A stoma (colostomy or ileostomy) is sometimes necessary after bowel surgery. In the first weeks after a stoma is formed people sometimes experience problems as the bowel gets used to working in a new way. This leaflet contains some advice about how and what to eat when you have a new stoma.
What is a stoma?
Sometimes part of the bowel has to be surgically removed or bypassed, which means that bowel movements (stools) can no longer pass out of the body through the anus. The surgeon creates a new opening through the skin of the tummy (abdominal) wall and attaches part of the remaining bowel to the inside.
If that is part of the large bowel (colon) then it is called a colostomy. If it is part of the small bowel (ileum) then it is called an ileostomy. Bowel movements pass out through the stoma into a bag which sticks on to the surrounding skin. If the urinary bladder is not able to function, a urostomy is formed and the bag collects urine.
Around 120,000 people in the UK are living with a stoma. Just over half of these have a colostomy, most of the rest have an ileostomy and the remainder have a urostomy. About one third of stomas created are permanent; the rest are reversed after some time.
There are no special dietary restrictions for people who have a urostomy, so the rest of this leaflet will focus on colostomies and ileostomies.
Most hospitals will have a team of stoma care nurses who will help people who have a stoma to become used to living with it. They will offer advice about bags, adhesives and other products and they will be able to help with advice about what to eat when you have a stoma.
Getting used to a stoma
When a stoma is created, it doesn't produce any waste for a few days; then a semi-liquid content will pass into the bag. After some time the output from an ileostomy is likely to settle down to a porridge-like consistency, and from a colostomy to a more solid output. This will, however, vary depending on what you are eating and drinking.
After a few months of living with a stoma, most people find that they are able to eat the same sorts of foods they ate before the operation. However, for several weeks after the operation, the bowel is healing and becoming used to functioning in a new way. During this period, many people find that a bland and low-fibre (low-residue) diet helps to avoid discomfort and some of the symptoms listed below. Usually after two to three months, you will find that you are able to eat a more normal diet.
It may be a good idea to eat your main meal in the middle of the day rather than in the evening, as this will reduce the amount of output into the bag during the night.
Some people find it helpful to keep a diary of what they eat when they are becoming used to having a stoma. If there is a food that causes a problem it will be easier to work out what it was.
Some problems you may experience with a stoma
Wind can be a particular difficulty for people who have a stoma. Obviously, all people produce wind, not only those with a stoma. However, you have no control over when the wind is released through your stoma and it can cause the stoma bag to bulge. Placing a hand over the stoma bag when you feel wind helps to reduce the noise.
Things that may cause excessive wind:
- Vegetables such as beans and cabbage.
- Fizzy drinks.
- Talking while eating.
- Drinking through a straw.
- Chewing gum.
- Eating and drinking at the same time.
- Missing meals.
There are some things that may help if you are experiencing wind:
- Charcoal tablets.
- Peppermint oil or peppermint tea.
- Fennel - to eat, or as tea.
- Tomato juice.
Some foods will make the stoma output smell more strongly. These include:
- Baked beans
Odour can be reduced by:
- Cranberry juice
- Orange juice
- Tomato juice
Hard to digest items may cause an obstruction near the opening of the stoma. You may experience pain, swelling, feeling sick (nausea) and being sick (vomiting). Blockage is more common with an ileostomy because the opening is smaller but colostomies can become blocked too. Chewing your food thoroughly will reduce the risk of an obstruction.
Foods which may cause a blockage include:
- High-fibre vegetables
- Dried fruit
An obstruction can be cleared by drinking clear fluids and massaging your tummy. However, if it does not clear you should go to hospital.
Output too soft or too hard
If your output is very loose and watery, there are some things which may help:
- Under-ripe bananas.
- Jelly babies.
- Smooth peanut butter.
- Cooked apple.
- White rice.
- Plain yoghurt.
- Plain noodles or pasta.
- Buttermilk (this will also help to reduce odour).
- Gravy granules.
However, many patients, particularly those with an ileostomy, still find that they need to take loperamide tablets to make the output more solid.
If the stoma output is too hard (constipated) you could try:
- Warm or hot drinks.
- Cooked fruits or vegetables.
- Raw fruits or vegetables.
- Fruit juice.
- Increasing the amount of fibre in the diet; this will reduce the risk of constipation developing.
Some foods may change the colour of your stoma output. There is no need to avoid these foods but seeing a change in colour can be alarming. These foods include:
- Red jelly
- Food colourings
- Iron tablets
- Tomato sauce
What about fibre?
There are two types of dietary fibre. Soluble fibre is found in fruits, oats, lentils, nuts and beans. It breaks down and forms a jelly-like substance in the gut and is generally quite easy to digest. Insoluble fibre is found in many vegetables and in wholegrain cereals and it makes the bowel movements (stools) softer and more bulky.
With a new stoma, you may find that eating a lot of fibre, particularly the insoluble kind, causes discomfort. However, as your body adjusts it may become easier to eat a higher-fibre diet. Build up the amount of fibre you are eating gradually.
Specific tips for an ileostomy
Ileostomy waste is more liquid than normal bowel movements (stools). This is because one of the functions of the large bowel (colon) is to absorb water from the stools. It is therefore important to drink plenty of fluid, especially in hot weather.
Salt is also lost through the ileostomy. Therefore, the usual healthy eating advice about cutting down on salty foods and not adding salt to your food may not apply to you to the same extent.
Potassium is another substance that is lost through the ileostomy. Many fruits and vegetables are rich in potassium and will help to keep up your levels.
Vitamin B12 is absorbed at the end of the small intestine, near to where it joins on to the large intestine. If this part is removed as part of your surgery, you may need to have B12 injections every three months so that you don't become low in B12.
You may need to take a supplement of other vitamins, especially in the first year after surgery. However, your surgeon or stoma nurse will be able to advise you about this.
Further reading and references
; NICE Clinical Guidelines (October 2012, last updated May 2016)
; NICE Clinical Guideline (June 2013)
; NICE Clinical Guideline (March 2011)
; NICE CKS, September 2017 (UK access only)
; NICE CKS, July 2015 (UK access only)
; Nutrition for people with stomas. 2: An overview of dietary advice. Nurs Times. 2008 Dec 9-15104(49):26-7.
; Inflammatory bowel disease surgery in the biologic era. World J Gastrointest Surg. 2016 May 278(5):363-70. doi: 10.4240/wjgs.v8.i5.363.