What can I eat now that I have a stoma?

20 March 2024
What can I eat now that I have a stoma?

Jennie Burch explores the available resources guiding ostomates on their diet and offers nutritional advice

A common concern among people with a stoma is what they can eat, and they often seek advice from their specialist stoma nurse. Unfortunately, there is little research to guide the nurse on this topic. Most advice is common sense and passed on by patients. This StomaTips article presents a few ideas that can help you understand what you can have to eat and drink once you have a stoma formed. It will provide some general information for all people living with a stoma. There will also be some specific information about diet and fluids
relevant to the three different types of stoma.

The three main stoma types

There are three main output stomas. Two will pass poo and wind and one will pass urine. A colostomy is formed from the colon (large bowel) and will pass formed poo and wind. An ileostomy is formed from the ileum (small bowel) and will pass poo and wind. A urostomy or ileal conduit will pass urine. The stoma types are explored more later.

A healthy diet

It can be useful to think about what makes a healthy diet. To help understand what foods should be part of a healthy diet, the government have developed the Eatwell guide (for more information go to https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/the-eatwell-guide/). The Eatwell guide includes guidance for eating a variety of different foods such as fruit, vegetables, starchy foods, proteins, milk and dairy foods, fats and sugars, as well as fluids.

The Eatwell guide recommends people eat five portions of fruit and vegetables each day. The guidance suggests that fruit and vegetables should make up about one-third of food eaten each day and should include a variety of each type. Fruit and vegetables are available in different ways such as fresh, frozen, tinned, dried or juiced. Fruit and vegetables are needed by the body as they are a good source of vitamins, minerals and fibre.

Read also: Eating plant-based: how to follow a vegan or vegetarian diet with a stoma

Starchy foods include potatoes, bread, rice and pasta. Starchy foods can be wholewheat pasta or brown rice which include more fibre than white pasta and white rice. Starchy foods provide the body with energy as well as other nutrients which are needed for health.

Proteins include beans, lentils, meat and fish. Proteins should be lean, without too much red meat or processed meats, such as bacon. For people who eat fish, it is recommended to have two or more portions each week and include oily fish such as salmon, mackerel or sardines. Proteins are needed by the body to repair your cells as well as to make new cells.

Milk and dairy foods include cheese, yoghurt and soya alternatives. Milk and dairy foods contain proteins, calcium and vitamins. For many people, it is important to take low-fat and low-sugar versions such as plain yoghurt. Calcium is needed to keep your bones healthy.
Fat in your diet includes oil or spreads. Unsaturated fats such as vegetable oils are more healthy than saturated fats. Fats are a source of energy, but you should eat them in small amounts.

Sugars are included in chocolate and cakes. Sugar is not needed in our diets so it should be eaten in small amounts and not often.
It is important to drink six to eight cups/glasses of fluid each day to keep your body hydrated. Water, juice, tea and coffee all count as good fluids to drink. It is important to consider the sugar in drinks as well as food. Drinking is necessary for many reasons including to flush waste from the body in the urine.

What about alcohol with a stoma?

It is generally ok for a person with a stoma to drink alcohol, within recommended limits. The current recommendation from the government is to drink no more than 14 units in a week. Also, it is important to spread drinking over multiple days but with alcohol-free days. It can be difficult to know what 14 units of alcohol looks like; 14 units is the equivalent of six pints of average-strength beer or 10 small glasses of lower-strength wine. For more information about alcohol, you can go to the NHS website: https://www.nhs.uk/live-well/alcohol-advice/calculating-alcohol-units/.

Read also: Stag with a stoma

Stomas and alcohol

Although it is safe to drink alcohol with a stoma here are some considerations you should think about. These considerations are separated into the three main types of stoma.

People with a colostomy might find they are a bit windy if they drink gassy alcoholic drinks. So, it might be beneficial to avoid these if wind is a problem. Alcohol can also make the poo smell a bit different than usual, especially something like stout.
People with an ileostomy might find that the amount of poo they make increases when they drink alcohol. More poo means that you might need to empty your bag a bit more often. People with an ileostomy, who drink pints of alcohol such as beer might find that beer makes their poo a bit looser. This might mean being careful to avoid becoming dehydrated.

People with a urostomy might need to empty their urostomy bag a bit more when they drink alcohol. Also, if you drink alcohol in the evening, you will pass more pee overnight. So, it is useful to use extra night drainage such as a leg bag or night bag attached to your urostomy appliance.

A word of caution about excessive or binge drinking, which is not advocated. Be careful not to drink too much that you forget to empty or change your bag.

Eating just after stoma formation

Following the formation of a stoma, it is important to eat and drink to help heal and ensure normal bodily functions. Depending on the reasons for the stoma, some hospitals may initiate this process on the same day as the surgery. However, the timing can vary. During the initial few weeks post-stoma formation, consuming small, frequent meals can be beneficial. This approach aids the body in readjusting to food intake. Chewing is important to aid easy digestion. Additionally, maintaining a daily fluid intake of about 1500-2000 ml (equivalent to 3–4 pints) is necessary for overall health.

Restarting foods

Sometimes it can be difficult to know how and when to reintroduce foods into your diet after a stoma is formed. There is no one-fits-all answer. In the case of emergency surgery accompanied by significant internal swelling (oedema), you may experience a swollen stoma and might need to proceed with caution compared to others with a newly formed stoma. Taking it slowly means chewing food well and eating little and often. Taking it slowly might also mean eating bland food for a few weeks, until the swelling has settled down. Eating a bland diet might include avoiding spicy and fatty foods. Most people do not need to eat a bland diet in the long term, just for the first four to eight weeks while the swelling is reducing.

