Living with an ileostomy can seem daunting for many new patients, but when it comes to your diet, it doesn’t have to be.
“Construction of an ileostomy is often done in patients with ileal perforation who are very toxic, having gross fecal contamination, multiple/large perforation or unhealthy bowel.
Construction of an ileostomy inevitably results in an increased fecal loss of fluids and electrolytes with a reduction in total body water and has been interpreted as a state of chronic dehydration. In addition to this, these patients often have an inappropriate food intake and are frequently in negative energy balance leading to malnutrition, impaired immunity, and deranged bodily functions. Even a modest resection of the terminal ileum undertaken during the course of proctocolectomy decreased body weight largely because of a reduction in body fat. It is important for healthcare professionals involved in the care of patients with an ileostomy to appreciate that stoma surgery changes the body’s usual processes of nutritional absorption and excretion, so that informed support and advice on diet can be provided.
The construction of ileostomies in ileal perforations in the setting of ileal perforations prevalent in resource crunched developing countries bears a special attention as the morbidity is high owing to the existing disease process, sepsis, and malnourishment.
General surgeons usually find nutritional assessment very difficult especially in those undergoing emergency laparotomy and often omit this during the management of the patients.”1
“An ileostomy is made to treat problems that impairs the gastrointestinal system and that disable the definitive or temporary use of the other system segments in question. Frequently, an ileostomy’s confection is made for medical treatment, being needed to externalize one part of the small intestine, the ileus. The ileostomy is located on the right lower quadrant and there is no presence of sphincter that voluntarily controls the evacuation, so, a pouch is needed to store the intestine’s content. Depending on the disease’s etiology, the intestine’s stomas are classified regarding the permanence time in definitive or temporary. The temporary stomas are accomplished to protect an anastomosis and its closure occurs on a short period of time when the problem that led to its making is solved. On the definitive stomas, an intestine’s segment is removed and are produced when there is no possibility to reestablish the normal intestinal flow, usually in cases of cancer. About the indications for the accomplishment of an ileostomy, it is possible to highlight the colon and rectum cancer and the ulcerative colitis”2
“Ileostomy formation is occasionally required in patients with complicated inflammatory bowel disease requiring colonic resection. This procedure can lead to a number of recognized complications including stomal obstruction, stomal prolapse, skin erythema and ileal inflammation. A less commonly described complication is high output ileostomy which occurs when there is a disproportionate fluid and electrolyte loss through the stoma. In the first few days after ileostomy formation, there is frequently an increased stool effluent through the stoma, but this rapidly decreases because of ‘ileostomy adaptation’. The normal output through an ileostomy following a total colectomy is between 400 and 600 g of stools daily. In a high output ileostomy, stool output is more than 1,000 g daily, which can result in severe dehydration and electrolyte imbalance. While impaired ‘ileostomy adaptation’ has been used to describe the pathogenesis of high output ileostomies, there is now an increasing body of evidence suggesting that enteral infection with Clostridium difficile might contribute to the cause. While it is difficult to estimate the incidence of this complication, it is certainly an important issue which has a significant effect on patients’ quality of life and significant morbidity and mortality. Therefore adequate management of high output ileostomies is important. In this article we present a patient with a high output ileostomy and describe the physiological changes that are believed to occur and the recommended management issues of this important complication.”3
Although you should be careful with what you eat the first few weeks after your surgery, remember that your digestive system is adjusting to a new way of processing food. In no time, you’ll be able to eat all the foods you used to enjoy pre-surgery. Here are the top eight tips for healthy nutrition when living with ileostomy:
1. Go bananas
As children, we were often told that an apple a day will keep the doctor away; in your case, have a banana. Rich in potassium, bananas will help you restore potassium levels that are lost through your stoma. Bananas can also help harden loose stools, making you more comfortable.
“Potassium (K+) is an essential dietary mineral and major intra-cellular cation. It constitutes the main intra-cellular electrolyte and osmolyte necessary for fundamental processes such as membrane excitability, ion and solute transport or cell volume regulation. Homeostatic maintenance of plasma K+ is therefore a critical physiological function. Total body exchangeable K+, measured with the use of radioactive K, averages 46mEq/kg in men and 39mEq/kg in women. Only 1.5 to 2.5 percent of total body K+ (about 65mEq) is found in the extracellular fluid. Under conditions of a normal dietary K+ intake (80 to 100mmol per day), about 90 percent of dietary K+ is absorbed in the small intestine and an equivalent amount of the absorbed K+ is excreted mainly by the distal tubules of the kidney (about 90mmol per day). The contribution of the colon to net K+ absorption and secretion is trivial, and fecal K+ averages about 10mmol per day in healthy subjects.”4
2. Carry peppermint tea bags
Affordable, practical, and found in most stores, peppermint tea helps prevent gas. While nobody is immune to gas (and the embarrassment that comes with it), it is more frequent among patients living with a stoma. Peppermint tea or oil can help you cope and prevent discomfort.
