Eating with an Ileostomy

Patient Experience

  • Reference Number: HEY-1383/2023
  • Departments:
  • Last Updated: 31 July 2023
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Introduction

An Ileostomy is made by surgically bringing part of your small bowel (ileum) through your abdominal wall, to form an opening on the surface of your skin.

Now you have an ileostomy, digested food will no longer enter the large bowel (colon).  The colon’s main role is to absorb salts and fluid; therefore, your stools may be looser than before.

It takes time for your stoma to function and the output can be watery and high in volume at first.  Over time, your ileum will adapt and the output should reduce.  The consistency is usually similar to porridge, however everyone is different and output may vary throughout the day.

The aims of this diet sheet are:

  • To advise on healthy eating habits with an Ileostomy
  • To help you deal with common stoma issues
  • To provide dietary advice if your appetite is poor

What to expect post-operatively

Initially you may experience a more liquid output from your ileostomy.  During this time, you may lose more fluid and salts than is normal, and therefore are at risk of becoming dehydrated.  To prevent this, you should ensure that you have an adequate fluid and salt intake:

  • Aim for at least 6-8 cups/glasses/mugs of fluid per day (1½ to 2 litres) including water, tea, coffee and squashes.
  • Add extra salt to your meals. Half to one teaspoon of salt spread evenly throughout the day should be adequate.

Over time as your ileum adapts, your stoma output will thicken.

If your output is classified as a high output i.e. over a litre per day, you may be commenced on medicines to slow the output and may be advised to take an electrolyte solution to help maintain hydration and salt levels.

A low fibre diet may help with symptom management in the adaptation stage.

What foods are high and low in fibre

Food Group Low in Fibre High in Fibre
Meats All other meat products: lean, well cooked meats may be best tolerated. Meat products made with wholemeal pastry, breaded meat products.  Processed products and meats high in fat may make diarrhoea worse.
Fish All other fish products Fish products made with wholemeal pastry, breaded fish products.  Oily fish such as mackerel, sardines may make diarrhoea worse.
Dairy Products Plain yoghurt, cheese, milk, eggs, margarine, butter, custard. Yoghurts containing fruit pieces, cereal, added fibre or nuts.

Cheeses containing fruit or nuts.
Puddings Milk puddings, Ice cream, Jellies, Meringue, Fruit crumble, plain sponges, Custard. Puddings made with wholemeal flour or dried fruit.
Drinks Tea, coffee, milkshakes, milk, hot chocolate, fruit squashes, fruit juice without bits Pickles, highly spiced foods, chocolate or sweets containing fruit or nuts, nuts.
Other Oils, smooth soups and sauces, jam with no bits, honey, shredless marmalade, boiled sweets, chocolate, toffee, crisps. Pickles, highly spiced foods, chocolate or sweets containing fruit or nuts, nuts.

Fruit

Where possible avoid skins and seeds. Try small portions initially to assess tolerance. The guide below outlines fruits lower in fibre.

  • Tinned fruits such as pears, peaches, mandarins, lychees
  • Mango
  • Melon
  • Ripe bananas
  • Peeled apples, pears

Please note dried fruits, coconut and pineapple should be avoided due to their high fibre content and potential to cause a blockage.

Vegetables

Where possible avoid skins, seeds and stalks.  Try small portions initially to assess tolerance.  The guide below outlines vegetable lower in fibre:

  • Well-cooked carrots, swede, squash
  • Courgettes
  • Aubergines
  • Boiled spinach
  • Well-cooked cauliflower and broccoli

Please note salad vegetables, peas, beans, sweetcorn, mushrooms, celery, Chinese vegetables (e.g. bean sprouts, bamboo shoots) should be avoided due to their high fibre content and potential to cause a blockage.

All potato varieties are suitable on a low fibre diet provided the skin is removed.

What to do if your appetite is reduced after surgery

Following your surgery, you may experience a reduction in your appetite.    If this is the case, the following measures may help:

  • Eating small amounts more frequently
  • Fortifying meals with foods high in calories such as full cream milk, cream, cheese, butter, jam, sugar.
  • Ensuring protein rich foods are included at each meal to aid healing these include meat, fish, cheese, milk, yoghurts and vegetarian alternatives such as Quorn, Tofu and tempeh.
  • Including high calorie snacks such as biscuits, cakes, crisps, cheese and biscuits, yoghurts, mousses, milk puddings.
  • Including nourishing drinks such as milk and milkshakes.

If you are struggling to meet your requirements with food, alone your medical team/dietitian can prescribe nutritional drinks/products to increase your intake.

What to eat post surgical recovery

Once your ileostomy is active and you are confident with its function, you should be able to reintroduce food with the aim of a healthy balanced diet as outlined in The Eatwell Guide.

 Fruit and vegetables (Green Section) 

  • Excellent source of vitamins and minerals
  • Aim for five portions per day, 1 portion = 80g
  • If some fruit and vegetables upset you aim to stick to lower fibre varieties

Starchy Foods (Yellow Section)

  • Provide energy, vitamins and fibre
  • Includes breads, breakfast cereals, potatoes, rice, pasta and other grains.
  • Should make up a third of what you eat and be the basis of each meal.
  • Starchy foods are reported to help thicken stool and reduce bowel frequency.

Beans, pulses, fish, eggs, meat and other proteins (Pink Section)

  • A good source of protein, vitamins and minerals
  • Aim for 2 portions of fish per week if eaten– 1 oily, 1 white

Dairy and alternatives (Blue Section)

  • Great source of calcium, protein and vitamins
  • Some bowel conditions increase the risk of bone thinning and as such a daily calcium intake of 700mg is recommended
  • If you are using dairy alternatives check they are fortified with calcium 

Oils and Fats (Purple Section)

  • Try and choose healthier unsaturated fats usually from plant sources e.g. rapeseed oil, sunflower oil or olive oil
  • Use in sparing amounts

Foods rich in fat, salt and sugar

  • Includes foods such as cakes, biscuits, crisps, chocolate, confectionary, butter and ice cream
  • Enjoy as a treat in small amounts. 

Fluids

  • Aim for 6-8 glasses/cups or mugs per day

Foods and associated symptoms

Some foods can be associated with bowel symptoms.  Please be aware that this can be very individual and what affects one person may not affect another.  If you are unsure about a food try in small amounts to assess tolerance.

Symptom Associated Foods
Stoma blockage (important to chew well) Beans, peas and lentils, sweetcorn,

mushrooms, pineapple, coconut, celery, fruit and vegetable skins, seeds, nuts, dried fruit and Chinese vegetables such as beansprouts and water chestnuts
Wind, bloating and gas Brussel sprouts, cabbage, broccoli, cauliflower, beans and pulses, onions and garlic, leeks, chewing gum, fizzy soft drinks,  beer, lager, sparkling wines
Decreased stools Bread, pasta, rice, potato, banana, tapioca, jelly babies, marshmallows
Excessive odour Fish, onions, garlic, eggs, brussel sprouts, cabbage, broccoli and cauliflower

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Dietetic Department on tel no: Hull Royal 01482 674490 Castle Hill: 01482 461941, Queens Centre: 01482 461135

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

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