Nutrition Therapy for Ostomates
Colostomy Nutrition Therapy
| After sugery, bowel is swollen and high-fiber foods should be avoided. This will allow bowel to heal and to avoid blockage. | Fiber restricted diet should contain less that 13 grams of fiber for the whole day and may be less than 8 grams, depending. | Most patients begin to eat more normally 6 weeks after surgery. |
| Eating small amounts every 2-4 hours is recommended. | Eat meals and snacks at the same time each day. | Eating the largest meal in the middle of the day may decrease stool output at night, making it easier for full night's rest. |
| Avoid acidic, spicy, fried or greasy foods, as well as foods high in sugar- all can cause diarrhea. | To reduce gas: avoid chewing gum, drinking through straws, carbonated drinks, smoking/chewing tobacco, eating too fast. | Missing meals can cause small intestine to be more active and increase gas/watery stools. |
| "Lag-time"- time from eating gas-producing foods and actual release of gas is 6-8 hours for distal colostomy pts. | Have at least 8-10 cups of fluids per day. More during hot weather, increased stools, and exercise. | Watch for signs of fluid-electrolyte imbalance: dry mouth, abdominal cramping, reduced urine output, dark concentrated urine, dizziness upon standing, and marked fatigue. *Ileostomy patients are more at risk for dehydration. |
| Add foods containing fiber gradually into diet- only small portions and chew very well. | Keep a food journal of foods tried and how felt after. | Only try one new food every 3 days. |
Short Bowel Syndrome (SBS) Nutrition Therapy
| SBS occurs when portion of intestin (small bowel and large bowel or colon) has been removed and not able to absorb enough fluids and nutrients to have healthy hydration and nutritional status. | Symptoms: diarrhea, steatorrhea (fat in stools, causing oily/greasy appearance), dehydration, eletrolyte issues (especially low potassium or magnesium) and unintended weight loss. | Over time (months to years) remaining bowel may start to work harder and improve absorption and decrease symptoms- adaptation. Eating can help promote adaptation. | Management may include diet changes, vitamin/mineral supplements, medications, fluids (IV or oral) and parenteral nutrition (IV nutrition). |
| Depending on remaining length of bowel and symptoms, Dr might decide you need less IV fluid or IV nutrition as bowel adapts. | Eat small, frequent meals and snacks (5-6 times a day). | Chew foods well. | Have drinks between meals, not with meals or snacks. |
| Eat salty foods and use table salt frequently, especially if you do not have a colon. | Avoid foods and drinks high in sugar. | Avoid stimulants such as caffeine and alcohol. | Limit sugar alcohols (sorbitol, mannitol, xylitol) found in many sugar-free products. |
| Only limit dairy products if lactose intolerant or if they have sugar added. | You may need to eat as much as 2-4 times more food than you did before SBS dx to maintain weight. | Choose diet moderate in complex carbs (40-50% of total calories), moderate to high in fat (30-40% of total calories), and adequate in protein (20% of total calories). | Foods high in fat provide additional calories but should not increase stoma output. |
Absorption versus Discharge
| Sigmoid Colostomy | Transverse colostomy | Ascending colostomy | Ileostomy | |
|---|---|---|---|---|
| Differences in absorption | Moves waste to the rectum. Sigmoid colostomies produce stool that is more solid and regular than other colostomies. | The stool leaves the colon through the stoma before reaching the descending colon. Stoma may have one or two openings. One opening is for stool. The second possible stoma is for the mucus that the resting part of colon normally keeps producing. If only one stoma, this mucus will pass through rectum and anus. | The ascending colon runs from the beginning of the large intestine to the right side of the abdomen. In this procedure, only part of the colon still works. As a result, little water is absorbed from the waste. This means the stool is usually liquid. | The end of the small intestine is pulled through the right lower part of the abdomen and secured to the outside skin. You then wear a pouch at all times to collect stool that moves through the opening. Decreased ability to absorb nutrients, fluid and electrolytes. Risk for dehydration and increased risk with excessive sweating, diarrhea, and/or vomiting. Severe dehydration might require intravenous (IV) fluids to rehydrate the body. Might affect ability to absorb vitamin B12; supplement might be needed. Stool consistency ranges from liquid to semisoft (mushy). Stool consistency will depend on how much ileum was removed; the shorter the ileum, the more liquid the stool will be. Stool color after surgery will often be dark green. Digestive enzymes are present in the stool and will be caustic/irritating to the skin, if pouch leakage occurs. The thicker the stool the more nutrients and fluids are being absorbed. |
| Differences in discharge | Contents become more formed. Resembles normal bowel movements. Regulated in some persons, not in others |
Semi-solid and can be unpredictable. Contains some digestive enzymes. Contents are less acidic liquid | Contents are acidic liquid | Liquid or paste consistency, unpredictable drainage. |