Diet with a stoma: what really matters

Key facts at a glance

• With an ileostomy, liquid stool is normal – it is not diarrhoea
• Drinking less does not help. It does not thicken the stool and can damage the kidneys
• With a colostomy, mainly the emptying changes, not nutrient absorption
• With a urostomy: around 1.5 litres spread over the day, otherwise no special diet
• Some medicines need to be switched because they are no longer absorbed properly

“What am I still allowed to eat?” is the most common question after stoma surgery. The answer depends less on lists of forbidden foods than on where the bowel was diverted. This article follows the account of the German ILCO.

The difference everything depends on

In the small intestine, proteins, fats, carbohydrates, fluid, vitamins, minerals and trace elements are absorbed. In the large intestine, mainly water is extracted from the stool.

• Colostomy – diversion of the large intestine. Nutrient absorption is largely preserved; mainly the emptying of stool changes.
• Ileostomy – diversion of the small intestine. Depending on which section is bypassed, certain deficiencies arise.
• Urostomy – diversion of urine. The digestive tract is not affected.

Ileostomy: the two most important points

Liquid stool is normal

The stool consistency remains permanently liquid to pasty, emptying frequent. Eating and drinking reflexively trigger bowel movements and thus emptying via the stoma.

The ILCO makes it expressly clear: this is normal and not diarrhoea. Anyone who treats it as such is fighting something that is not a disorder.

Drinking less is the wrong way

The obvious idea – drink less so that less comes out – is dangerous:

“Restricting fluid intake does not thicken the stool in an ileostomy and can damage the kidneys.”

The body permanently loses a lot of fluid and nutrients through an ileostomy. This is compensated by drinking more and targeted supplementation – not by economising.

Deficiencies need to be monitored

Which deficiencies arise depends on which part of the small intestine has been bypassed. They have to be detected by regular laboratory tests and compensated in a targeted way. With an ileal conduit, in which the last part of the small intestine was used, the vitamin B12 status in particular should be checked.

Building up the diet after surgery

The diet is built up in stages, and as quickly as possible:

1. Clear fluids – mild tea, water, clear broth
2. Easily digestible, cooked foods, lactose-free, low-fat, low-fibre – rusks, white toast, oat gruel, mashed potato, lean cold cuts, low-fat quark
3. Increasing calories, protein, fat and fibre

In uncomplicated procedures, stage 3 is reached by discharge. Then follows the stabilisation phase: several weeks for a colostomy, several months for an ileostomy. During this time the remaining bowel builds up a higher digestive capacity, and tolerated foods are gradually chosen from all food groups until a light full diet is reached.

With an uncomplicated course, the function of the small intestine and the ileostomy should have stabilised after about two months.

The point that is often forgotten: medicines

Tablets, coated tablets and capsules are absorbed in the small intestine. After ileostomy surgery it may be necessary to change the dosage form with the treatment team:

• from slow-release or gastro-resistant tablets to normal tablets
• partly from oral form to injections
• for contraception, from the pill to hormone patches or injections

Anyone who does not discuss this may be taking medicines that no longer work properly. With contraception this has particularly serious consequences.

Urostomy

Here the most important recommendation is simply: about 1.5 litres of fluid, spread over the day. With normal kidney function there is no special diet because of the changed urinary diversion.

What this means for everyday life

• No general lists of forbidden foods. Tolerance is individual and changes during the stabilisation phase.
• Try out for yourself what agrees with you – that is the ILCO's advice, and try new things cautiously at first and preferably one at a time, otherwise you will not know afterwards what it was.
• Chewing well makes digestion easier, especially with fibre-rich food.
• Good nutritional status and normal body weight support recovery and prevent complications.

Frequently asked questions

Do I have to avoid fibre?

In the adjustment phase after surgery, the diet is deliberately low in fibre. After that, fibre is increased step by step. Permanent avoidance is not intended.

Why does something come out right after eating?

Eating and drinking reflexively trigger bowel movements. With an ileostomy this leads to emptying – normal and not a sign of intolerance.

Do I need supplements?

With an ileostomy possibly yes, depending on the laboratory results. This should be medically supervised, not done on your own initiative.

How does diet affect stoma care?

The amount and consistency of the output help determine how long a baseplate lasts. More on this in our article on one-piece and two-piece systems.

Your next step

We stock one-piece and two-piece systems, drainable and closed bags and urostomy bags from Coloplast, Dansac, Hollister and B. Braun. With a prescription, we handle the coordination with your health insurance fund.

Sources

• Healthy eating for people with a stoma, Deutsche ILCO e.V. (in German)
• Diet after stoma or bowel cancer surgery, Deutsche ILCO e.V. (in German)