Dietetics - Eating with a new Ileostomy

An ileostomy is a type of stoma that is created through surgery. Your ileum (a part of your small bowel) is brought out to form an opening on the surface of your skin to divert your faeces (food waste) out of the body.

Having an ileostomy means that the undigested food leaves the body before getting to the large bowel, which is where most of our water and salts are absorbed into the body. This means that your ileostomy output can be looser in consistency (porridge-like) rather than a formed stool.

As your body isn’t getting to absorb as much water and salt, it's important that you take care to avoid becoming dehydrated.
Signs of this can include feeling thirsty or feeling dizzy/ lightheaded. You may also notice that you are passing less urine or have urine that is darker in colour.

Eating Behaviours

Adopting good eating behaviours may help to relieve some problems you may experience with having an ileostomy such as excessive wind, increased odour, or high stoma output. Some tips are listed below:

• Eat regular meals: long breaks between meals may increase stoma action after meals. Try eating smaller meals more regularly throughout the day and avoid overeating at any one meal
• Eat Slowly: Digestion starts in your mouth. Make sure you sit down, take your time with meals, and chew your food well
• Stay Hydrated: You may have been advised to follow a fluid restriction by your clinical team and if this is the case, then it is important you comply with this. Otherwise aim for around 1500-2000mls (about 10-12 cups) fluid per day. Try not to drink whilst eating, instead have a drink half an hour before or after your meal. Avoid drinking through a straw as this may increase symptoms of wind

We recommend you follow a diet low in fibre for the first 6-8 weeks after your ileostomy has been formed. Foods high in fibre can be difficult to digest, so they could increase your output. There is also a risk of undigested fibrous foods causing a blockage or inflammation in your stoma. Below are some examples of foods which we recommend to choose, and to avoid.

Food to choose and avoid

Starchy foods

Low fibre - eat freely

• Peeled potatoes (roast, boiled, mashed, chips, jacket potato without skin)
• White pasta, cous-cous, rice noodles
• White breads, bagels (without seeds), tortilla wraps, chapatis, naan breads, pitta made with white flour
• Crumpets, potato cakes
• Cream crackers, Ritz style crackers, rice crackers
• Cakes and scones, brioche, croissants, pancakes made with white flour
• Biscuits made with white flour (rich tea, custard cream, bourbons, shortbread)
• Low fibre breakfast cereals (cornflakes, rice krispies, frosties, sugar puffs, coco-pops)

High fibre - restrict these

• Jacket potato with skin, boiled potato with skin, potato wedges with skin
• Brown; rice, pasta or noodles, bulgar wheat or wild rice
• Brown/wholemeal/seeded breads or crackers
• Cakes and pastry made with brown flour and that contain dried fruit and/or nuts
• Wholegrain cereals (Weetabix, shredded wheat, muesli, porridge oats)

Fruit

Low fibre - eat freely

• Peeled fresh fruit (pears, peaches, apples, bananas, melon, mango, lychees)
• Stewed peeled fruits (apples, plums)
• Tinned fruit (peaches, pears, apricots, mandarins)
• Smooth fruit juice - up to 150mls twice daily

High fibre - restrict these

• Dried fruit, (figs, prunes)
• Fruit with skins on (apples, grapes, blueberries, plums)
• Fruit with seeds (all berries, passionfruit, kiwi, pomegranate)
• Fruits with pith (oranges, satsumas, grapefruits)
• Coconut

Vegetables

Low fibre - eat freely

• Peeled and de seeded cucumber, courgette, marrow, aubergine, roasted pepper and tomato
• Well-cooked heads of broccoli or cauliflower
• Passata or tomato puree
• Peeled and well-cooked vegetables (swede, carrot, parsnip, sweet potato, pumpkin, butter nut squash beetroot - note this may turn your output red)
• Garlic puree, onion or garlic salt, finely chopped herbs

High fibre - restrict these

• Salad vegetables (lettuce, lambs’ lettuce, watercress, curly kales spinach and other salad leaves)
• Pickled beetroot and olives
• Peas and sweetcorn
• Garlic, onion, celery, mushrooms, asparagus, pack choi, bean sprouts, cabbage, fennel, okra, artichokes, Brussel sprouts)
• Pulses (lentils, green beans, chickpeas, baked beans and other types of beans)

Dairy products

Low fibre - eat freely

• Milk, (fresh, evaporated or condensed)
• Cheese (including cottage cheese, cream cheese, cheese spreads)
• Smooth yoghurt with no bits, plain yoghurt, fromage frais
• Cream, crème fraiche, ice cream

