This diet should only be followed with the guidance of your dietitian or doctor. The information needs to be carefully explained to you so that you know how to use it.
The information in this leaflet is to support if you:
- Have been diagnosed with bowel obstruction
- Are at risk of developing bowel obstruction
- Have a mass in your small or large intestine (bowel) and are at risk of a blockage
How do I use this leaflet?
This booklet is divided into four stages. Please carefully read through all the information provided so that you understand what to do. You may also find it helpful to write down any questions you have about the diet. Please always ask your dietitian if you are not sure about what to do.
It is likely that you will need to make significant dietary changes. It is important not to eat or drink large amounts of food or fluid in one sitting. If you are at risk of bowel obstruction, eating and drinking ‘little and often’ will help with your symptoms. Everyone is different and no day is the same. Depending on your situation, you may need to make more changes than others.
Your dietitian will let you know which stage you should be following. They will also advise you when you can move to the next stage. You may find that you have to go backwards and forwards through the stages depending on your symptoms.
For example, if you are in pain or your bowels stop working, you will need to return to fluids only for a while until your symptoms settle again.
You are likely to require nutritional supplement drinks at times to make sure you meet your nutritional needs. Speak to your dietitian about these if you are not already prescribed them.
Back to topWhy is it important for me to eat the right foods with bowel obstruction?
Some foods pass through our body without being broken down properly. They can pass through in big pieces and can increase your risk of a blockage by getting caught in a narrow space. For example:
- the skins, pips and seeds of fruit and vegetables
- ‘stringy’ fruits and vegetables e.g. rhubarb, celery
- raw or undercooked vegetables
- vegetables that are difficult to digest e.g. mushrooms, sweetcorn, lettuce and other salad leaves
- bread and bread products e.g. crumpets, muffins, doughnuts
Fibre also makes our stools form a ‘bulk’ and makes them solid. When you are at risk of bowel obstruction it is better to avoid stools that are too solid. This is why you are encouraged to have a low fibre diet.
Certain foods may also lead to symptoms such as pain, bloating, feeling full, feeling sick and tightness across your stomach. You may also find it harder to pass a bowel motion.
The four stage bowel obstruction diet
Stage One: Clear fluids ONLY
Stage Two: All thin fluids
Stage Three: Smooth or pureed low fibre foods only
Stage Four: Soft and sloppy low fibre foods
Stage One: Clear fluids ONLY
You need to follow Stage One if you have had a complete blockage. When your bowels start to open regularly again you will be encouraged to start to sip on clear fluids only.
You will need to follow Stage One if you have proceeded to Stage Two, Three or Four and start to develop symptoms of obstruction.
Only clear fluids are allowed.
Examples are:
- Water
- Black tea
- Black coffee
- Squash
- Smooth clear fruit juice e.g. apple, cranberry juice
- Flavoured water
- Oasis®, Rubicon® (still), Vimto®
- Coconut water
- Herbal and fruit teas
- Clear consommé soup (no bits)
- Clear miso soup
- Hot cup of Marmite® or Bovril®
- Hot cup of water with a dissolved stock cube or stock pot
- Still isotonic sports drinks e.g. Lucozade Sport®, Gatorade Sport®, Powerade®
Stage Two: All thin fluids
If your bowels have been opening regularly and your symptoms from bowel obstruction have settled, you will be advised to move to Stage Two. This means that you can have all forms of fluids.
It is important to introduce the drinks in Stage Two very gradually. This will let your body tell you if you can tolerate the changes and continue with Stage Two. Each day add one extra drink. If you increase slowly you are more likely to be able to stay on Stage Two and will not get symptoms that mean you need to go back to Stage One.
Please remember:
The fluids need to be a thin consistency i.e. no thicker than full fat milk.
The fluids need to be completely smooth with no bits.
The fluids need to be low in fibre e.g. thin smooth fruit juice with no bits – no smoothies.
The following drinks provide energy, protein, vitamins and minerals.
