Colostomy, Ileostomy, Rectal Pouch Diets

Author:  Frank W. Jackson, M.D.

Purpose

Surgery is often needed to treat certain conditions of the colon (large bowel). Sometimes the surgeon must make an opening on the abdominal wall through which intestinal waste (feces) can pass. This surgery is medically known as colostomy and ileostomy. The opening itself is called a stoma. A lightweight, disposable bag is then worn over the stoma. This condition is often permanent. However, in certain cases it is a temporary detour that can be reversed at a later time.

There are two forms of this surgery where a bag may not be needed. Sometimes a rectal pouch can be created from the small intestine, forming a reservoir for the stool behind the stoma. A tube is put in place so the reservoir can be emptied when needed, usually once a day. This procedure is no longer very common. In another procedure, all of the colon is removed except for the last part of the rectum. A pouch ( Ileal-Anal Pouch) is created from the small intestine and it is attached to the rectum so liquid stool can pass normally through the anus (opening to the outside of the body) about 3 to 7 times a day.

After all of these surgeries, the stool consistency, amount, and frequency will depend on the type and amount of foods eaten. So, this diet is to help patients gain adequate control of their bowel movements.

Nutrition Facts

Generally, colostomy and ileostomy patients can easily maintain a balanced diet to provide all the vitamins, minerals and calories needed for good health. In those cases where certain foods have to be restricted to control stool patterns or stool consistency, the physician may prescribe a vitamin-mineral supplement.

Special Considerations
  1. Because each patient and type of surgery are different, no standard recommendations can be given for everyone. Most patients return to a fairly normal diet. Still, a trial and error pattern of eating is often necessary to identify those foods that may have an undesirable effect on the patient’s stool. Then it is simply a matter of changing how much of these foods are eaten. The lists that follow are a guideline.
  2. Eat foods at a regular time each day. Eating 4 to 6 smaller meals may help to promote a regular bowel pattern.
  3. Try eating the main dinner meal at noon and a smaller meal in the evening. This helps to reduce the stool output at night.
  4. Introduce one type of food at a time to test how it affects bowel function. If it does not produce a good result, stop eating it. However, as the body heals and adjusts, the offending food may become easier to tolerate, so try adding it to the diet again on several occasions before giving up on it.
  5. Chew foods completely to help the digestive process. Especially avoid swallowing large pieces of leafy vegetables since they can block the stoma opening on the abdominal wall.
  6. Fresh fruit may cause loose stool.
  7. Drink 2 to 3 quarts of water a day. This helps to keep the stool fluid, and it also prevents dehydration. Normally, the colon absorbs water and electrolytes (substances such as sodium and potassium) from the stool, so people who have all or part of the colon removed will lose more water. Because electrolytes are also lost, do not restrict salt in the diet.
  8. Maintain an ideal body weight. Extra fat in the abdominal wall can make it difficult for the stoma to function properly.
  9. Colostomy patients may find that foods which caused problems before surgery continue to do so afterward.
  10. During the first 4 to 6 weeks after surgery, ileostomy patients should limit foods that caused problems prior to surgery. This will reduce the chance of stoma blockage and lower the amount of gas.
  11. Certain substances can change the appearance of the stool. Bile that cannot be reabsorbed in the intestine can cause a yellow or green stool color, especially when diarrhea or rapid bowel action occurs. Beets make the stool appear red; it is not blood! Broccoli, asparagus, spinach, and Pepto-Bismol can darken, even blacken, the stool.
  12. Certain medications such as Imodium, Lomotil, Levsin, and Bentyl can help to slow the bowel when diarrhea is a problem.
  13. Foods containing large amounts of fiber and bran should be avoided for 6 to 8 weeks after surgery. After that time, certain bulking agents such as psyllium (Metamucil), methylcellulose (Citrucel), and calcium polycarbophil (FiberCon) may help firm the stool. Only certain patients need to have a firmer stool, so do not use these agents without the physician’s instructions.
Guidelines and SuggestionsFoods that Are Poorly or Incompletely Digested and that May Block a Narrowed Stoma
Cabbage Lettuce
Celery Mushrooms
Coconut Nuts
Corn Olives
Cucumbers Peas
Dried fruits Pickles
Green peppers Pineapple
Things that Cause Excess Swallowed Air and Then Gas

  • Jittery or stressed personality and excessive saliva swallowing
  • Poorly fitting dentures, smoking pipes or cigarettes, chewing gum or tobacco can cause increased salivation and swallowing
  • Eating fast and swallowing large chunks of food or large amounts of beverages
  • Using straws or drinking from a bottle or can
  • Inactivity and lying down after eating
Foods that Tend to Form Gas
Legumes Most beans, especially dried beans and peas, baked beans, soy beans, lima beans
Vegetables Cabbage, radishes, onions, broccoli, Brussels sprouts, cauliflower, cucumbers, sauerkraut, kohlrabi, rutabaga, turnips, asparagus, onions
Fruits Prunes, apples, raisins, bananas, excessive amounts of fruit
Cereals, breads Excessive wheat products, including breads and cereals. Check labels for specific grains.
Milk, milk products Excessive milk, ice cream, cheese
Fatty foods Excessive pan-fried or deep-fried foods, fatty meats; rich cream sauces and gravies; pastries
Liquids Carbonated beverages
Odor-Reducing Foods and Medications
Buttermilk Yogurt
Cranberry juice Charcoal tablets (check with physician )
Parsley
Odor-Producing Foods
Asparagus Garlic
Eggs Onions
Fish
Foods that Tend to Thicken Stool
Applesauce Pasta
Bananas Creamy peanut butter
Breads Starchy foods, such as potatoes
Cheeses
Foods that Tend to Cause Diarrhea
Apple juice Prune juice
Grape juice Highly seasoned foods, especially hot peppers
Sample Menu
Breakfast Lunch Dinner
  • canned peaches
    1/2 cup
  • skim milk 1/2 cup
  • white toast 1 slice
  • margarine 1 tsp
  • decaffeinated tea
    1 cup
  • lemon juice 1 tsp
  • sugar 2 tsp
  • baked chicken breast 3 oz
  • steamed white rice
    1/2 cup
  • cooked carrots
    1/2 cup
  • low-fat vanilla yogurt 1/2 cup
  • margarine 1 tsp
  • decaffeinated coffee
    1 cup
  • skim milk 1/2 cup
  • sugar 1 tsp
  • salt 1/8 tsp
  • chicken noodle soup 1/2 cup
  • saltines 2
  • sandwich 1/2
    white bread 1 slice
    creamy peanut butter 1 Tbsp
    jelly 1 Tbsp
  • applesauce 1/2 cup
  • decaffeinated tea
    1 cup
  • lemon juice 1/2 cup
This Sample Diet Provides the Following
Calories 1065 Sodium 1662 mg
Protein 54 gm Potassium 1512 mg
Carbohydrates 151 gm Fiber 9 gm
Fat 29 gm

© Frank W. Jackson, M.D.