Colostomy, Ileostomy, Rectal Pouch Diets

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 may be permanent, or, in other cases, a temporary detour that can be reversed at a later time.

A colostomy is created when a portion of the colon is brought to the skin on the abdomen. Stool then flows through the remaining colon and then out the stoma and into bag. An ileostomy is like a colostomy except that the lower small intestine, called the ileum, is brought up to the skin rather than the large intestine. There are other types of ostomies but these are by far the two most common. An important difference between these two surgeries, however, is that dehydration and electrolyte changes is more common in those with an ileostomy.

In both of these surgeries, an external bag is applied over the stoma to collect the feces.

After either 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
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. Eat foods at a regular time each day. Eating 4 to 6 smaller meals may help to promote a regular bowel pattern. Try eating the main dinner meal at noon and a smaller meal in the evening. This helps to reduce the stool output at night. 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. 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. Fresh fruit may cause loose stool. 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. Maintain an ideal body weight. Extra fat in the abdominal wall can make it difficult for the stoma to function properly. Colostomy patients may find that foods which caused problems before surgery continue to do so afterward. 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. 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. Certain medications such as Imodium, Lomotil, Levsin, and Bentyl can help to slow the bowel when diarrhea is a problem.

Special Considerations

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.
Eat foods at a regular time each day. Eating 4 to 6 smaller meals may help to promote a regular bowel pattern.
Try eating the main dinner meal at noon and a smaller meal in the evening. This helps to reduce the stool output at night.
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.
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.
Fresh fruit may cause loose stool.
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.
Maintain an ideal body weight. Extra fat in the abdominal wall can make it difficult for the stoma to function properly.
Colostomy patients may find that foods which caused problems before surgery continue to do so afterward.
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.
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.
Certain medications such as Imodium, Lomotil, Levsin, and Bentyl can help to slow the bowel when diarrhea is a problem.

Guidelines and Suggestions Foods 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 with 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 or 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	1,065	Sodium	1,662 mg
Protein	54 gm	Potassium	1,512 mg
Carbohydrates	151 gm	Fiber	9 gm
Fat	29 gm

Related Conditions

Crohn’s Disease
Crohn’s disease is a chronic, recurrent inflammatory disease of the intestinal tract. The intestinal tract…
Inflammatory Bowel Disease
Understanding IBD. What is inflammatory bowel disease (IBD)? The term inflammatory bowel disease (IBD) is…
Ostomy, Colostomy, Ileostomy
These three words and the images they convey produce dread in many people who may know…
Ulcerative Colitis
Ulcerative colitis is a chronic, recurring disease of the large bowel. The large bowel (colon)…