What are strictures and adhesions?
A stricture is a narrowing anywhere in the lining of the gut. These can be caused by long term inflammation, usually by Crohn’s Disease. After continued cycles of inflammation and healing in the lining of the gut, scar tissue can replace the inflamed lining and cause strictures, leading to narrowing of the intestines.
Adhesions are a band of scar tissue that can make the intestines stick to the abdominal wall, other parts of the intestines or to other organs close by.
Severe strictures and adhesions can lead to bowel obstructions which can cause symptoms such as nausea, vomiting, tummy discomfort or bloating.
Why should I change my diet?
Strictures or adhesions can narrow the lining of the gut, making it difficult for harder or fibrous foods to pass through. This can lead to bowel obstructions, which is why it is important to change your diet. Foods that are easier to digest with strictures or adhesions, tend to be foods which are lower in fibre, have been softened by cooking, can be mashed with a fork, and have a moister texture.
The extent how much you change your diet also depends on how narrow your strictures are and the area of your gut which is affected. If you have several strictures or a very tight (pinhole) stricture, then you may tolerate more fluid based or very soft foods better.
Your dietitian can help to guide your food choices, support you to help monitor your symptoms and ensure your diet is nutritionally adequate.
How long should I follow this diet for?
In some cases, this diet may be temporary until you receive surgery or an endoscopic dilatation. In some situations, you may need to adjust your diet for the long term.
Starchy foods
Include
- Mashed potatoes
- Well cooked potatoes without skins
- Any soft potato product with no skin e.g hash browns or latkes (without onion, croquettes, waffles)
- Well-cooked white rice
- Any starchy food made from white flour - white pasta, white noodles, white bread, white pitta breads, white chapattis, plain white bagels
- Yorkshire puddings with added gravy
- Pastries (without nuts or dried fruit)
Trial small amounts with caution
- Matzah crackers - ensure not made with whole wheat or labelled “high fibre”
Avoid
- Potatoes with skins
- Rye, granary bread
- Any starchy food made with brown or wholemeal flour - brown chapattis, wholemeal pittas, wholemeal pasta
- Bread products with fruit, fibre, nuts, or seeds added
- Breads/pastas labelled high fibre
Cereals
Include
- Low fibre cereals, softened easily with milk e.g. rice krispies, cornflakes, sugar puffs, coco pops, frosties
- Ready brek
Avoid
- High fibre/wholegrain cereals - all-bran, bran flakes, shredded wheat, Weetabix, puffed wheat, muesli, granola
- Cereals with nuts, seeds, or dried fruits
- Porridge oats
Protein
It is important to include a source of protein with each meal or snack. This helps to contribute to the maintenance of your lean muscle mass.
If you have vegetarian protein products such as Quorn, they will always have a fibre content due to being plant based. It is more important to opt for sources which are softer, such as mince or smooth peanut butter.
Include
- Soft, well-cooked meats/poultry which is either minced/pureed, with skins and fat removed
- Thinly sliced meat slices e.g pastrami, ham
- Poached/baked/steamed/boiled fish with no bones, served with added sauce
- Tinned fish
- Eggs
- Tofu - all kinds, cooked soft
- Smooth, pureed, or mashed lentils and chickpeas without skins, i.e. hummus, blended lentil soup
- Any meat/fish substitute which can be cooked soft, without skin and can be mashed e.g Quorn mince, meat style slices, meat style fillets
- Matzo balls or vegetarian meatballs - cut into small pieces/ mashed/served with sauce or yogurt
Avoid
- Tough, gristly meat with skin/bones
- Dried meats with skins - sausages/chorizo
- Fish with bones
- Firm beans and pulses with coarse skins e.g. kidney beans, baked beans, haricot beans, barlotti beans, chickpeas, soya beans
- Any meat/fish substitute which is chewy, has skins or is gristly e.g vegetarian sausages, Quorn chicken pieces
- Tempeh
Dairy
Dairy products are high in calcium, which is important to maintain healthy bones. Bone health is essential in IBD as continued use of steroids can lead to weaker bones.
