Who likes to eat?!  You can still do that with an ostomy! If you have an ileostomy or colostomy, you probably know it affects your digestive system.  What you may not know (or believe), is that after you’re healed, it doesn’t have to affect what you eat.

Key things to remember to encourage a good eating experience:

  1. CHEW THOROUGHLY
  2. Pay attention to quantity and food combinations. If you’re trying a new food, try a little at a time to see how your body reacts.
  3. Track what you’re eating, so if you have a problem, you have a clue what caused it.
  4. Explore the tabs below to educate yourself about the mechanics of digestion with an ostomy and see some post-op food ideas!

 

A urostomy doesn’t affect your digestive system, so if you have a urostomy you can continue to follow the same diet you were on before surgery. One thing to note is that certain foods can change the odor and/or color of your urine. Remember to hydrate!

With an ileostomy and colostomy you can work your way up to eating almost anything you could eat before your surgery. Everyone’s body is different – what is easily digested by one person might not go through so easily in another, so trial and error is a big part of learning to live and eat with an ostomy. That said, there are a few foods that are known to cause blockages that many ostomates avoid or consume only in very small amounts (ex. nuts and popcorn). It can be a little overwhelming to follow a special diet (gluten free, vegetarian, vegan) along with the low residue/ostomy diet right off the bat after surgery but don’t be discouraged. There are a number of gluten free and vegan people with ostomies who have managed (and continue to thrive).

The United Ostomy Association of America has some great information about nutrition including generalized dietary guidelines, an ostomy food chart, and other helpful information for ostomates. Check out the UOAA’s nutrition guide .

Your doctor or hospital dietitian may have instructed you to follow a “low residue” diet, or gave you a list of high fiber foods that you should avoid for at least the first couple weeks or months after surgery, but that does not mean it’s easy to figure out what to eat! It’s hard to get all the nutrition you need when you’re following a low residue diet, and easy to get bored with a bunch of bland foods. Thankfully the low residue diet is only recommended in the beginning and you can start adding new foods to your diet slowly once your inflammation goes down. Here’s the National Library of Medicine’s information on low residue diets.

When trying a new food, take it slow, chew a ton, and hydrate. Try not to add multiple new foods in a day so that you can tell better what your body likes and what it doesn’t. While on the low residue diet, I tried to get the nutrition from fruits and vegetables through pureed soups, well-blended smoothies, and juices. I didn’t add any foods on the “foods that may cause blockages” lists to my diet until after 8 weeks post-surgery and my swelling was pretty much gone.

Each food you consume can affect whether your output is thicker or more liquid. Certain foods can affect the odor of your output more strongly as well. Your housemates and house guests might appreciate you using a bathroom spray to neutralize the odor you leave after you empty your pouch. For more information about odor, what foods affect it, and options to neutralize it, visit this page.

Remember to chew everything thoroughly; the foods with high fiber that you might try adding down the line (like nuts) will come out the same size they were swallowed and can bind together in your stomach if you eat too much at once.

Eat soluble fiber to help the insoluble fiber go through. My background isn’t in nutrition, but one thing I’ve learned since my surgery is the difference between soluble and insoluble fiber and how it can affect digestion with an ostomy.

In the simplest terms, soluble fiber gets broken down in water throughout your digestive system. As it’s broken down, it turns into a gel, which traps the sugar, cholesterol, and fats and slows digestion and absorption as the food passes through your GI tract. This sounds bad, but it’s actually really important and saves you from a crazy sugar rush (controls your glucose levels), helps regulate your weight, and can lower cholesterol.

Insoluble fiber (nuts, lettuce, etc) does not get broken down any further than your teeth break it down so once it’s swallowed, that’s it. That is the single most important thing to remember about food with an ostomy, and it’s the reason it’s so important to really chew your food. If you eat insoluble fiber all by itself, it can get stuck at the exit of your ostomy causing a blockage. If you eat some soluble fiber just before and/or with the insoluble fiber, it can help break up the insoluble fiber some so it’s not all clumped together as it moves through your intestine(s). Many fiber foods have both types of fiber in them. For example, the skins of fruits are insoluble, while the insides are typically soluble.

Fiber Infographic from the National Fiber Council

Courtesy of National Fiber Council

I learned about fiber digestion the hard way, twice. The first time was with almond meal pancakes. Almonds are nuts and while almond meal is small enough to make it out, when you eat a lot of it and don’t consume enough liquids or soluble fiber to help it move along, it starts to pile up. Think of a lot of cars on a 5 lane highway trying to merge onto a 2 lane road – there’s going to be a backup. The almond meal pancakes resulted in a partial blockage two days before Christmas. Ouch. You can read my blog post about it. The second time was with spaghetti squash, which I had successfully consumed previously, and have since consumed, without issue. On the night it was an issue, all I had for dinner was two servings of spaghetti squash with some olive oil and maybe a little tomato. I chewed, but the spaghetti squash didn’t get broken down any further than I chewed and didn’t have any other soluble fiber to join up with so it piled up and gave me another partial blockage. On other spaghetti squash occasions, I’ve had it as a side dish accompanied by other foods and other than seeing little bits of it in my bag, it hasn’t been an issue.

