My ileostomy was a surprise when I woke up from surgery. Thankfully, I had some prior experience with ostomies and I had spent about thirty minutes grilling my provider about my ostomy diet and what I could and couldn’t eat after surgery.
The good news? I’ve had an ileostomy, now I have a permanent colostomy, and not much about my diet has changed. There is some important dietary advice to follow in the immediate postoperative period but after that, most ostomates are able to return to their former patterns of eating.
Here, we will discuss some dietary advice particular to the different types of ostomies, as well as general advice for all ostomates.
Ostomy Diet 101: What can I eat right after I have surgery?
The general recommendation is to follow a low-fiber, low-residue diet for approximately 4-6 weeks. This diet helps the bowel rest, is easy to digest, and is less likely to cause painful gas. In the immediate post-op period, ostomates should focus on consuming enough calories, especially protein, for healing.
Good sources of protein include:
- Lean meats (chicken, pork, turkey)
- Fish and shellfish
- Dairy (milk, yogurt, cheese)
You will also need to make sure to stay adequately hydrated. Ileostomates need to pay attention to what foods they are eating and how well they chew in order to prevent a blockage. My post-op course after my temporary ileostomy was relatively uneventful and my surgeon said that I could add in some pureed and/or well-cooked vegetables after my second post-op week, but you should discuss this with your doctor.
Your appetite may be poor during the immediate post-op period. Try eating smaller, more frequent meals and include protein as much as possible.
Specific Ostomy Diets
It’s important to mention that people with urostomies are unlikely to experience a need to change their diet aside from the immediate postoperative period, as only a small portion of the intestine is used to form the ileal conduit.
If you have a colostomy, your output will vary based on the amount of bowel you have removed during surgery. Those who have less of the bowel removed, as in a descending or sigmoid colostomy, will have similar output and hydration needs as before surgery. Those who have more of the bowel removed, such as a transverse or ascending colostomy, will have looser stools and be more at risk for dehydration like someone with an ileostomy. In general, after the 4-6 week post-op period you will be able to return to eating most of the foods you ate before you had a colostomy. Those with transverse or ascending colostomies need to pay additional attention to hydration.
If you have a new ileostomy you are more at risk for blockages than someone with a colostomy. The diameter of the stoma for an ileostomy is smaller than that of a colostomy, which means it can be hard for large food particles to be broken down in the small intestine, and you may see whole pieces of food in your output if you do not chew well.
These large pieces can get stuck in the swollen bowel especially at the point where your intestines pass through your abdominal wall.
If you’re an ileostomate, you can prevent issues by following these simple tips:
- Follow the low-fiber, low-residue diet
- Hydrate, hydrate, hydrate- try for 8-10 glasses of fluid a day
- Chew your food well
- Avoid foods that have tough skins and large seeds
- Use caution consuming raw fruits and vegetables, consider steaming items to make them softer and easier to process
Some foods have a reputation for causing blockages for ileostomates. The list below includes some common culprits that are a good idea to avoid in the postoperative period.
I found that I could include some fresh/raw foods earlier on by pureeing them into smoothies or soups. Use the list below as a guide but realize that each patient is an individual and your experience with these foods after the initial 4-6 week period will vary.
I ate many of the foods below (making sure to chew well and hydrate) but I found that fibrous foods like arugula and bok choy caused blockages. You are likely to discover that you can consume many of the foods on this list in moderation, and there may be foods not listed here that cause you trouble. Feel free to try them but start slow and remember to follow the tips listed above when you do.
List of foods that often cause blockages:
- Whole nuts and seeds, dried fruit
- Whole beans or lentils
- Leafy greens and cooking greens (kale, collards, swiss chard)
- Dried and fresh coconut
Overall I encourage ostomates to try small portions of these foods after 4-6 weeks have passed and see how your bowel responds. Signs of a blockage include pain, lack of output, and nausea/vomiting. REMEMBER: If you have no output for 8 hours, have significant pain, or have vomited please contact your surgeon immediately or seek emergency medical care!
One final consideration specific to ileostomates is hydration. The large bowel reabsorbs much of the fluid from our stool. An ileostomy bypasses the large intestine so ileostomates are more at risk for dehydration. Ileostomates are especially at risk for dehydration if they have a high output stoma – meaning that you have greater than 1200ml, or more than approximately 5 cups, of output in 24 hours. If you suspect that you are having high output make sure to contact your surgeon, as you can be at risk for dehydration and electrolyte imbalances.
You should aim to consume 64-80 oz of fluid per day. 64oz is the same as a half-gallon or about 8 cups. It is important that some of those fluids contain electrolytes like sodium and potassium. If drinking that much seems intimidating, here are some tips to stay hydrated:
- Carry a water bottle with you and take sips. If you’re not into plain water it can be jazzed up with fruit and/or herbs. I love to throw some mint and blackberries in my water to give a little flavor and make it feel fancy
- Try to drink a glass of fluid every time you empty your pouch
- Avoid or limit caffeine or alcohol containing drinks as these can actually lead to dehydration by increasing the amount you urinate
And remember, it’s not just water that counts as hydration. Consider the food and drinks below to meet your daily fluid requirements:
- Coconut water (great for electrolytes but can cause increased output if consumed in excess)
- Broth or soup (tip: bone broth has protein!)
- Diluted sports drinks or fruit juice
Carbonated sugar-free drinks are okay to drink but you may find that these cause a lot of gas. I enjoy seltzer and drink it on a regular basis, but I did limit my intake during the first 4-6 weeks after surgery. You should limit beverages that contain large amounts of sugar as these are not healthy and can contribute to loose stools and dehydration.
Ostomy Diet: Postoperative period
So you made it to the 6-week point, you’re recovering well, and are ready to start introducing new foods and getting back to your regular diet. What else is important to know about your post-ostomy diet?
You probably noticed, even before you had an ostomy, that what you eat can have an impact on your stool. The same principles apply once you have an ostomy but are more important to consider due to the risk of blockages or dehydration.
Foods can thin or thicken your output and also have an impact on odor and gas. Below is a handy chart from the United Ostomy Association of America to help you make smart choices about foods.
The information on this chart is meant as a guide to help you but there will certainly be exceptions to the information listed here — remember, we all have different tolerances for different foods. If something gives you trouble, don’t worry! It doesn’t mean you can never eat that food again. It just means that you might need to give it more time. If you’re having trouble figuring out how foods are affecting your output it can be helpful to keep a food diary. A food diary is just recording the meals you ate and the resulting output. This can help you determine which foods may be problematic, think or thicken output, or cause odor and gas.
As you have probably realized while reading this article, there is no specific “ostomy diet” that will work for every ostomate. We are all unique individuals and, when it comes to your ostomy diet, you will have to spend some time after surgery, and beyond, figuring out what is right for you. If you enjoy cooking as I do, the early dietary restrictions with an ostomy can be frustrating. I tried to think about how I could modify some of my favorite recipes to incorporate them into my diet. Sometimes it’s just a matter of cutting pieces of vegetables smaller or taking a sauce and pureeing it so it does not have large chunks of food.
I made a few meals and froze them prior to surgery so I would have healthy options to eat even when I wasn’t feeling up to cooking. I would also recommend discussing your early dietary guidelines with friends and family that want to bring food while you are recovering from surgery. A very well-meaning friend gifted me an entire tower of snacks that I could not eat because most of it was fresh fruit, nuts, and candy with nuts in them (although my husband and children enjoyed the treats!)
Click here to download several recipes that were staples for me in the postoperative period