Include
- All milk, cheeses, creams
- Milk powder
- Smooth, natural, Greek yogurt
- Smooth fromage frais
- Curd
- Smooth frozen yogurt
- Ice cream
- Butter/margarine
Avoid
- Any dairy products which contain fruit, nuts, dried fruit, or muesli
Fruits
Opt for a smaller portion size than usual, such as one to two tablespoons or a palm sized portion. You may be able to increase these portions, ddepending on your tolerance.
Include
- Pureed fruit
- Fruit coulis
- Tinned/cooked/stewed fruit with no skins
- Fruit juice or smoothies with no skins, seeds, or pulp
Trial small amounts with caution
- Ripe bananas
Avoid
- Fruit with skins, pips, pith, seeds, and stones
- All types of berries including strawberries
- All dried fruit
- Seeded, peeled de-piped fruit such as pears, apples, peaches, plums, apricots
- Canned citrus fruit with no pith, skin, or pips e.g mandarins or grapefruit
Vegetables
Opt for a smaller portion size than usual, such as one to two tablespoons or a palm sized portion. You may be able to increase these portions, depending on your tolerance.
Include
- Soft, well-cooked/mashed root veg, with no skins: carrots, swede, parsnips
- Tinned, deseeded tomatoes
- Tomato puree or passata
- Vegetable juice without pulp
Avoid
- Any vegetables with skins, stalks, seeds
- Any raw/crunchy vegetables such as peppers, radishes, celery, onions, cabbage, leeks, sweet corn, and mushroom
- Salad leaves
- Vegetable juice with pulp
Puddings
Include
- Milk puddings/cows’ milk alternative based puddings
- Custard
- Jelly
- Smooth ice cream
- Frozen yogurt
- Sorbet
- Mousse
- Plain madeira cake, sponges, Swiss/chocolate roll
- Meringue
- Profiteroles
- Tapioca pudding
- Panna cotta
Avoid
- Puddings made with/containing fruit, nuts, dried fruit, oats, or wholemeal flour
- Trifle
Savoury Snacks
Inlcude
- Softer crisps: quavers, wotsits, monster munch, prawn crackers, frazzles, bacon streaks, potato crisps
- Plain biscuits, white crackers
- Lentil based crisps
- Rice cakes
Avoid
- Wholegrain/seeded snacks, e.g. seeded breadsticks, seeded crackers
- Tortilla crisps
- Twiglets
- Bombay mix/trail mix
- Nuts
- Seeds
Sweet Snacks
Include
- Plain, smooth chocolate - made with either cow’s milk or alternative milk
- Plain, smooth toffee and fudge
- Jelly sweets
- Fruit pastilles
- Fruit gums
- Peppermints
- Honey, syrup
- Fine cut marmalade
- Smooth chocolate spread
Avoid
- Jams with seeds or skins, thick cut/chunky marmalade
- Sweets and chocolate containing dried fruit or nuts e.g. fruit and nut chocolate, snickers, and bounty
- Liquorice allsorts
- Chocolate spread with nuts
- Cereal bars
- Marzipan
Fluids
Include
- Clear, strained, creamy soups
- Soups with meat pieces
- Smooth/blended lentil soup
- Milk - any type which is well tolerated
- Either store brought milkshakes or homemade milkshakes ensuring smooth consistency
- Gravy without onions
Avoid
- Soups with vegetable pieces
- Lentil soups with solid lentils present
Top Tips
- Trial little and often. Aim to have 5-6 smaller meals or snacks spread out throughout the day
- Portion sizes will vary depending on the site and length of your stricture, but we would encourage you to start with much smaller portions and build to individual tolerance
- Opt for full fat dairy products - full fat milk, yogurt, cheese, cream. Use these in cooking or added to meals where possible
- If you avoid lactose - opt for lactose free cheese, cream, milk added to meals (see meal plans for more ideas) or plant-based alternatives
- If you tolerate cow’s milk products with lactose well: trial fortified milk: add 4 tablespoons of skimmed milk powder added to one pint of milk. Aim to have this as a drink or used in cooking
- Avoid drinking large quantities of fluids at mealtimes. Save fluids for between meals and divide into smaller quantities
- Your dietitian may have advised you oral nutritional supplements to help further nourish your intake
- Try adding regular alarms on your phone, e.g. every 3-4 hours, to remind yourself to have a snack or nourishing drink
Lactose Intolerance
Often, people with IBD find that they have a poor tolerance to large amounts of dairy products. This is due to poor tolerance of lactose, which is a naturally occurring sugar found in dairy products. It is thought that those with IBD, especially Crohn’s Disease of the small bowel, have a poor production of lactase, which is the enzyme needed to break down lactose. This can happen temporarily during a flare or can be permanent.
