Dietetics - Eating with your new Colostomy bag

What is a stoma? 

A stoma is a surgically created opening on the surface of the body which is connected to your bowel to divert waste (faeces) out of your body. A colostomy is a type of stoma where your colon (large bowel) has been connected to the surface of the body to divert your faeces. Once your colostomy has been formed, food travels through your small bowel and partway through your large bowel, before passing through your stoma out into your stoma bag.

You will continue to absorb most of your nutrients from your food and drink as you did prior to your surgery. You may however find that the output from your stoma is looser depending on the amount of bowel you had removed during surgery.

Although every person with a colostomy has different food preferences and tolerances, this leaflet aims to provide some general advice to help you with managing your stoma output.

After your operation

Most people who have had a colostomy can resume a normal diet within a few days of their operation. The introduction of food will depend largely on the type of operation you have had and how you are progressing. Each person progresses at a different rate and progression of reintroducing diet will be guided by your surgeon alongside support from your dietitian. A typical build up plan is shown below.

First day: Clear fluids: such as water, black tea and coffee, clear soup and sugar free cordial.

Next stage: Free fluids: any liquids such as low fibre soups, tea and coffee with milk and nutritional supplement drinks e.g., Ensure Plus/Fortisip.

First few days of eating/soft diet: This is usually very individualised and decided by the surgical team but would usually include soft, moist easy to digest foods in small portions avoiding anything high in fibre or spice. Examples could be a small bowl of cornflakes, mashed potatoes and gravy, cottage pie with no vegetables, ice cream and sponge and custard style meals.

Normal Diet: This would include many foods you included in your diet prior to the operation apart from avoiding any potential foods which could cause a blockage e.g., peas, sweetcorn, whole mushrooms and nuts.

It takes time to progress through the stages and the rate at which you will progress will depend on your surgeon’s advice and your individual recovery, remember everyone’s recovery is different.

A Healthy diet and your colostomy

It is important to aim for a healthy balanced diet for overall health following a colostomy. This includes ensuring you include foods from all the groups from the eat well plate below.

Fibre

You should aim for the recommended five portions of fruit and vegetables daily alongside wholegrain products to ensure you have adequate fibre in your diet. You may wish to avoid anything very high in fibre for the first few weeks postoperatively until your stoma output has settled. These include salad items, fruits and vegetables with skins and pips as- well as beans and lentils. You can re-introduce these as your stoma output thickens and reduces in volume. This will help prevent any constipation in the long term. You may find it beneficial to reintroduce higher fibre foods such as baked beans one at a time to check on how your stoma responds.

Fluid

It is important to ensure you follow any fluid restrictions set by your medical team if applicable. Otherwise aim for 1500-2000mls daily (6-8 cups a day). You may need to increase this if you are particularly active or partake in physical activity/sport on a regular basis. Checking the colour of your urine can give you a good indication of your hydration status. A light straw colour indicates good hydration levels darker urine may indicate dehydration.

Avoid having large volumes to drink at mealtimes as this will increase your stoma output. Alcohol, caffeinated beverages (coffee, tea and cola) alongside fresh fruit juices and smoothies may also increase your stoma output. Therefore, it is important to drink these within moderation and decrease them if you find they increase your output. The recommended number of weekly alcohol units from the NHS is no more than 14 units a week ensuring you have some alcohol-free days.

Common problems and solutions

You may find that certain foods can cause your stoma to act differently. They may cause issues such as excessive wind, a loose watery output, or an unpleasant odour. Every stoma is different, so it is important to adapt your diet to suit your symptoms and your dietary preferences. It is also important to remember that stress and certain medications can have a negative impact on your stoma output. Speak to your local stoma nurse for advice if you feel any of your symptoms may not be dietary related.

Potential Problems

Below is a list of potential problems and the trigger food, along with things which may help.

Excessive odour - Avoid large volumes of foods such as cucumber, fish, eggs, onion and garlic. You may find peppermint tea/or drops or natural yoghurt may help with the odour.

Watery output - avoid high sugar foods, e.g jelly sweets. Fresh fuit smoothies, spicey foods, caffeine, very high fibre foods and artifical sweetners. Foods which may help include bananas, boiled rice, potates, pasta, rice pudding, crackers and other low fibre starchy carbohydrate foods.

Wind - High fibre green leafy vegetables, onion, garic, lentils, fizzy drinks, alcohol and chewing gum may cause excessive wind production. Wind in your stoma bag is part of the normal digestive process, but if it is excessive you can aim to reduce it by avoiding wind forming foods if you feel it is impacting on your daily activities.

Constipation - Ensure having 6-8 cups of fluid daily (unless advised otherwise by your medical team). Aim for 5 portions of fruit and vegetables daily. Also, try to include a variety of whole grain foods within your diet, eg brown bread or try some gentle exercise. If this advice does not alleviate your symptoms, contact your GP of local stoma nurse.

Your symptoms may not be related to your food intake. They may be related to a medication, stomach bug or stress, therefore if the problem persists it is important to seek advice from your GP or stoma team.

What to do if I have a poor appetite or I am losing weight

These tips can be helpful if you have a poor appetite or if you have lost weight without meaning to. If after 4-6 weeks of trying some of the suggestions in this section, you are still concerned or continue to lose weight please contact your GP and/or dietitian for additional support.

• Try small regular meals and snacks across the day so you are not over faced
• Try to eat every 2-3 hours even if it is a few crackers or biscuits
• Include puddings or desserts once a day - if you are too full after a meal wait 30 minutes
• Get some fresh air before meals to help stimulate your appetite
• Choose full fat products to increase calories in your diet e.g. thick and creamy yoghurts over low fat varieties
• If you smoke, avoid smoking half an hour before your meal as this can affect your appetite

Too tired to cook?

After surgery it can take a few months to get back to your normal daily activities and cooking can be difficult. The following tips may help.

• Try ready meals for a quick and convenient option, choose ones low in fibre and avoid the low-fat versions with less calories
• Add extra grated cheese/butter to ready meals to add extra calories
• Try meal delivery services e.g. Wiltshire Farm Foods, Meals on Wheels, Oakhouse foods or pick a supermarket delivery
• Choose easy to make meals such as toast/crumpets with nourishing toppings e.g., eggs, cheese, mackerel, pate, or spaghetti hoops
• Toasted sandwiches/tinned macaroni/ravioli or cold pre prepared foods such as sausage rolls, pork pies, quiches or scotch eggs can be easy snack meal options

Top Tips

• Eat regular meals. Long periods between meals may lead to overeating and cause an increase in your stoma output
• Take your time when eating, make sure you chew all your foods well. Eating quickly or on the go may cause an increase in wind in your stoma bag
• Spicy foods may also cause an initial increase to your stoma output. Try choosing a milder version of your favourite foods while you rebuild your tolerance
• Try to get in some gentle exercise to help with the post operative recovery and prevent constipation

If you would like further advice or have any concerns, please contact your dietitian. Stoma nurse or GP.

Useful links

www.colostomyuk.org

www.crohnsandcolitis.uk