This booklet provides advice for patients and/or carers of patients who have an ileostomy. It provides information on what to eat and drink.
The process of digestion
To help understand how your ileostomy works it is useful to know what happens when you eat and drink:
STAGE 1
Food is chewed in the mouth and swallowed.
STAGE 2
Food passes down the food pipe (oesophagus) and into the stomach.
STAGE 3
In the stomach food is churned and mixed with stomach juices (acid).
STAGE 4
The mixture passes into the small bowel where it is digested, and nutrients are absorbed into the blood stream.
STAGE 5
The remaining bulk passes into the large bowel (colon). Water and salt are absorbed into the bloodstream and a stool is formed from the waste products.
STAGE 6
The stool is stored in the rectum until it is ready to be passed.
STAGE 7
Once ready, the stool is passed out through the anus as faeces at the toilet.
What is an ileostomy?
An ileostomy is a surgery where part of the small bowel (ileum) is brought out onto the surface of the tummy (abdomen) creating an opening called a stoma. This opening allows faeces and gas to leave the body. This is called stoma output and it is collected in a stoma bag attached to the body. Having an ileostomy means that stages 5, 6 and 7 of the digestion process of eating and drinking do not occur.
lleostomy output – what to expect
It can take time for a stoma to work after surgery and at first the output might be loose liquid. With time this should thicken, and the normal consistency is like thick porridge/toothpaste, but this may change throughout the day dependent on what you eat and drink.
What can I eat after my operation?
Following your operation, you will gradually start to build up the amounts that you eat and drink. At first you may find it easier to eat soft foods and little and often.
For the first few weeks after your operation, it is advised that you follow a low fibre diet. Foods high in fibre pass through the bowel more quickly and can increase stoma output. The following table lists examples of low fibre foods to choose and those higher in fibre to avoid.
High Fibre to avoid
- Brown and wholemeal bread
- All-Bran, Bran flakes, Weetabix, Shredded Wheat or muesli and porridge oats
- Brown pasta/rice/noodles
- Potato skins
- Biscuits and cakes containing fruit or nuts and wholemeal varieties e.g. Hobnobs, Digestives, fig rolls, fruit cake, mince pies and flapjack
- Crackers made with wholemeal flour e.g. Ryvita and oatcakes
- Nuts and seeds
Low Fibre to choose
- White bread
- Cornflakes, Rice Krispies, Coco Pops, Frosties, Special K and instant porridge
- White pasta/rice/noodles
- Potatoes without skins
- Sweet or savoury biscuits and cakes made with white floure.g. Rich Tea, shortbread, Nice, plain sponge, scones and Madeira cake
- Crackers made with white flour e.g. cream crackers, Ritz biscuits and breadsticks
- Smooth peanut butter
- Limit your intake of pulses (beans, peas, and lentils) unless you are vegetarian when you should include one portion a day for protein
- You can have up to 2 portions of fruit and vegetables a day but avoid skins, stalks, seeds, pips and pith.
Reintroduction of fibre
After two weeks you should be able to slowly build up the amount of fibre in your diet. However, make sure that your stoma output is a toothpaste consistency before you do this and that you are familiar with its pattern. This will allow you to see any changes in consistency or volume when you reintroduce foods again. We recommend that you reintroduce high fibre foods one at a time, and in small amounts. If any new foods cause a higher than normal output of liquid consistency, then they should be avoided for a little longer and tried again at a later date. Remember everyone’s tolerance to different foods varies and your bowel absorption can improve with time.
We recommend you keep a food diary to help monitor the reintroduction of foods.
Once you have re-introduced fibre into your diet, you should aim to eat a healthy balanced diet. Choose a range of foods from different food groups and try to eat three meals per day. Use the Eatwell guide below.
Blockages
Your ileostomy may occasionally become blocked with undigested food. Some hard to digest food such as sweetcorn, mushrooms, dried fruit, skins, pips, nuts, seeds, and peas may be seen in the ileostomy bag. To help this remember to relax, take time over your meals, and chew your food well. Drink plenty of fluid after you have eaten to aid digestion and the passage of faeces through the ileostomy.
Foods which might affect your ileostomy output
Some foods may cause more wind, odour/smell and/or an increased output through your stoma.
Wind
- Beans, Beer, Broccoli, Cabbage, Cauliflower, Chewing gum, Fizzy drinks, Fruit, Lentils Nuts, Onions, Peas, Pulses, Spicy foods.
Odour
- Asparagus, Beans, Eggs, Fish, Garlic,Leafy green vegetables, Onions, Spicy food
Increased output
- Alcohol, Caffeine, Fruit, Fruit juice, Vegetables, Onions, Spicy foods, Sweeteners
What should I do if my ileostomy becomes more active than normal?
Your ileostomy may become more active in the following situations:
If you are unwell with a high temperature
If you have food poisoning or an upset stomach
If your ileostomy is more active than normal your body will lose more water and salt. This increases your risk of dehydration.
How do I know if I am dehydrated?
Looking for the following signs can help you to recognise if you are dehydrated:
Dehydrated
- Dark coloured/strong smelling urine and a decrease in the amount of urine you pass.
- Headaches or feeling light headed/dizzy
- Increased thirst
- Cramps
- Dry lips and skin
If this happens you need to drink a rehydration solution such as Dioralyte® (available on prescription or bought over the counter).
Alternatively you can make a homemade solution called St Marks Electrolyte mix using ingredients you can buy from a pharmacy and some supermarkets as follows:
St Marks Electrolyte mix
- One heaped 2.5ml spoon of sodium bicarbonate (also known as bicarbonate of soda or baking soda)
- One level 5ml spoon of salt (sodium chloride)
- Six level 5ml spoons of glucose powder
Stir all the ingredients above into 1000mls of tap water and store in the fridge. Try to sip this throughout the day. You can use a straw, try it served chilled or it can be frozen and taken as a slush drink. A small amount of no added sugar squash can be added if required.
You can also add extra salt to your food to make up for the salt your body loses through the ileostomy. Add salt during cooking and eat salty foods such as crisps, cheese, salted biscuits, tinned foods in brine and Marmite. When your output has returned to normal remember to reduce your salt intake.
If your ileostomy output remains higher than normal or you have concerns, contact your dietitian or colorectal nurse specialist on the number below. Also refer to the diet sheet eating and drinking with a high output stoma.
Poor Appetite
If you have a poor appetite or have lost weight, try the following tips to help.
Tips
- Eat small, frequent meals with snacks in between
- Avoid drinks with meals, have them afterwards instead
- Use full fat milk and aim for 1 pint per day. Make this more nourishing by mixing in 4 tablespoons of dried skimmed milk powder
- Choose full fat products such as thick and creamy yoghurts
- Add margarine or butter to foods such as potato
- Add sugar, honey or syrup to cereals and puddings
- Add evaporated milk or cream to puddings, desserts and soups
- Grate cheese over potatoes and pasta dishes
If you are following a special diet for another medical condition, please discuss this with your dietitian.
Other useful contacts:
Colorectal Nurse Specialist
Cancer Research UK
Crohn’s and Colitis UK
Ileostomy & Internal Pouch Association
If you have any suggestions or comments regarding this leaflet please let your dietitian know.
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