Always use full fat milk where possible:
- Whole milk / milk with Nesquik® or Milo®
- Milky coffee / latté / cappuccino
- Yoghurt drinks
- Hot chocolate
- Thin milkshakes e.g. Frijj®, Yop®, Yazoo®
- Malted drinks e.g. Horlicks® / Ovaltine®
- Thin smooth soups e.g. chicken, oxtail, sweet potato, butternut squash
- Thin smooth fruit juice (no bits)
- Thin custard
- Jelly / milky jelly
- Smooth ice cream, smooth frozen yoghurt, sorbet (no bits)
- Ice lollies, Mini Milk® lollies, frozen yoghurt lollies
You can also suck on boiled sweets, mints and smooth chocolate. These must not be chewed or swallowed.
You can also include the clear fluids from Stage One. To stop you getting dehydrated, try to sip on small amounts of drinks through the day.
What do I do if my symptoms return?
If you start to experience any of the following, please contact your doctor or dietitian immediately.
- Nausea (feeling sick)
- Vomiting
- Feeling full after drinking
- Your bowels do not open for more than two days
- A feeling of ‘tightness’ across your stomach
- Feeling bloated
- Stomach swelling
- Stomach pain
These symptoms could be a sign that your bowel may be blocked. It is important to speak to your dietitian so that they can advise you what to do. If you are unable to speak to them immediately, return to Stage One and clear fluids only.
Stage Three: Smooth or pureed low fibre foods
If your bowels are opening regularly and you are not in any pain after several days of Stage Two fluids, your dietitian or doctor will ask you to move to Stage Three.
This means that you can start to eat smooth or pureed low fibre foods, as well as all fluids in Stage One and Two.
It is important to introduce the foods in Stage Three very gradually. This will let your body tell you if you can tolerate the changes and continue with a smooth / purée diet. Each day add only one extra food. If you increase slowly you are more likely to be able to stay on Stage Three and not get symptoms that mean you need to go back to Stage One.
- Always eat little and often by having six small portions daily. Larger meals may increase your risk of symptoms returning.
- All food should be smooth or melt in your mouth, ‘fall off’ a spoon easily and be able to be swallowed without needing to be chewed.
- All food should be low in fibre
- It is recommended to have only one portion of fruit and one portion of vegetables daily. Some fruit and vegetables must be avoided completely
Tips for following a soft smooth/puree diet
Equipment: Using a hand blender is the simplest way of producing pureed foods
Pureed foods can look more appetising if they are presented separately e.g. separate a pureed meat casserole from the (allowed) vegetables and potatoes
Colour is also important e.g. try serving brightly coloured vegetables such as pureed carrots with mashed potato and pureed chicken and sauce/gravy
Cooked foods should be cut into small pieces then liquidised, blended or mashed, and if necessary sieved to a smooth consistency
You will need to add extra liquid to most foods before or after they have been pureed. To improve the taste and nutritional value; add whole milk, melted butter, cream or creamy soup instead of water
Back to topWhat foods do I need to avoid during Stage Three?
Some foods need to be completely avoided (even if pureed). These foods pass through our body without being broken down properly. They can pass through in big pieces and can increase your risk of a blockage by getting caught in a narrow space.
