Healthy eating with a Colostomy

What is a colostomy?

A colostomy is a surgical procedure involving the removal of part of the large bowel (colon). The healthy end of the colon is drawn through an incision in the abdominal wall to form an opening called a stoma or colostomy. A stoma bag is attached to this opening, providing an alternative route for faeces to leave the body.

The main functions of the colon are to form stools and absorb water and salt.

Stoma output is often determined by how much of the colon is removed and how much is left. The larger the resection, the looser the expected output.

What can I eat after my operation?

After your procedure, it is usually advised by your Surgeon to start off slowly with sips of water and build up volumes gradually to assess tolerance of all types of fluid, (for example tea, juice or milk), before progressing gradually to all types of food without restrictions. Initially the bowel function and stoma output may be very different from normal and could last for several weeks. Therefore, to help breakdown and digest food well the following approaches can be adapted:

• Take time to eat slowly and chew your food well.
• Smaller meals with frequent snacks and nourishing drinks between meals
• Regular intake of food and fluids to help achieve optimal colostomy function
• Minimise high intakes of caffeine from tea, coffee, and fizzy drinks, and alcohol.

How will having a colostomy affect my diet?

After a colostomy, you will continue to digest and absorb nutrients as usual as this takes place in the small bowel which has not been operated on. This is why most people with a colostomy can eat a normal, well-balanced diet with an adequate fluid intake and not require any dietary restrictions. However, the way your body adapts, tolerates or responds after surgery to certain foods or drinks is very individual. Some foods or drinks may make the stoma output looser or harder and may cause wind or odour. The following information is only a rough guide. Keeping a food and symptom diary can help you identify which foods or drinks you are not tolerating. It is important to try everything (more than once to be certain).

What is included in a healthy balanced diet?

It is important to have a well-balanced diet to aid your recovery. Once you feel confident, you can experiment with different foods to achieve a diverse diet.

Starchy foods (carbohydrates)

Include one of the following at each meal; bread, breakfast cereals, pasta, rice, potatoes, noodles, crackers, crisp-bread or couscous. Wholemeal varieties can be tried long-term to help prevent the risk of constipation.

Protein foods including meat, fish or alternatives

Aim for two portions per day of the following: meat, poultry, fish, eggs, lentils, tofu, quorn or beans (which are also good sources of iron).

Dairy products

Aim for two to three portions a day: milk, cheese or yoghurt (which are also a good source of calcium, protein and energy).

Fruit and Vegetables

Try to have five portions of fruit and vegetables every day. (A portion is roughly what fits in the palm of one hand).

Fatty and sugary foods

These should be eaten in moderation but, if you have a poor appetite, these can be added to foods to provide more energy (see below).

Fluid

It is important to drink plenty of fluids to avoid dehydration. Aim for at least 8-10 glasses (the equivalent of 1.5 to 2 litres or 3 to 4 pints) of fluid per day and extra during warm weather. These can include water, juice, tea, coffee, squash or sports drinks. This intake should continue long term unless any other health condition indicates otherwise.

What if I have a poor appetite?

It can take time for your appetite to return after your operation. However, this should return to normal in time. Here are some tips to follow to help with poor appetite:

• Aim for a little and often approach to eating (three small meals with snacks in between)
• Snack suggestions: biscuits, yogurts, cheese and crackers
• Try nutritious drinks such as milk or supplements recommended by your dietitian
• Relax and minimise distractions at mealtimes
• Eat slowly and chew your food well at meal times
• Convenience foods are a useful standby.
• Accept offers from friends and relatives to help with cooking and shopping.
• Minimise over-drinking with meals, as this may fill you up and spoil your appetite.

Which foods may affect my stoma output?

Many people with a stoma can eat a normal diet. However, some people find certain foods can alter their stoma output and cause symptoms such as diarrhoea, constipation, wind, odour or a blockage of the stoma. 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 / Diarrhoea

Some people find certain foods can alter their stoma output. For example, fibrous foods can stimulate the gut and may cause diarrhoea.

It is important to ensure you are drinking enough fluid and add salt to your diet to avoid dehydration as more water and salt will be lost in loose or high colostomy outputs. Sports drinks and glasses of milk can be very useful as they replace essential salts and glucose.

