Helping your body heal after surgery.

“Diets for people with new ostomies have been a longstanding source of confusion and (sometimes) fear: … Meal times can become a source of worry rather than enjoyment.”

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An ostomy is a big adjustment, but ostomy products are designed to allow you to
continue with all your regular activities, including going back to work, a reasonable exercise regime, traveling and sex.

But first things first. After you’ve had your colon surgery, the main focus should be on eating to advance healing and stay healthy. The right food choices begin just after surgery. Once your ostomy is in place, your ostomy team will give you special diet instructions for the first 6 to 8 weeks after your surgery. This diet will help you get adjusted to your ostomy while providing you with the right balance of nutrients to help with healing and activities of daily living. After your surgery, you may have some food intolerances or uncomfortable symptoms that you didn’t have before surgery. These could include diarrhea, bloating, gas, or bad odor. Sometimes, food intolerances go away as your colon heals.

For all ostomy types, your initial post-surgery diet will be low in fiber and residue (poop), which helps to rest the gastrointestinal tract. These foods are easier to digest and produce less gas. The goals are to maintain weight, promote healing, prevent stoma blockage, and maintain healthy fluid levels to prevent dehydration.

For the first few weeks after your surgery, it is common to have gas in your pouch and a bad odor when you open your pouch. You may have more gas if you had robotic surgery. If you’re having problems with gas or odor, talk to your ostomy care nurse or cancer care team.

Here are some basic guidelines as you start to eat after surgery:

• Eat three or more very small meals per day.
• Eat soft, bland foods to go easy on your colon as it heals.
• Chew your food thoroughly to help the digestive process.
• Eat meals and snacks on a similar schedule every day.
• Eat your largest meal during the middle of the day to avoid high colostomy output at night.
• Avoid fiber. Don’t introduce high-fiber foods back into your diet for the first 4-6 weeks. For an ileostomy, ask your care team before you eat high-fiber foods.
• Drink plenty of fluids, especially water, to stay hydrated and avoid constipation. If you have an ileostomy, you may receive specific instructions about fluids.

What you eat and when you eat have a direct effect on your bowel movements.

You may experience a few irregularities as you get used to your new diet. What you need to look out for are constipation and diarrhea. Constipation is having fewer than 3 bowel movements per week, having dry, hard bowel movements, or having a tough time pushing stool out.

Constipation can be caused by pain medications, anti-nausea medications, a lack of fiber in your diet, being sedentary, not moving enough, or not drinking enough liquids. If you are constipated, especially after surgery:

• Talk to your cancer care team and see if they may give you medication to help.
• Drink warm water with lemon or lemon juice, coffee, or prune juice.
• Do light exercise (such as walking) if you can.
• Ask your doctor if eating high-fiber foods or taking a fiber supplement will help.

Diarrhea is having loose or watery bowel movements, having more bowel movements than what’s normal for you, or both. It can be caused by certain medications, such as antibiotics, bowel infections, bowel blockages, or even excess stress.

To avoid diarrhea:

• Don't chew gum.
• Don't drink with a straw.
• Don't smoke or chew tobacco.
• Don't eat too fast.
• Don't skip meals.
• Ask your healthcare provider if you can take an over-the-counter medication (such as Beano or simethicone) before meals to help prevent gas.

There are a few things you may need to keep out of your diet (as much as possible) as long as you have an ostomy.

These foods tend to be hard to digest and may cause blockages. These include nuts, seeds, popcorn, dried fruit such as currants and raisins, dried coconut and mushrooms, and crunchy raw vegetables like cauliflower and broccoli. Eat these foods in small amounts, and chew them up very well. Some foods are incompletely digested and pass through the stoma unchanged. This may include fibrous foods such as sweet corn. This is quite normal. If you think you have a blockage, call your ostomy nurse to ask what you should do. Contact your cancer care team if you see undigested pills or medication in your stoma bag.

 At 6–8 weeks after surgery, fiber-containing foods can be started. 

Foods should be added slowly to help your bowel get back to a normal diet that provides all the healthy macro- and micronutrients you need. When you add foods back into your diet, introduce them one at a time. If a certain food causes uncomfortable symptoms, don’t eat it for a few weeks and re-introduce it slowly in small quantities. Each person is unique, and no two people will react the same way to food. When you start adding high-fiber foods back into your diet, make sure you’re also drinking enough liquids. Try to drink 8 to 10 (8-ounce) glasses (about 2 liters) of liquid every day.

While your cancer care team and doctors will explain everything in detail, here’s a handy list of common intestinal reactions to common foods.

• Gas: Asparagus, beans, beer, broccoli, Brussels sprouts, cabbage, carbonated beverages, cauliflower, onions, peas.
• Incomplete Digestion: Apple peels, cabbage, celery, coconut, corn, dried fruit, mushrooms, nuts, pineapple, popcorn, seeds, skins from fruits, skins from vegetables.
• Thickened Stool: Applesauce, bananas, cheese, pasta, rice, peanut butter (creamy), potato (without skin), tapioca.
• Thinned Stool: Fried foods, grape juice, high-sugar foods, prune juice, spicy foods.
• Increased Odor: Alcohol, asparagus, broccoli, dried beans, eggs, fish, garlic, onions, peas.
• Reduced Odor: Buttermilk, cranberry juice, parsley, yogurt.

Source: Academy of Nutrition and Dietetics, United Ostomy Associations of America

As you get used to the colostomy bag and your body heals, getting the required nutrition to maintain good health becomes easier. Trust your gut, both metaphorically and literally. It is a long road, but with the right support systems in place, a colostomy bag can become a routine part of your daily life.