After ileostomy surgery, your small intestine will need some time to adapt before you can slowly add back and consume all nutrients. It also affects the way your body digests and absorbs nutrients as the large intestine is no longer in use and most of the time you could experience dehydration.

Therefore, as follow, we have carefully collected helpful advice and developed a recommended ileostomy diet to allow you stay well hydrated and reduce some unpleasant symptoms such as gas, odour, watery outputs, and blockage. 

 Nutrition after surgery: What you need to know

A significant portion of your large intestine is not functioning properly or permanently disabled now so it’s one important factor to consider before eating and drinking anything.

Below, we shared some key information you should follow:

1. Why should I be cautious about what I eat and drink now that I have an ileostomy?

With an Ileostomy, the food and drinks you consume are no longer flowing through your whole bowel, which means that there is less time to digest and absorb nutrients. If you don’t take the proper precaution, it will often lead to dehydration, watery output, excessive gas production, and blockage.

2. Do I need to change my diet permanently?

No, after your ileostomy surgery, the small intestine needs some time to adjust, but you will be able to go back to your regular diet in about 8 – 12 weeks. However, in the meantime, you have to make small changes in your nutrition habits, for example: 

• It is advised to break your main meals into 6 small ones to help digestion. 
• Avoid or limit the consumption of food that your digestive system will be unable to break down such as raw fruits and vegetables, dry fruits and seeds etc., (see table below).
• Avoid food that causes an excessive output and  gas production.
• You have to choose healthy preparation methods, chop properly all the ingredients and avoid spices.

Ileostomy Diet: Recommended and not Recommended Food

Especially after your stoma surgery, it is better to follow a proper Ileostomy diet that includes the consumption of well-cocked and low-fiber foods.

Therefore, in the following paragraph, we give you all the information that you need to keep yourself well-fed, well-hydrated and away from any sort of complications.

Recommended Food to Stay Hydrated with an Ileostomy

The average person could lose about 2.5 liter of water a day but someone with an ileostomy loses 0.8 to 1 liter more. So basically, you are required to be more conscious about your fluid intake.

Here’s a list of food and beverages for hydration:

• Skimmed or low-fat (1% or 2%) milk
• Powdered milk
• Soy or almond milk
• Lactose-free dairy products
• Yogurt
• Cheese
• Low-fat ice cream or sherbet
• Lean animal proteins, such as:
  • Meat without visible fat
  • Skinless poultry
  • Fish
  • Creamy peanut butter
• Pulp-free vegetable juice
• Water
• Decaffeinated coffee or tea
• Drinks that aren’t carbonated
• Sports drinks (helpful for their electrolyte content)
• Rehydration drinks

Low-fiber foods, such as:

• White bread, pasta, and rice
• Bagels, rolls, and crackers made from refined flour
• Cereals made from refined flour
• Well-cooked vegetables without skin or seeds (ex. potatoes, zucchini, and tomatoes)
• Lettuce
• Pulp-free fruit juice (except prune juice and grape juice)
• Cooked peeled fruit (such as a cooked peeled apple)
• Soft watermelon and honeydew
• Orange without the membrane
• Ripe banana

Food to Avoid or Limit

There are foods that draw water into the bowel which might cause dehydration if you don’t drink enough fluids. Moreover, you might experience other digestion issues such as constipation, gas, and bloating if you eat them uncontrollably.

Here are foods to limit:

• High-fat milk and dairy products, such as:
  • Whole milk
  • Regular ice cream or sherbet
  • Dairy products with lactose (if you have diarrhea after having them)

• High-fat foods such as:
  • fried red meat
  • Poultry (with skin)
  • Oily fishes

• High-fiber foods such as:
  • dried or canned legumes (beans)
  • Whole grains (whole wheat bread, brown rice, bran cereal, quinoa, and buckwheat)
  • Raw vegetables (except lettuce)

• High-fiber fruits such as:
  • Fresh fruits (bananas, persimmons, kiwis, guava, oranges, lemons, pomegranates etc.)
  • Prune juice
  • Grape juice

• High-fat foods such as fried foods

• Alcoholic and carbonated drinks (causes gas and dehydration)

Below are foods to completely avoid as they may cause ileostomy blockage:

• Corn 
• Raw fruits with skin, such as:
  • Apples
  • Strawberries
  • Blueberries
  • Raspberries
  • Blackberries
  • Grapes

The Importance of Staying Hydrated

As someone with ileostomy, losing fluids quickly could also mean losing potassium and sodium which could lead to dehydration.

If you are dehydrated for long (24 hours or less), you might risk having kidney failure.

If you experience excessive perspiration, vomiting, or suffering from diarrhea, you need to replace what you lost immediately and stay hydrated.

Monitor your urine, the colour should be clear to pale yellow. If it is darker, it means you need to increase your fluid intake.

Signs and Symptoms of Dehydration

You might experience two or more of these symptoms but if you do, consider doing a first aid immediately then consult with your physician before things get worse.

• Dizziness
• Dark, amber-coloured, and low urine output
• Headache
• Muscle cramps
• Dry mouth or cracked lips
• Feeling thirstier than usual
• Heart palpitations (a fast, irregular heartbeat)
• Loss of appetite
• Emptying your ostomy pouch more often than usual (such as every hour)
• Tiredness

How Can an Ileostomy Prevent Dehydration?

Now that you’ve learned that you are losing more sodium, potassium, and water than usual, you might be wondering how you could stay hydrated no matter what lifestyle or other medical conditions you have right now.