for example:
The skins, pips and seeds of fruit and vegetables
’Stringy’ fruits and vegetables e.g. rhubarb, celery
Raw or undercooked vegetables
Vegetables that are difficult to digest e.g. mushrooms, sweetcorn, lettuce and other salad leaves
Bread and bread products e.g. crumpets, muffins, doughnut
Foods to choose and avoid during Stage 3
Breakfast cereals to choose
- ‘Soggy’ cereal e.g. Rice Krispies®, Cornflakes®, Cocopops®, Frosties® soaked in whole milk,Ready Brek®
Breakfast cereals to avoid
- Wholemeal, wholegrain and bran cereals e.g. All Bran®, Branflakes®,Weetabix®, Special K®, Cheerios®Cereals containing dried fruit, seeds or nuts e.g. Sultana Bran®, Fruit’nFibre®, Muesli, Crunchy Nut Cornflakes®, granolaRolled oats, porridge
Rice, bread, pasta, grains and potatoes to choose
- Mashed potato with no skin, mashed sweet potato with no skin, inside of a jacket potato, mashed yam with no skin.White rice, white pasta, noodles, cous cous blended with lots of sauce Melt in the mouth Ritz® crackers or Tuc® (without seeds) biscuits, rice cakes eaten with cream cheese
Rice, bread, pasta, grains and potatoes to avoid
- Any bread, brown or wild rice, wholegrains, brown pasta or potatoes with skins.Wholegrain or seeded crackers or crispbreads, cream crackers, oat cakes, corn cakes, cereal barsBarley, pearl barley, spelt, quinoa, gnocchi, bulgar wheat, farro, freekeh, amaranth
Biscuits and cakes to choose
- Madeleines, madeira cake, angel slices, mini chocolate rolls, lemon slices, apple pie: all blended until smooth with sauce, cream, custard or ice cream Rich tea, malted milk, custard cream ‘dunked’
Biscuits and cakes to avoid
- Crumpets, muffins, pancakes, croissants, brioche Cakes made with wholemeal or wholegrain flour Cakes made with dried fruit and nuts Wholemeal and wholegrain biscuits e.g. Digestives, Hobnobs®Biscuits containing dried fruit e.g. fig rolls, Garibaldi®Hot cross buns, tea cakes, fruit scones
Dairy and alternatives to choose
- All types of milk e.g. cow’s, goat’s, sheep’s, soya, rice, oat, almond Cream, sour cream, crème fraiche Smooth dips e.g.taramasalata, smooth guacamole Hard cheese that can be melted, soft cheese, cream cheese or cheese sauce Buttermilk Butter, margarine, spread Full fat smooth (no lumps) yoghurt including dairy free alternatives Custard, ground rice pudding, semolina, tapioca, blancmange, mousse, fruit fool, Angel Delight®, ice cream, sorbet, frozen yoghurt
Dairy and alternatives to avoid
- Soft or hard cheese containing dried fruit or nutsYoghurt containing whole fruit, nuts, seeds or pipsIce cream and sorbet containing nuts, seeds and whole fruits
Miscellaneous foods to choose
- Crisps that ‘melt-in the-mouth’ e.g. Skips®, Wotsits®, Quavers®,Pom Bears®, Pringles® Tomato ketchup, barbecue sauce, smooth mustard, brown sauce, worcester sauce, Tabasco® sauce, smooth chutneys, soy sauce, mayonnaise, salad cream Ginger, garlic, lemongrass, chilli, horseradish puree Salt and pepper, dried herbs and spices Gravy Marmite®, Vegemite® ,Bovril®
Miscellaneous foods to avoid
- Chunky/crunchy peanut butter Nut and seeds Popcorn Bombay Mix Dips that contain whole tomatoes, cucumbers, onions e.g. salsa, tzatziki Crisps and bread sticks that do not melt in the mouth Cheese straws Fresh herbs
Fruits to choose (only have one portion per day and puree)
- Apples (peeled),apricots (fresh, peeled),bananas, mango, melon, nectarines (peeled),papaya, pears (peeled),peaches (peeled),plums (peeled),watermelon (no pips)Tinned or stewed fruit, fruit compote, fresh fruit juice (no bits)
Fruits to avoid (only have one portion per day and puree)
- Blackberries, blackcurrants, blueberries, cherries, clementines, coconut, cranberries (fresh and dried), dates, dried apricots, figs, grapefruit, grapes, kiwi, mandarins, oranges, passion fruit, pineapple, pomegranate, prunes, raisins, raspberries, redcurrants, rhubarb, satsumas, strawberries, sultanas
Vegetables to choose (only have one portion per day and puree)
- Aubergine (peeled and deseeded), avocado, broccoli (no stalks), butternut squash, cabbage (white or green), carrots, cauliflower (no stalks), celeriac, chilli puree, courgette (peeled), cucumber (peeled and deseeded), daikon (asian radish), garlic puree, gem squash, ginger puree, horseradish puree, lemongrass puree, marrow (peeled), onion (well-cooked as a paste), parsnips, patty pan (peeled), peppers (peeled and deseeded), pumpkin, shallots (well cooked as a paste), spinach (well-cooked), swede, tomato passata, tomatoes (peeled and deseeded), turnips, smooth vegetable soups