“Peppermint tea is a delicious and refreshing way to boost your overall health in a number of ways, due to its ability to improve digestion, reduce pain, eliminate inflammation, relax the body and mind, cure bad breath, aids in weight loss and boosts the immune system. Its impact on the digestive system is considerable, and its base element of menthol is perhaps the most valuable part of its organic structure.”5“Peppermint has been traditionally considered to have carminative effects, generally used as tea or digestive tablet or candy. The exact mechanism is not known, but it is proposed that one way is the essential oils relax the esophageal sphincter, which then releases the gas. Essential oils used directly in the stomach, however, give many people heartburn, especially if hiatus hernia is present.
Peppermint is a plant. The leaf and oil are used as medicine. Peppermint is one of the most popular flavoring agents used for the common cold, cough, inflammation of the mouth and throat, sinus infections, and respiratory infections. It is also used for digestive problems including heartburn, nausea, vomiting, morning sickness, irritable bowel syndrome (IBS), cramps of the upper GIT and bile ducts, upset stomach, diarrhea, bacterial overgrowth of the small intestine, and gas. When peppermint is taken after a meal, its effects will reduce gas and help the digestion of food by reducing the amount of time the food is in the stomach. This is one reason after-dinner mints are so popular”6
3. Eat throughout the day
This is good advice for everybody, eating smaller portions during the day will help boost your metabolism. Eat heavier meals during the daytime, preferably lunch. Sleep well by keeping dinner light, as large meals before bedtime can increase stoma output.
4. Drink plenty of water
It is essential to keep hydrated throughout the day. Your body will release higher levels of fluids through your stoma and it is important for you to compensate by drinking water, at least 8 to 10 glasses a day. If you are one of those people that have a hard time remembering to regularly drink water, a good tip is to carry a water bottle with you; set a reminder every hour to keep you on track, or download an app (yes there is an app for that).
“To date, recommendations to drink water for weight management have primarily been motivated by evidence that drinking water can decrease energy intake (EI). While drinking water can lower energy intake, it does not always have this effect. Under some conditions, drinking water has no effect or even increases energy intake. Drinking water, furthermore, has heterogeneous effects on key intermediates besides energy intake, namely energy expenditure (EE) and fat oxidation (FO). If weight management recommendations and interventions do not specify conditions where drinking water lowers energy intake, increases energy expenditure and/or increases fat oxidation, null or negative effects of drinking water on weight change would not be surprising. Reviews of beverage effects, to date, offer limited insight regarding conditions that might optimize the effects of drinking water for weight management, as they are focused on summarizing the magnitude of effect across studies. Available reviews alert readers to significant between-study variation in effect size and outlier effects, but do not systematically evaluate factors associated with this heterogeneity. They suggest poor study quality, intervention setting or mode, young participant age and the timing of drinking water (delay times of 30–80 min between drinking water and meals) as potential reasons for null effects of drinking water and different hypotheses, research questions or parameters as reasons for inconsistent findings, without considering the determinants of weight change, such as background diet and/or activity conditions. Further research is needed to determine if, what and how background study conditions modify drinking water effects”7
5. Introduce new foods gradually
All bodies are different, what sits well with you may not sit well for somebody else. Were you able to eat broccoli, cabbage, and other gassy foods before your surgery? You may still be able to enjoy them post-surgery, just make sure to incorporate these foods one at a time into your diet. This way, if you experience any discomfort you can easily identify which food is best to avoid. It’s recommended to keep a simple and bland diet for the first few weeks after your surgery to give your body time to adjust and then slowly add new foods to your diet. You will quickly learn that living with Ileostomy is not tantamount to boring tasteless meals.
6. Pass the salt, please
Yes, salty foods are actually good for you if you are an ileostomy patient. Add a bit more salt to your diet to help you recover the sodium loss from your stoma. Carry a bag of pretzels to satisfy salty cravings; it will also help you thicken loose output.
