Eating after ileostomy surgery: the early adjustments

Call 911 if you have severe abdominal pain with vomiting and nothing at all is coming out of your stoma.

Call your care team right away if your stoma turns purple, black or white, or bleeds more than usual. MedlinePlus lists these among the reasons to contact your provider. Raising the call to right away is the cautious choice.

Call your care team right away if your stoma is producing less stool than usual, or if you have belly swelling or pain. MedlinePlus names those as the warning signs of a blockage. Another MedlinePlus guide adds sudden belly cramping, nausea with or without vomiting, and a sudden jump in very watery output. It also says to call right away if your pouch stays empty for more than 4 to 6 hours, because the bowel may be blocked. Do not just take a laxative.

Call your care team right away if you have signs of dehydration (dry mouth, urinating less often, feeling lightheaded or weak), or diarrhea that will not go away. MedlinePlus warns that diarrhea can be dangerous, so do not wait.

Call your care team the same day if you have frequent leaking, a rash or raw skin around the stoma, a sore on that skin, or a bad-smelling discharge. If you are having chemotherapy, call your care team right away, day or night, for any sign of a blockage or dehydration.

An ileostomy is an opening (stoma) in the belly that lets waste leave the body from the small intestine. MedlinePlus says you can get dehydrated more easily with an ileostomy. That is why fluid intake is a medical instruction here, not general advice.

Start here. Most of what follows is temporary.

MedlinePlus says that people who have had an ileostomy can most often eat a normal diet. It adds that tolerance varies from person to person.

You are not facing a lifetime of restriction. You are facing a stretch of learning what your own system now handles. That is a different thing, and a much better one.

This is the most useful rule in the whole business. MedlinePlus explains the reason well. Try only one at a time. Then if you have trouble, you will know which food caused it.

Picture adding corn, mushrooms, and a curry to the same meal. Something goes wrong. You have learned nothing, except that dinner now scares you.

Keep a simple note. Date, food, what happened. Within a few weeks you will have your own personal list. That beats a generic one, because tolerance really does differ between people.

MedlinePlus gives a two-word instruction that is easy to shrug off. Chew your food well.

MedlinePlus says chewing well helps keep high-fiber food from blocking your stoma. It lists foods that may block the stoma, such as raw pineapple, nuts and seeds, celery, popcorn, corn, dried fruits, mushrooms and coconut. Eating slowly also helps with gas.

MedlinePlus is specific here. Drink 6 to 8 cups, which is 1.5 to 2 liters, of fluid every day. The reason is the risk of dehydration. Another MedlinePlus guide says 8 to 10 glasses a day, and more when it is hot or you have been very active. Ask your provider which amount is right for you.

MedlinePlus lists these signs of dehydration: dry mouth, urinating less often, and feeling lightheaded or weak. Call your team if you notice them.

MedlinePlus gives two lists. They matter more for social planning than for health.

Odor-producing foods: onions, garlic, broccoli, asparagus, cabbage, fish, certain cheeses, eggs, baked beans, Brussels sprouts, and alcohol.

Gas-producing foods: cucumbers, radishes, sweets, melons, and carbonated drinks.

You may want to pick your timing before a long meeting or a wedding.

MedlinePlus also offers a small tip for noise. On an empty stomach, eat solid foods before liquids. That can quiet stomach sounds.

MedlinePlus says some people are put on a low-fiber diet for a while after gut surgery such as an ileostomy. Fiber is a substance found in plants. MedlinePlus describes what a low-fiber diet looks like:

• Refined white bread, white pasta, crackers, and low-fiber dry cereals
• Cooked or canned vegetables
• Canned fruit and fruit juice without pulp
• Cooked meat, fish, poultry, eggs, and smooth peanut butter

The same guidance lists what to avoid:

• Whole grains, beans, legumes, nuts, seeds, and raw vegetables
• High-fiber and dried fruits
• Deli meats, hot dogs, and fried vegetables

How long this phase lasts is a question for your surgical team. It is not a question for the internet. Ask them directly. Ask too when they want you to start adding things back.

Find someone who works often with ostomy patients. They can save you weeks of trial and error. They can also help you eat enough while you recover from major surgery. Ask whether one is available through your cancer center.

• MedlinePlus: Ileostomy and your diet
• MedlinePlus: Ileostomy - discharge
• MedlinePlus: Low-fiber diet