Vegetables to avoid (only have one portion per day and puree)
- All skins, pips and seeds Tough stalks of vegetables e.g. cauliflower, broccoli Raw vegetables Soup with whole vegetables e.g. minestrone Asparagus, baby corn, bean sprouts, beetroot, bok choi, broad beans, brussels sprouts, celery, chicory, chilli (fresh), coleslaw, edamame, fennel, french beans, garlic (whole, raw or undercooked), gherkins, ginger, globe artichokes, green beans, jerusalem artichokes, kohlrabi, leeks, lemongrass, lettuce, mangetout, mushrooms, okra, olives, onion (whole, raw or undercooked), pak choi, peas, pickled onions, radishes, rocket, runner beans, salad leaves, shallots (whole, raw or undercooked), soya beans, spinach (raw), spring greens, spring onions, sugar snap peas, sweetcorn
Meat, fish and meat alternatives to choose
- Pureed meat with gravy (blended stew, mince, chicken)Pureed fish (fish pie or fish in white sauce)Tofu and seitan cooked until soft and blended with sauce Soya/pea protein powders can be blended into sauces or soya milk Scrambled egg or egg mayonnaise
Meat, fish and meat alternatives to avoid
- Gristly and fatty meat,tough skin, fish skin and bones Quorn and soya beans Hard boiled eggs or omelettes Beans (Borlotti, Cannellini, Kidney, soya, baked beans, broad beans)
What do I do if my symptoms return?
If you start to experience any of the following, please contact your doctor or dietitian immediately.
- Nausea (feeling sick)
- Vomiting
- Feeling full after drinking
- Your bowels do not open for more than two days
- A feeling of ‘tightness’ across your stomach
- Feeling bloated
- Stomach swelling
- Stomach pain
These symptoms could be a sign that your bowel may be blocked. It is important to speak to your dietitian so that they can advise you what to do. If you are unable to speak to them immediately, return to Stage One and clear fluids only.
Stage Four: Soft and sloppy low fibre
What can I eat for Stage Four?
If your bowels are opening regularly and you are not in any pain after several days on Stage Three consistencies, your dietitian or doctor will ask you to move to Stage Four.
This means that you can start to eat soft and sloppy low fibre foods, as well as all liquids and smooth, pureed low fibre foods from stages one, two and three.
It is important to introduce the foods in Stage Four very gradually. This will let your body tell you if you can tolerate the changes and continue with a soft and sloppy low fibre diet. Each day add only one extra food. If you increase slowly you are more likely to be able to stay on Stage Four and not get symptoms that mean you need to go back to Stage One.
- Always eat little and often by having six small portions daily. Larger meals may increase your risk of symptoms returning.
- All food should be soft, sloppy and chewed well before you swallow each mouthful. Small sips of a drink can help with swallowing foods. Avoid foods that needs a lot of chewing or do not break down well when chewed. You can soften foods by chopping, mincing, and mashing.
- Make sure all your meals have additional sauce, butter, gravy, cream or custard to help soften them and keep them moist.
- All food should be low in fibre
- It is recommended to have only one portion of fruit and one portion of vegetables daily. Some fruit and vegetables must be avoided completely.
What foods do I need to avoid during Stage Four?
Some foods need to be completely avoided (even if soft/sloppy). These foods pass through our body without being broken down properly. They can pass through in big pieces and can increase your risk of a blockage by getting caught in a narrow space.
For example:
The skins, pips and seeds of fruit and vegetables
’Stringy’ fruits or vegetables e.g. rhubarb, celery
Raw or undercooked vegetables
Vegetables that humans are unable to digest e.g. mushrooms, sweetcorn, lettuce and other salad leaves
Dry bread and bread products e.g. crumpets, muffins, doughnuts
What foods do I need to avoid during Stage Four?