1. One practical way to do that is to keep track of your fluid intake every single day. Be your own nurse and record how much liquid you take in and out. If your output is more than 1 liter per day, you might need to take more fiber. Contact your physician for possible medication or recommendation. 
2. You can also drink sports drinks or oral rehydration solutions to help replace your fluid loss immediately. You might want to check the do-it-yourself (DIY) recipes below if you don’t have sports drinks or rehydration solutions available.
3. Another is to maintain your 8-12 glasses of liquids every day. Even if your outputs are watery, getting enough liquids is still a must. Failing to do so will increase your risk of dehydration.
4. You may drink coffee but choose the dark roasted ones because they have less caffeine. Limit it to 1 cup a day only. Also limit liquids that are high in fat (such as regular milk) and alcoholic drinks because it may cause you to lose more fluid. 
5. Avoid sugary drinks and foods with artificial sweeteners such as sugar-free drinks, candies, gum, and cough drops.
6. Eat foods that contain electrolytes such as sodium and potassium instead. Read the table below for examples of foods that are high in sodium and potassium.

Foods high in Sodium

• Broth
• Buttermilk
• Pureed canned soups
• Cheese
• Commercially prepared or processed packaged foods (such as TV dinners)
• Salted crackers
• Salted pretzels
• Soy sauce
• Table salt
• Tomato juice

Foods high in potassium:

Integrate a number of good sources of potassium in your daily diet such as:

• Ripe bananas*
• Orange juice
• Tomato juice
• Mashed potatoes
• Broccoli
• Coconut water
• Chicken, turkey,  fish, and veal
• Oranges without seeds or membrane (the thin clear or white part around each section)
• Orange juice without pulp
• Potatoes without skin
• Soy milk
• Tomato or vegetable soup
• Yogurt

*Be mindful not to eat more than 1 small ripe banana per day for the first 3 to 4 weeks after your surgery to avoid ileostomy blockage.

DIY Electrolyte Drink: How to Prepare Your Own Electrolytes Drink at Home

In case you are out of electrolyte drinks, you can check these ingredients if they are readily available in your pantry to immediately rehydrate yourself.

#1: Sugar-based

1 liter of water 

2 flat tablespoons of sugar

½ flat teaspoon of unrefined sea salt

#2: Cranberry

½ liter of cranberry juice

1 liter of water

1/2 flat teaspoon of unrefined sea salt

#3: Honey

1 liter of water

6 flat tablespoons of Honey or Agave

1 flat tablespoon of unrefined sea salt

½ flat teaspoon of sodium bicarbonate

#4: Coconut Water Mix

1 liter of coconut water

4 freshly orange juice 

1 freshly lemon juice

8 flat tablespoons of raw honey or agave

¼ flat teaspoon of unrefined sea salt

#5: Citrus Scent

1 liter of water

1 sliced orange with peel or 1 sliced cucumber with peel

1 sliced lemon with peel

¼ flat teaspoon of unrefined sea salt

#6: Citrus Mix 2

1 liter of water

1 cup orange juice

8 flat teaspoons of sugar

1 flat  teaspoon of salt

 

Note: You may add flavour by adding fresh vegetable or fruit juice (without the pulp).

Preparation:

1. Combine ingredients in a glass water bottle or pitcher with a lid.
2. Shake or stir and cool in the refrigerator.
3. These solutions are good for consumption for over 24hr.

Special Recommendations Table

To guide you during your challenging times, we’ve come up with the different Food Tables below to help you prepare the most appropriate diet depending on your output.

Preventing an ileostomy obstruction

Blockages or obstructions in your ileostomy happens when your inputs and gas are not able to move through your intestine. You will notice it if you feel cramping, pain, nausea, or if there’s no output or gas coming out for 6 hours. These can be caused by the food you take, a scar tissue, or twist in your intestine. If this happens, call your physician right away.

Guidelines to follow so you can prevent such situations:

1. To apply first aid to your symptoms, you may take a warm bath to relax your abdominal muscles. You can also draw your knees up to your chest in a lying down position for temporary relief.
2. Avoid taking a laxative as it will worsen the case, try with prune or grape juice first and it would not help, then, get in touch with your doctor for medication advice. 

Here are foods to avoid that may cause blockage:

• Apples with the skin
• Bean sprouts
• Cabbage, raw
• Celery
• Bok Choy
• Corn
• Cucumber
• Dried fruit
• Grapes
• Green peppers
• Mushrooms
• Nuts
• Peas
• Popcorn
• Relishes and olives
• Salad greens
• Seeds
• Spinach
• Whole grains

Are you right now trying to deal with a blockage or you want further tips for prevention, symptoms & management? We have asked experts and created a full article on stoma blockage – check it out.

Conclusion

Dehydration is very possible to happen to ileostomy patients but this doesn’t mean you have to sacrifice your usual diet and lifestyle. If you are an active person with ileostomy, discuss your routine with your physician, an ostomy nutrition expert, and your physical trainer (or fitness coach).

You might want to take a look at these exercise routines perfect for individuals with an ostomy bag if you are ready to tweak your usual physical activities.

As mentioned above, you have to increase your usual fluid intake as you are also losing more than before your surgery. Water, non-caffeinated drinks, or other recommended liquids (see tables above) should be an essential in your bag wherever you go. Besides paying attention on your diet, we recommend you to always take care of the hygine of your stoma and use specific cleansing products.