When reintroducing foods, there are no precise guidelines to follow. It is generally advisable to start with small portions of whatever foods you prefer and observe for any potential side effects. Gradually reintroducing high-fibre foods like fruits and vegetables may lead to increased gas, looser stools, or abdominal discomfort, primarily due to increased gas production. Therefore, it’s crucial to experiment with small portions to gauge their effects on you, now that you have a stoma. Root vegetables are often better tolerated than above-ground vegetables. Additionally, cooked fruits and vegetables are generally better tolerated than raw ones.

Eating with a colostomy

A colostomy will usually pass soft, formed poos once a day. However, this can vary for individuals and may be more or less often, depending upon what you eat. People with a colostomy should eat fibre to avoid constipation. Fibre is found in fruit and vegetables as well as wholemeal and wholewheat versions of starchy, carbohydrate foods.

Wind passed from a colostomy can be caused by eating fibre. Wind can also be the result of smoking, using a straw to drink with, chewing gum, drinking carbonated drinks or eating in a rush. If wind is a problem, changing what you eat or how you eat might help, but take care not to become constipated.

Eating with an ileostomy

An ileostomy will usually pass loose poo, needing the bag to be emptied several times a day (often four to six times). As the poo is looser than before the stoma was formed, some people choose to eat less fruit and vegetables. However, it is important to ensure you eat enough to have adequate vitamins. Root vegetables such as carrots are often better tolerated than leafy green vegetables or small hard vegetables such as sweetcorn.

People with an ileostomy often find that having a low-fibre diet such as white bread instead of wholewheat helps to thicken up their poo, which makes it easier to manage. As the poo is also looser than it was before the ileostomy, it is important to drink enough fluids every day, about 1500-2000 ml per day (3-4 pints). It is also necessary to consider the weather, if it is hot, 2000ml per day is needed. People living with an ileostomy also need to ensure they do not become dehydrated when sweating during exercise such
as running.

Loose poo means that salt is lost in your poo. So, to address this, many people with an ileostomy add a bit of salt each day to their diet. Extra salt is not needed if you already eat a lot of processed foods.

Some people try gelatine-based foods to try and thicken the consistency of their poo. Gelatine-based foods include marshmallow and jelly sweets. There is little evidence to support this but for some people, it might help a little to thicken the consistency. Caution is needed as gelatine-based foods also contain sugar, which needs to be eaten with care.

Most people with an ileostomy do not need to take medication to manage their stoma such as Imodium (loperamide). However, if your poo is very loose you could ask your specialist stoma nurse if this is something that might help you to manage your ileostomy. Most people start on a small dose and see how that helps them.

Table 1. Stoma company's websites that include diet

Company name Website
BBraun https://www.bbraun.com/en/patient-care/conditions/stoma/stoma-diet.html
Bullen https://www.bullens.com/stoma-guides/diet-and-exercise-guide/?gad_source=1&gclid=EAIaIQobChMI9LiTwr-ehAMVyJCDBx14gwASEAMYASAAEgLI9vD_BwE
Coloplast https://www.coloplast.co.uk/stoma/people-with-a-stoma/living-with-a-stoma/food-and-beverage/
ConvaTec https://www.convatec.com/en-gb/stoma-care/living-with-a-stoma/lifestyle-support/nutritional-advice/
Dansac https://www.dansac.co.uk/en-gb/livingwithastoma/recoveryafterstomasurgery/whattoeatafterstomasurgery
Eakin https://www.eakin.eu/help-advice/returning-to-normal-life/food-and-drink/
Fittleworth https://www.fittleworth.com/advice-centre/stoma/dietary-advice-for-people-living-with-a-stoma/
Hollister https://www.hollister.co.uk/-/media/files/pdfs-for-download/ostomy-care/qp-2869-healthy-eating-07.ashx
Oakmed https://www.oakmed.co.uk/advice-centre/articles/diet-and-nutrition/
Pelican https://www.pelicanhealthcare.co.uk/eating-with-a-stoma-1-year-after-surgery/
Salts https://www.salts.co.uk/en-gb/your-stoma/living-with-a-stoma/dietary-nutritional-advice
Securicare https://www.securicaremedical.co.uk/advice-and-support/stoma-care/diet-with-a-stoma/ileostomy-food-and-drink-hints-and-tips

Eating with a urostomy

A urostomy will pass urine, which should be clear, with traces of mucous. It is important to drink enough fluids each day to flush your kidneys. It is important to drink about 2000 ml each day. Eating (after the first few weeks) is usually ok, and most people with a urostomy can eat any type of food.

Table 2. Dietary information from charities

Charity name Website link
Bowel and Bladder Community https://www.bladderandbowel.org/bowel/stoma/diet-exercise-stoma/
Colostomy UK https://www.colostomyuk.org/information/diet/
Crohn’s & Colitis UK https://crohnsandcolitis.org.uk/info-support/information-about-crohns-and-colitis/all-information-about-crohns-and-colitis/surgery-and-complications/living-with-a-stoma
Ileostomy & Internal Pouch Association https://iasupport.org/wp-content/uploads/2020/11/EatingHabits.pdf
Urostomy Association https://urostomyassociation.org.uk/living-with-a-urostomy/getting-back-to-normal/

Who to ask for advice from?

In general, your specialist stoma nurse is the best person to speak to about diet. Your nurse can provide you with information or signpost you to useful websites.

There are lots of websites available for advice about eating. Some of the more common have been added to two tables: Table 1 shows information from stoma companies and Table 2 from UK-based charities. There is also a link to the NHS website: https://www.nhs.uk/conditions/colostomy/living-with/.

Jennie Burch is Head of Gastrointestinal Nurse Education at St Mark’s Hospital in London