Breakfast cereals to choose
- ‘Soggy’ cereal e.g. Rice Krispies®, Cornflakes®, Coco pops®, Frosties® soaked in whole milk,Ready Brek
Breakfast cereals to avoid
- Wholemeal, wholegrain and bran cereals e.g. All Bran®, Branflakes®,Weetabix®, Special K®, Cheerios®Cereals containing dried fruit, seeds or nuts e.g. Sultana Bran®, Fruit ‘n’ Fibre®, Muesli, Crunchy Nut Cornflakes®, granola Rolled oats, porridge
Rice, bread, pasta, grains and potatoes to choose
- Mashed potato with no skin, mashed sweet potato with no skin, inside of a jacket potato, mashed yam with no skin.Well cooked white rice, white pasta, noodles, cous cous with lots of sauce.Melt in the mouth Ritz® crackers or Tuc® (without seeds) biscuits, rice cakes eaten with cream cheese
Rice, bread, pasta, grains and potatoes to avoid
- Any bread, brown or wild rice, wholegrains, brown pasta or potatoes with skins.Wholegrain or seeded crackers or crispbreads, cream crackers, oat cakes, corn cakes, cereal bars Barley, pearl barley, spelt, quinoa, gnocchi, bulgar wheat, farro, freekeh, amaranth
Biscuits and cakes to choose
- Madeleines, madeira cake, angel slices, mini chocolate rolls, lemon slices, apple pie softened with sauce, cream, custard or ice cream Rich tea, malted milk, custard cream ‘dunked’
Biscuits and cakes to avoid
- Crumpets, muffins, pancakes, croissants, brioche Cakes made with wholemeal or wholegrain flour Cakes made with dried fruit and nuts Wholemeal and wholegrain biscuits e.g. Digestives, Hobnobs®Biscuits containing dried fruit e.g. fig rolls, Garibaldi®Hot cross buns, tea cakes, fruit scones
Dairy and alternatives to choose
- All types of milk e.g. cow’s, goat’s, sheep’s, soya, rice, oat, almond Cream, sour cream, crème fraiche Smooth dips e.g.taramasalata, smooth guacamole Soft cheese or cream cheese Buttermilk Butter, margarine, spread Full fat yoghurt including dairy alternatives Custard, ground rice pudding, semolina, tapioca, blancmange, mousse, fruit fool, angel delight, ice cream, sorbet, frozen yoghurt
Dairy and alternatives to avoid
- Cheese containing dried fruit or nuts Yoghurt containing whole fruit, nuts, seeds or pips Ice cream and sorbet containing nuts, seeds and whole fruits
Sweets and preserves to choose
- Honey, seedless jam, lemon curd, hazelnut spread e.g Nutella® Golden syrup, maple syrup, treacle Smooth nut butters e.g. peanut or almond Jelly and milk jelly Crème caramel Smooth white, milk or plain chocolate Fudge
Sweets and preserves to avoid
- Jams or marmalade containing peel/seeds, chutney, marzipan Jelly made with fresh berries Chocolate with nuts and dried fruit Nougat Toffee Jelly sweets Marshmallows
Miscellaneous foods to choose
- Crisps that ‘melt-in-the-mouth’ e.g. Skips®, Wotsits®, Quavers®,Pom Bears®, Pringles® Tomato ketchup, barbecue sauce, smooth mustard, brown sauce, Worcester sauce, Tabasco® sauce, smooth chutneys, soy sauce, mayonnaise, salad cream Ginger, garlic, lemongrass, chilli, horseradish puree Salt and pepper, dried herbs and spices Gravy Marmite®, Vegemite®, Bovril®
Miscellaneous foods to avoid
- Chunky/crunchy peanut butter Nuts and seeds Popcorn Bombay Mix Dips that contain whole tomatoes, cucumbers, onions e.g. salsa, tzatziki Crisps and bread sticks that do not melt-in-the mouth Cheese straws Fresh herbs
Fruits to choose (only have one portion per day and puree)
- Apples (peeled),apricots (fresh, peeled),bananas, mango, melon, nectarines (peeled),papaya, pears (peeled),peaches (peeled),plums (peeled),watermelon (no pips)Tinned or stewed fruit, fruit compote, fresh fruit juice (no bits)
Fruits to avoid (only have one portion per day and puree)
- Blackberries, blackcurrants, blueberries, cherries, clementines, coconut, cranberries (fresh and dried), dates, dried apricots, figs, grapefruit, grapes, kiwi, mandarins, oranges, passion fruit, pineapple, pomegranate, prunes, raisins, raspberries, redcurrants, rhubarb, satsumas, strawberries, sultanas