It is important to have a regular intake of dairy products as these are a good source of calcium, which is essential for healthy bones and B12 which keeps our nerves and blood cells healthy.
You can try lactose free dairy products or cow’s milk alternatives, such as soya milk, rice milk or oat milk, ensuring they have added calcium and B12 in the ingredients list.
Snacks Ideas
- Waffles (cut in small pieces) and topped with any flavoured, full fat yoghurt
- Bananas with smooth nut butter
- Cheese and white crackers
- Smooth hummus with soft white pitta
- Mashed avocado with white bread
- Hard-boiled egg
- Greek yoghurt
- Full fat milk with low fibre cereal (cornflakes, sugar puffs, coco pops, Frosties)
- Baked potatoes, no skin and cheese
- Omelettes made with cheese and either vegetarian protein or meat
- Smoked salmon and avocado on white bread/toast
- Tuna mayo on a white cracker
- Nutella on white toast
- Cake and custard
- Rice pudding
Breakfast
- Any suitable cereal with extra milk (ensure lots of milk over cereal). Choose either full fat milk or alternative milk of choice. Consider adding fortified milk to the cereal
- White toast with butter, scrambled egg (fortify with extra milk) or cheese (any kind) or smooth nutella/peanut butter
- White bagels with smooth, plain cream cheese and/or smoked salmon or tuna or tinned fish of choice
- Omelettes with added cheese and suitable protein
- Latkes (without onion) and sour cream
- Fruit juice without pulp
Lunch
- Smooth soup with added cream, with white bread/cheese toastie
- White bread sandwich with protein rich filling (smooth hummus, suitable meats, suitable fish, or suitable vegetarian alternative). Add butter/cheese/spread to the sandwich
- White tortilla wrap with chicken breast/meat free fillets with cheese/greek yogurt and avocado
- Matzo ball soup - ensure matzo balls are soft and cut into smaller pieces. Ensure only suitable vegetables in soup along with suitable meat portion. Avoid adding onions
Evening Meals
- Any pasta dish made with white pasta e.g macaroni cheese/ lasagne/ravioli/cannoli/kugel
- Ensure using tomato passata or puree. Add extra grated cheese on top
- White chappati or soft white rice with well cooked, mashed lentils (no skins) or with well-cooked suitable vegetables
- Chicken/fish/minced meat or minced Quorn with sauce of choice and mashed potatoes. Add extra cream, milk, or cheese to mash
- Jacket potato (with no skin) with added cheese/tuna/ mayonnaise
Further Reading
Information on Crohn’s Disease
Crohn’s and Colitis UK website on diet
Guts UK info on Crohn’s Disease
https://gutscharity.org.uk/advice-and-information/conditions/ crohns-disease/
If you have any questions or concerns regarding your diet and managing your symptoms, please contact us on gastrodietitians@nca.nhs.uk
Date of Review: April 2024
Date of Next Review: April 2026
Ref No: PI_M_1897 (Salford)