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Colostomy, Ileostomy, Rectal Pouch Diet

Surgery is often needed to treat certain conditions of the colon (large bowel). Sometimes the surgeon must make an opening on the abdominal wall through which intestinal waste (feces) can pass. This surgery is medically known as colostomy and ileostomy. The opening itself is called a stoma. A lightweight, disposable bag is then worn over the stoma. This condition is often permanent. However, in certain cases it is a temporary detour that can be reversed at a later time.

There are two forms of this surgery where a bag may not be needed. Sometimes a rectal pouch can be created from the small intestine, forming a reservoir for the stool behind the stoma. A tube is put in place so the reservoir can be emptied when needed, usually once a day. In another procedure, all of the colon is removed except for the last part of the rectum, A pouch is created from the small intestine and it is attached to the rectum so liquid stool can pass normally through the anus (opening to the outside of the body) about 3 to 7 times a day.

After all of these surgeries, the stool consistency, amount, and frequency will depend on the type and amount of foods eaten. So, this diet is to help patients gain adequate control of their bowel movements.

Nutritional Facts

Generally, colostomy and ileostomy patients can easily maintain a balanced diet to provide all the vitamins, minerals and calories needed for good health. In those cases where certain foods have to be restricted to control stool patterns or stool consistency, the physician may prescribe a vitamin-mineral supplement.

Special Considerations

  1. Because each patient and type of surgery are different, no standard recommendations can be given for everyone. Most patients return to a fairly normal diet. Still, a trial and error pattern of eating is often necessary to identify those foods that may have an undesirable effect on the patient’s stool. Then it is simply a matter of changing how much of these foods are eaten. The lists that follow are a guideline.
  2. Eat foods at a regular time each day. Eating 4 to 6 smaller meals may help to promote a regular bowel pattern.
  3. Try eating the main dinner meal at noon and a smaller meal in the evening. This helps to reduce the stool output at night.
  4. Introduce one type of food at a time to test how it affects bowel function. If it does not produce a good result, stop eating it. However, as the body heals and adjusts, the offending food may become easier to tolerate, so try adding it to the diet again on several occasions before giving up on it.
  5. Chew foods completely to help the digestive process. Especially avoid swallowing large pieces of leafy vegetables since they can block the stoma opening on the abdominal wall.
  6. Fresh fruit may cause loose stool.
  7. Drink 2 to 3 quarts of water a day. This helps to keep the stool fluid, and it also prevents dehydration. Normally, the colon absorbs water and electrolytes (substances such as sodium and potassium) from the stool, so people who have all or part of the colon removed will lose more water. Because electrolytes are also lost, do not restrict salt in the diet.
  8. Maintain an ideal body weight. Extra fat in the abdominal wall can make it difficult for the stomach to function properly.
  9. Colostomy patients may find that foods which caused problems before surgery continue to do so afterward.
  10. During the first 4 to 6 weeks after surgery, ileostomy patients should limit foods that caused problems prior to surgery. This will reduce the chance of stoma blockage and lower the amount of gas.
  11. Certain substances can change the appearance of the stool. Bile that cannot be reabsorbed in the intestine can cause a yellow or green stool color, especially when diarrhea or rapid bowel action occurs. Beets make the stool appear red; it is not blood! Broccoli, asparagus, spinach, and Pepto-Bismol can darken, even blacken, the stool.
  12. Certain medications such as lmodium, Lomotil, Levsin, and Bentyl can help to slow the bowel when diarrhea is a problem.
  13. Foods containing large amounts of fiber and bran should be avoided for 6 to 8 weeks after surgery. After that time, certain bulking agents such as psyllium (Metamucil), methylcellulose (Citrucel), and calcium polycarbophil (FiberCon) may help firm the stool. Only certain patients need to have a firmer stool, so do not use these agents without the physician’s instructions.

Note: the information in this section is provided as a supplement to information discussed with your healthcare provider. It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.

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