Vegetables to choose (only have one portion per day and puree)
- All vegetables need to be well cooked Aubergine (peeled and deseeded), avocado, broccoli (no stalks), butternut squash, cabbage (white or green), carrots, cauliflower (no stalks), celeriac, chilli purée, courgette (peeled), cucumber (peeled and deseeded), daikon (asian radish), garlic purée, gem squash, ginger purée, horseradish purée, lemongrass purée, marrow (peeled), onion (well-cooked as a paste), parsnips, patty pan (peeled), peppers (peeled and deseeded), pumpkin, shallots (well cooked as a paste), spinach (well-cooked), swede, tomato passata, tomatoes (peeled and deseeded), turnips, smooth vegetable soups
Vegetables to choose avoid (only have one portion per day and puree)
- All skins, pips and seeds Tough stalks of vegetables e.g. cauliflower, broccoli Raw vegetables Soup with whole vegetables e.g. minestrone Asparagus, baby corn, bean sprouts, beetroot, bok choi, broad beans, brussels sprouts, celery, chicory, chilli (fresh), coleslaw, edamame, fennel, french beans, garlic (whole, raw or undercooked), gherkins, ginger, globe artichokes, green beans, jerusalem artichokes, kohlrabi, leeks, lemongrass, lettuce, mangetout, mushrooms, okra, olives, onion (whole, raw or undercooked), pak choi, peas, pickled onions, radishes, rocket, runner beans, salad leaves, shallots (whole, raw or undercooked), soya beans, spinach (raw), spring greens, spring onions, sugar snap peas, sweetcorn
Meat, fish, and meat alternatives to choose
- Pureed meat with gravy (blended stew, mince, chicken), pureed fish (fish pie or fish in white sauce)Tofu and seitan cooked until soft with sauce Soya/pea protein powders can be blended into sauces or soya milk Omelette, scrambled,poached or soft, boiled egg
Meat, fish, and meat alternatives to avoid
- Gristly and fatty meat,tough skin, fish skin and bones Quorn and Beans (Borlotti, Cannellini, Kidney, soya, baked beans, broad beans)
What can I drink during Stage Four?
It is important to drink plenty of fluid each day to prevent dehydration. You can choose any of the liquids listed in Stage One or Stage Two.
What do I do if my symptoms return?
If you start to experience any of the following, please contact your doctor or dietitian immediately.
- Nausea (feeling sick)
- Vomiting
- Feeling full after drinking
- Your bowels do not open for more than two days
- A feeling of ‘tightness’ across your stomach
- Feeling bloated
- Stomach swelling
- Stomach pain.
These symptoms could be a sign that your bowel may be blocked. It is important to speak to your dietitian so that they can advise you what to do. If you are unable to speak to them immediately, return to Stage one and clear fluids only.
After Stage Four
What can I eat and drink after Stage Four?
If you have had previous episodes of bowel obstruction you may need to continue with Stage Four for an extended period of time. If you are doing well it may be possible to move on from Stage Four. Please always speak to your dietitian before making any changes. They will advise you if it is possible to include other foods and how to do this.
Which foods can increase my risk of a blockage?
It is important to completely avoid the foods that may increase your chance of getting a blockage. We advise that you follow a strict LOW FIBRE diet. This is because fibre is not easily digested and can pass through your bowel in large lumps. It also bulks your stools and makes them solid.
High fibre foods that need to be completely avoided (even if pureed) include:
- the skins, pips and seeds of fruit and vegetables
- ’stringy’ fruits or vegetables e.g. rhubarb, celery
- raw or undercooked vegetables
- vegetables that are difficult to digest e.g. mushrooms, sweetcorn, lettuce and other salad leaves
Contact information
If you have any suggestions, comments or queries regarding this leaflet please contact your dietician
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