7. Yogurt is your new super-food
Yogurt can help you control gas, harden stools, and prevent unpleasant smells. “The nutrient composition of yogurt is based on the nutrient composition of the milk from which it is derived, which is affected by many factors, such as genetic and individual mammalian differences, feed, stage of lactation, age, and environmental factors such as the season of the year. Other variables that play a role during processing of milk, including temperature, duration of heat exposure, exposure to light, and storage conditions, also affect the nutritional value of the final product. In addition, the changes in milk constituents that occur during lactic acid fermentation influence the nutritional and physiologic value of the finished yogurt product. The final nutritional composition of yogurt is also affected by the species and strains of bacteria used in the fermentation, the source and type of milk solids that may be added before fermentation, and the temperature and duration of the fermentation process.”8
8. Properly chew your food
Eating should be one of life’s biggest pleasures. Eat slowly, savor the flavors! By chewing each mouthful 20 times, you can prevent blockage in your stoma.
“The formation of intestinal stomas, mainly ileostomy and colostomy, has become an integral approach to the surgical management of several pathologies of the gastrointestinal tract – in both the emergency and elective patient. The basic underlying principle is that fecal flow is diverted away from the site of the pathology, by bringing an end or a loop of bowel, through the anterior abdominal wall. Either in a temporary capacity or permanent role stomas can reduce morbidity and mortality associated with several conditions of the gastrointestinal tract such as perforated colon, inflammatory bowel disease, bowel obstruction and elective cancer operations, for example a low anastomosis in an anterior resection of rectum. It has to be appreciated though that stomas are not without their own set of complications, both in the early and late phases. Initial concerns can be due to ischemia of the bowel forming the stoma, stomal retraction and obstruction through to later complications such as parastomal hernia formation, stomal prolapse and peristomal skin changes.”9
(1) Mohil, R. S., Narayan, N., Sreenivas, S., Singh, N., Bansal, A., & Singh, G. J. (2012). Challenges of Managing Emergency Ileostomy: Nutrition—A Neglected Aspect. ISRN Emergency Medicine, 2012. Available online at https://www.hindawi.com/journals/isrn/2012/968023/
(2) Queiroz, C. G., Freitas, L. S., de Medeiros, L. P., Melo, M. D. M., de Andrade, R., & Costa, I. K. F. (2017). Caracterización de ileostomizados atendidos en un servicio de referencia de ostomizados. Enfermería Global, 16(46), 1-36. Available online at http://scielo.isciii.es/pdf/eg/v16n46/en_1695-6141-eg-16-46-00001.pdf
(3) Azzopardi, N., & Ellul, P. (2011). Proton pump inhibitors in the management of tachypnoea following panproctocolectomy: a case of high output ileostomy. Case reports in gastroenterology, 5(1), 212-216. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088751/
(4) Kononowa, N., Dickenmann, M. J., & Kim, M. J. (2013). Severe hyperkalemia following colon diversion surgery in a patient undergoing chronic hemodialysis: a case report. Journal of medical case reports, 7(1), 207. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3765186
(5) Salamon, I. (2016, November). Herbal teas from different origin and their essential oil composition. In International Symposia on Tropical and Temperate Horticulture-ISTTH2016 1205 (pp. 539-546). Available online at https://www.researchgate.net/publication/327053878_Herbal_teas_from_different_origin_and_their_essential_oil_composition
(6) Ahmed, E. M. S., Soliman, S. M., & Mahmoud, H. M. (2012). Effect of peppermint as one of carminatives on relieving gastroesophageal reflux disease (GERD) during pregnancy. Journal of American Science, 8(4). Available online at http://www.jofamericanscience.org/journals/am-sci/am0804/017_8600am0804_132_143.pdf
(7) Pine, J., & Stevenson, L. (2014). Ileostomy and colostomy. Surgery (Oxford), 32(4), 212-217. Available online at https://www.surgeryjournal.co.uk/article/S0263-9319(14)00020-9/pdf
(8) Adolfsson, O., Meydani, S. N., & Russell, R. M. (2004). Yogurt and gut function. The American journal of clinical nutrition, 80(2), 245-256. Available online at https://academic.oup.com/ajcn/article/80/2/245/4690304
(9) Stookey, J. (2016). Negative, null and beneficial effects of drinking water on energy intake, energy expenditure, fat oxidation and weight change in randomized trials: a qualitative review. Nutrients, 8(1), 19. Available online at https://www.mdpi.com/2072-6643/8/1/19