 

This is especially true for ileostomates, because with an ileostomy there is no colon to absorb water leaving you with more liquid output, which can lead to dehydration. It doesn’t have to be just water you drink! In fact, drinking ONLY water can still lead to dehydration, or at least an electrolyte imbalance because it can flush right through you. Mix it up, getting your liquids from teas, soups, popsicles, fruits, veggies, electrolyte drinks, etc. Doctors often suggest gatorade for hydration because of the electrolytes, but there is so much sugar in gatorade that it could be counterproductive in the long run. It’s worth researching good electrolyte replenishing drinks/mixes that are lower in sugar. Learn why dehydration is a risk for ostomates.
In general (and especially for ileostomates), chewable, liquid, or sublingual vitamins are easier to digest. Coated tablets and time-release capsules aren’t always digested in the small intestine and can come out whole. Let your pharmacist know that you have trouble digesting the above mentioned medicines to see if they have them in different form. If they only come in tablets, the UOAA suggests crushing them between two spoons and mixing them with water to take them. It will probably taste horrible but at least it will be absorbed. With capsules, you can usually open them and consume them with water or in applesauce, yogurt, or another smooth food you enjoy. Talk to your doctor before crushing any tablets or opening any capsules.

Different parts of your bowel absorb different nutrients. The more bowel you have, the more likely it is that you will be able to absorb all the vitamins and minerals you need.  People with ileostomies and those who have short bowel syndrome are more likely to need to supplement with vitamins to ensure they’re getting proper nutrients.  A typical ileostomy is a stoma made using the ileum part of the small intestine, so it is possible that an ileostomate will need to supplement Vitamin B12, K, Fats, Potassium, Salts or water intake.  It wouldn’t hurt to ask your doctor to run your bloodwork and ask them about supplementing some vitamins if you are concerned about how well your body is absorbing nutrients. Here’s a handy absorption chart to display which part of the bowel is responsible for absorbing which vitamins and minerals.

Bowel Vitamins & Minerals Absorption Chart

Courtesy of the UOAA Ostomy Nutrition Guide

Immediately after surgery is the hardest, because it’s a good idea to follow a low residue diet (and no, you probably shouldn’t stick to ice cream and cake, even though they’re okay foods!). This was really overwhelming for me. I wanted to be healthy but I was so scared about what I’d be able to pass through my ostomy (and my dietician at the hospital didn’t ease that fear or explain very well). I printed out the UOAA Ostomy Food Reference Chart and put it on my fridge for easy reference, then I tracked what I ate the first couple weeks in hopes to inspire you:

  • Bagel with cream cheese or peanut butter (creamy only!)
  • Sourdough bread with honey and/or butter (my favorite)
  • White bread/toast with jelly (no seeds, though after the inflammation goes down, a little seedy jelly would be worth trying to see if your body tolerates it)
  • Eggs (scrambled or over easy)
  • Greek Yogurt
  • Cheerios
  • Pancakes, french toast, or waffles (not whole grain) with maple syrup
  • Green smoothie (there are so many variations, it really depends on your taste preferences)
  • Cheese quesadilla with sourcream, tabasco and avocado (and sometimes chicken)
  • Carrot Ginger Soup (from a box, so it was all pureed, no chunks)
  • Pureed butternut squash soup
  • Pureed carrot and sweet potato soup
  • Tomato Soup (homemade from garden tomatoes, with the seeds and skins strained out)
  • Pasta with Alfredo Sauce and small pieces of soft chicken
  • Mashed potatoes (no skins)
  • Salmon
  • White rice
  • Baked chicken
  • Cheese Ravioli
  • Butternut squash ravioli
  • Ice cream
  • Brownies
  • Chocolate chip cookies
  • Cheesecake

(the list goes on and on and on, but try not to go crazy!)

  • Potato Chips
  • Saltines
  • Hummus and crackers
  • Canned Peaches & Cottage cheese
  • Smudgies (frozen graham cracker, banana, peanut butter sandwiches)

Anything, really, as long as it doesn’t have a pulp or seeds in it.

Be warned that for some, carbonation causes increased gas (which can be loud, and cause your ostomy pouch to expand).

Coffee and other caffeinated beverages can run right through you and increase the liquidity of your output and risk for dehydration.

Alcohol can increase your output and risk for dehydration too. If the carbonation turns out to be a problem for you, you may want to be careful with beer.

In order to make sure you’re getting enough nutrients, it wouldn’t hurt to include smoothies or juicing in your diet. I’ve noticed that the quantity of my output increases a lot when I have greens in my smoothies, a small price to pay for getting some vitamins in me!