Foods that may cause loose stools or diarrhoea:

• High intakes of vegetables, particularly; cabbage; green leafy vegetables, lettuce, celery, green beans, tomato skins, broccoli
• High intakes of fresh fruit or dried fruit
• Wholegrain cereals and wholemeal bread
• Nuts, seeds, pulses or coconut
• Alcohol
• Spicy foods
• Fried or fatty foods
• Artificial sweeteners

Foods that may help to improve diarrhoea:

• Bananas
• Tapioca pudding
• Cheese
• Boiled milk
• Smooth peanut butter
• Marshmallows/Jelly babies
• Toast
• Rice
• Noodles

Diarrhoea can occur for many reasons such as a stomach bug, stress or antibiotics. If it persists more than two days, seek medical advice from your GP.

Constipation

You may find that you become prone to constipation. This may be helped by eating regular meals, increasing your fluid intake and doing a little bit of exercise.

It is normal for some food to pass through to the stoma unaltered. However, foods high in fibre may cause a blockage because they are difficult to digest when eaten in large quantities or not chewed well.

Foods that may cause constipation or blockage:

• Vegetables with skins or stalks such as celery, peas or sweetcorn
• Fruit with skins, seeds, pips
• Wholegrain cereal such as All Bran, Weetabix, porridge or muesli
• Wholegrain or granary bread
• Brown pasta or rice
• Nuts, seeds, pulses, coconut and coconut containing products
• Thick-cut marmalade
• Dried fruit
• Digestive biscuits, fig rolls, oatcakes

Foods that may improve constipation or blockage:

• Vegetables - where possible, peel and remove seeds, pips, and stalks
• Fruit - where possible, peel and remove seeds, pips, and stalks
• Rice Krispies, Cornflakes or Special K
• Plain biscuits
• White bread, pasta, rice

Wind

When fibrous food reaches the colon, bacteria that are naturally present in the colon break down and ferment it which may cause some wind. If this wind is excessive and has not settled a few weeks after stoma formation, this may be due to fibrous foods or swallowing air when eating and drinking.

Foods that may cause wind:

• Carbonated drinks
• Beer
• Onions and garlic
• Beans and pulses
• Some vegetables ie. Broccoli, cabbage, cauliflower, Brussel sprouts
• Drinking through a straw, chewing gum or talking when eating and drinking can cause increased air swallowing and thus wind

Foods that may help to reduce wind:

• Marshmallows
• Jelly
• Live Yoghurt
• Peppermint tea, water, tablets or oil capsules

Odour

Some people may find that certain foods cause more odour than others. If you feel this is a problem, you may wish to alter your diet slightly to manage odour

Foods that may cause odour:

• Fish
• Eggs
• Spices
• Garlic
• Baked beans
• Certain vegetables such as Brussel sprouts, asparagus, cabbage, cauliflower, onions

Foods that may help reduce odour:

• Tomato juice
• Yoghurt
• Orange juice
• Parsley
• Peppermint tea, tablets, water or oil capsules

Take home advice:

1. It may take up to several weeks-months for the stoma to settle down.
2. Eat a varied and well balanced diet for good health.
3. Ensure an adequate fluid intake.
4. Adopt a regular eating pattern for optimal colostomy function.
5. Try all foods and only avoid those that repeatedly cause problematic symptoms for you
6. You should not require any dietary restrictions.
7. If you suffer from poor appetite after discharge, please contact your GP who can refer to your local Dietetic team for further advice and support. Alternatively, please contact the Addenbrooke’s Dietetic team for immediate advice if required.
8. We would encourage you to speak with your stoma nurses if you have any questions or concerns regarding your stoma output and management.

Contact Dietitian: . . . . . . . . . . . . . . . . . . . . . . .
Tel No: . . . . . . . . . . . . . . . . . . . . . . .

Further information can be obtained from:

Colostomy UK
100 Berkshire Place,
Winnersh,
Wokingham,
RG41 5RD

Tel: 0800 328 4257 (09.00 – 17.00 – Monday – Friday)

24hr helpline: 0800 328 4257

Email Colostomy UK

Addenbrooke’s Stoma Care Nurses
Level 4, Treatment Centre,
Addenbrooke's Hospital,
Hills Road,
Cambridge,
CB2 0QQ

Tel: 01223 216505 (08:00-16:00 – Monday-Friday)

Email the Stoma Care nurses