet and then gradually increased to a low fiber and low residual diet. Your appetite may take 4 to 6 weeks to return after surgery. For optimal nutrition, it is best to eat small frequent meals and slowly increase the amount of food. While recovering from your surgery at home, you will continue a transition diet and gradually introduce foods into your diet and assess their effects. The transitional diet can last at least two to six weeks after surgery, depending on ostomy surgery. The nurses will provide basic nutritional information after your surgery. However, a registered dietitian can help you better understand your dietary needs. They can develop a personalized eating plan based on your medical history and personal preferences. 

 

Absorption and Elimination

The ability to absorb nutrients and fluids will depend on the type of ostomy surgery and the number of intestines removed. It can also determine the consistency of your stool. At first, your stool will be loose, and as the body adapts a couple of months after surgery, it will thicken, but this will depend upon how much bowel remains. 

 

Colostomy

There are three types of colostomies. 

  • Descending or Sigmoid colostomy: A small portion of the bowel is removed. Therefore, the nutrients and fluids are wall absorbent in the GI tract. The stool consistency ranges from pasty to formed. 
  • Transverse colostomy: There is a moderate portion of the large intestine removed. As a result, there may be a decrease in absorbing nutrients, fluids, and electrolytes. The stool consistency ranges from a thick liquid to pasty. 
  • Ascending colostomy: There is a large portion of the bowel removed. There is a risk for dehydration due to the decreased ability to absorb fluid and electrolytes. The stool consistency with ranges from liquid to pasty. The more nutrients and fluids are absorbed, the thicker the stool.

Ileostomy

  • The entire large bowel is bypassed or removed, so there is a decreased ability to absorb nutrients, fluids, and electrolytes. 
  • The stool consistency ranges from liquid to pasty. 
  • A vitamin B12 supplement: There may be a deficiency due to part of the ileum being removed during surgery.
  • The transition diet is six to eight weeks after surgery. A longer time frame is necessary because of post-op edema, and the opening of the stoma is smaller. Food particles may become stuck and cause blockages. After six to eight weeks, introduces foods gradually and avoid food intolerances (lactulose or likelihood of blockages. See link for food reference chart).
  • Enteric and timed released medications can not be adequately absorbed.
  • Laxatives can be dangerous and cause significant fluid and electrolyte imbalances.
  • Marshmallows: Eating marshmallows has been associated with thickening stool and reducing output. The gelatine ingredient might be the reason for thickening liquid output.

Urostomy

 it is essential to maintain hydration to prevent urinary tract infections. 

  • Drink at least 8-10 classes of fluid daily to keep the urine dilute. Caffeinated beverages are not counted in the daily fluid intake because it increases urinary output.
  • Concentrated urine causes increased odors and risk for urinary tract infections. 
  • It is also essential to keep your acidic. Acidic urine will decrease the risk of urinary tract infections in forming urinary crystals. Urinary crystals may also irritate the stoma and skin. 
  • A vitamin B12 supplement: There may be a deficiency due to part of the ileum being removed during surgery.

 

Conclusion

Many ostomates, especially those with ileostomies, will restrict their diet intake to control loose stools and gas. Skipping meals will loosen stools, increase gas, and decrease nutrition and fluid needs. Therefore, you can modify food & drinks to reduce gas and control stool thickness. Dehydration is the main reason for hospital readmission. Inform your healthcare provider if you have more than two liters of liquid stool in twenty-four hours. Consulting with a dietitian can help you better understand your dietary needs and develop a personalized nutritional plan.

 

Further Reading Suggestions

 Eating With an Ostomy: A Comprehensive Nutrition Guide for those Living with an Ostomy https://www.ostomy.org/wp-content/uploads/2022/02/Eating_with_an_Ostomy_2022-02.pdf

Eating with an Ostomy; Foods and Their Effects Food Reference Chart for People with an Ostomy https://www.ostomy.org/wp-content/uploads/2022/02/Food_Reference_Chart_2022-02.pdf

 

References

Burgess-Stocks, J. Eating With an Ostomy: A Comprehensive Nutrition Guide for those Living with an Ostomy. (2022). Retrieved from UOAA: https://www.ostomy.org/wp-content/uploads/2022/02/Eating_with_an_Ostomy_2022-02.pdf

Clarebrough E, Guest G, Stupart D. Eating marshmallows reduces ileostomy output: a randomized crossover trial. Colorectal Dis. 2015 Dec;17(12):1100-3. doi: 10.1111/codi.12992. PMID: 25951410.

de Oliveira AL, Boroni Moreira AP, Pereira Netto M, Gonçalves Leite IC. A Cross-sectional Study of Nutritional Status, Diet, and Dietary Restrictions Among Persons With an Ileostomy or Colostomy. Ostomy Wound Manage. 2018 May;64(5):18-29. PMID: 29847308.

 

Eating with an Ostomy; Foods and Their Effects Food Reference Chart for People with an Ostomy. (2022). Retrieved from UOAA: https://www.ostomy.org/wp-content/uploads/2022/02/Food_Reference_Chart_2022-02.pdf

 

Kirkland-Kyhn, Holly PhD, FNP-BC, GNP-BC; Martin, Sanaz MS, RN; Zaratkiewicz, Sunniva PhD, RN, CWCN; Whitmore, Morgan MSN, RN; Young, Heather M. PhD, RN, FAAN Ostomy Care at Home, AJN, American Journal of Nursing: April 2018 – Volume 118 – Issue 4 – p 63-68

doi: 10.1097/01.NAJ.0000532079.49501.ce 

 

Rowe, K. M., & Schiller, L. R. (2020). Ileostomy diarrhea: Pathophysiology and management. Proceedings (Baylor University. Medical Center), 33(2), 218–226. https://doi.org/10.1080/08998280.2020.1712926

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