Ileostomy

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• Seeing a dietitian is recommended.
• Nutrition after Ileostomy (VCH diet booklet, PDF)

Ileostomy output is liquid to mushy because it does not go through the large bowel. Water and salt are reabsorbed into the body via the large intestine. When you have an ileostomy, this does not occur. Therefore, you need to help your body reabsorb the water and salt by adjusting your diet. Ileostomy obstructions can occur when eating certain foods. It is essential to follow the following guidelines:

• Eat slowly and chew your food well.
• Eat small frequent meals.
• Add salt to your food – unless advised by your G.P. not to.
• Drink 6-8 glasses of water. Don't gulp but drink slowly and eat salty crackers or pretzels to help absorb the water.
• If feeling tired, consider adding an electrolyte replacement to your water.
• When trying new foods, add one at a time.

Initially post-surgery

• Low fiber diet

Established stoma

• Introduce one new food at a time

Urostomy

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There is no need to change your diet; some food like fish and asparagus may change your urine smell. Ensure you drink eight glasses of water a day to prevent dehydration and infection by keeping the urine flowing unless advised not to by your physician.

Dehydration

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Prevention of dehydration

• Always carry a bottle of water and sip throughout the day.
• Limit your caffeine intake and replace it with non or decaffeinated drinks.
• If drinking alcohol, drink in moderation and for every alcoholic beverage, drink a glass of water.
• Add electrolyte replacement tablets such as NUUN to your water.
• If you dislike water, adding natural flavours like lemon may help.
• Avoid beverages with sugar or sugar substitutes as these may increase your output, which increases dehydration.
• Eat salty crackers/pretzels or similar while drinking to help with the absorption.

Dehydration - ileostomy

Change in temperatures (heat) or when traveling to different countries, it is imperative to stay hydrated. Sometimes, the heat, diet changes, difficulty finding water, or even travelers' diarrhea can cause dehydration.

Signs of dehydration

1. Feeling tired, dizzy, lightheaded, confusion.
2. Restless, agitated.
3. Your urine is darker than a yellow post-it note.
4. Increased thirst, dry mouth, dry skin, loss of appetite, or stomach cramps.
5. Shortness of breath or feeling faint.
6. Muscle cramps or weakness decreased sensation or cold arms and legs.
7. Ostomy starts to put out high volumes of very liquid output > 1.5L.

Tips to stay hydrated

1. Ensure you carry a water bottle and drink the water.
2. Adding an electrolyte tablet/powder to your water will help with the absorption of the water.
3. Always try to have a snack or salty cracker when drinking.
4. Drink slowly; ideally, sipping on liquids is better than gulping throughout the day.
5. If you drink alcohol, drink more water with electrolytes.
6. Check your urine output – if dark, you need to drink more.
7. If your ostomy is very liquid and large amounts, take Imodium 1/2 hr before your meals.
8. Try to thicken your output – cream of wheat, peanut butter, marshmallows.

Blockage

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Foods to avoid

Nuts, popcorn, high fibrous foods (e.g., mango, celery, skins of foods, mushrooms, pineapple, raw vegetables, coconut, dried fruits and vegetables, sausages, or meats with casings)

Foods that thicken stool and slow output

Applesauce, bagels, bananas, bread, toast, cheese, crackers, marshmallows, oatmeal, peanut butter, jello, gelatin, potatoes, pretzels, rice, tapioca, yogurt

Foods that loosen stool and increase output

Alcohol, beer, wine, beans (baked), black licorice, caffeinated drinks, chocolate, fried food, prunes, prune juice, spicy food

Foods that increase odour

Asparagus, brussel sprouts, cauliflower, cheese (strong), eggs, fish, garlic, mushrooms, onions

Foods that cause gas

Apple skins, beans (baked, kidney, white), broccoli, brussels sprouts, cabbage, carbonated drinks, cauliflower, cucumber, eggs, mushrooms, beer, onions, peas, spinach

Foods that cause colour changes (output)

Asparagus, beets, food colouring, licorice, strawberries, tomato sauces, iron pills

Signs of Complete Blockage:

No ostomy output and are vomiting

1. Go to the nearest Emergency room
2. Stop eating or drinking

High output ileostomy

If your output is very liquid and you find you are emptying your pouch every hour, I suggest measuring your output, and if it's more than 1.5L in 24hours, please seek medical attention. (See foods above to help slow and thicken output)

Obstruction (ileostomy or colostomy)

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Ileostomy obstruction

Ileostomy obstruction can be caused by foods, a hernia, or twisting of the bowel. Occasionally, when the rectus muscle is strengthened too much, narrowing the stoma opening can occur, leading to an obstruction. Not chewing or eating foods on the DO NOT EAT LIST can lead to an obstruction. e.g., mangoes, mushrooms, nuts, pineapple, grape tomatoes, and raw vegetables.

Signs of partial ileostomy obstruction

• Pain
• Nausea
• Liquid thin output
• Stoma swelling
• Output is more odorous

Treatment

1. Cut the opening of your pouch a little larger than usual.
2. If you still have output, only take in liquids, ideally warm drinks such as tea or electrolyte drinks.
3. Take a warm bath to relax the abdominal muscles.
4. Try several different body positions, such as a knee-chest position.
5. Massage the area around the stoma.

*** if this doesn't resolve in a few hours, you start vomiting, or the pain becomes intolerable, go to the nearest Emergency room.

Complete blockage

No ileostomy output, and you are vomiting:

1. Go to the nearest Emergency room.
2. Stop eating or drinking.

Colostomy obstruction

Colostomy obstruction is commonly due to constipation. It could also be due to a hernia or twisting of the bowel.

Signs of colostomy obstruction

Pain, a slight decrease in output that leads to no output and a feeling of bloatedness and discomfort leading to pain, nausea, and vomiting.

Treatment

1. Cut the opening of your pouch a little larger than usual.
2. Drink fluids, such as water, fresh fruit juice e.g., prune juice, or tea.
3. Take a warm bath to relax the abdominal muscles.
4. Short walks.
5. Try several different body positions, such as a knee-chest position.
6. Massage the area around the stoma.
7. You may need a laxative. Discuss with your stoma nurse.