High fibre - restrict these

• Yoghurt, cheese, ice cream containing pieces of real fruit or nuts
• Milkshake made with fresh fruit

Meat, fish and alternatives

Low fibre - eat freely

• Meat (beef, lamb, pork)
• Poultry (chicken, turkey)
• Fish (white fish, salmon, tuna)
• Eggs (boiled, scrambles, poached or fried)
• Tofu
• Sausage rolls, meat pies (made with white flour)

High fibre - restrict these

• Beans (including baked beans)
• Lentils
• Nuts
• Seeds
• Quorn
• Pie or pastries made with wholemeal flour

Miscellaneous

Low fibre - eat freely

• Jams, and marmalade without seeds or skins
• Marmite, smooth nut butters, lemon curd and honey, treacle, syrup
• Plain or milk chocolate
• Condiments (tomato ketchup, brown sauce, soya sauce, mayonnaise)
• Stock cubes
• Boiled sweets, jelly babies fudge, mints (in small quantities)

High fibre - restrict these

• Chocolate with dried fruit or whole nuts or seeds
• Popcorn
• Marmalade or jams with seeds or shreds
• Crunchy nut butters

Reintroducing foods

After 6-8 weeks you may wish to reintroduce small amounts of fibre back into your diet. Be aware that some of these foods can carry a blocking risk and therefore should only be eaten if well cooked, chewed well and in small portions. We recommend that you start with foods containing soluble fibre as these are easier to digest. These foods include porridge oats, banana and root vegetables. Add these in small amounts starting at one mealtime a day and increasing as your symptoms allow. If your output becomes more watery or loose, decrease your fibre intake and retry again in a few weeks.

Food such as sweetcorn, peas, nuts, seeds and mushrooms should always be avoided as these pass through the bowel undigested and can carry a potential blockage risk.

In the longer term you can aim for a healthy, balance diet including food from each of the foods from groups; carbohydrates, fruits and vegetables, protein, dairy and fats.

If you would like any further information, please ask your GP or contact your dietitian.

Common problems and solutions

You may find that certain foods cause problems such as wind, loose or watery output or excessive odour.

This can vary for different people, so it’s best to adapt to your own diet according to tolerance. Remember that stress, lifestyle changes and medications can also affect your stoma output. You may find the following tips useful:

• Excessive Odour: Potential trigger foods include cucumber, eggs, fish, onions and garlic. Try having buttermilk, parsley, natural yoghurt and peppermint to help with the odour
• Watery Output: Potential triggers include excessive alcohol, fatty foods, fish, sugary and fizzy drinks, fruit or fruit juice, garlic and onions, spicy foods and caffeine. Foods such as banana, cheese, mash potato and starchy foods such as white bread, rice, pasta, crackers, biscuits and cakes may help to thicken your output
• Wind: Potential trigger foods include green leafy vegetables, onions, garlic, pulses, fizzy drinks, beer/lager and chewing gums. Peppermint oil or tea can help reduce wind

Hot Weather and traveling abroad

As well as the salt that you lose from your ileostomy, sweating is a further way in which the body loses salt. It is important therefore that in hot weather, when you are exercising or on holiday in a hot country, that you should replace your salts by increasing your intake of salty foods. Some examples are.

• Bacon, ham, sausages or tinned meat products
• Hard cheeses
• Marmite
• Bovril or Oxo
• Tinned or cup a soup
• Crisps
• Sprinkle salt onto your food to help replace salts lost

Top Tips

• Eat slowly and chew your food well
• Try to avoid drinking large amounts of fluid before, during or after meals
• Use garlic puree, or onion salts as well as herbs instead of having spicy foods to increase the flavour of foods
• Starchy carbohydrates may help to thicken up your output - make sure they are low fibre choices such as white bread, white rice or pasta or potatoes (peeled)
• You may find that having more frequent small meals is better tolerated than three large meals, especially if you have a smaller appetite
• Try to include foods from each of the food groups on the eat well plate as its important to have a well-balanced diet
• You may need a vitamin or mineral tablet daily, but this should be discussed and decided by your medical team or dietitian. Please tell us if you are having any over the counter vitamins/ minerals or herbal remedies

What to do if your output is high

If your output is consistently over 1200mls daily, becomes looser and increases in volume, or you experience symptoms such as cramps, fatigue and excessive thirst, you should contact your doctor or stoma nurse for further advice.

Contact Detail

If you would like any further information please contact your local stoma team, dietitian or GP.

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