Blockages

July, 2017

Question:

I have an ilesotomy and do have a hernia, have had 4 blockages this spring and am nervous about diet and different food’s effects with regard to blockages or diarrhea.

Response:

Illeostomy – Dealing with a potential blockage:

After an ileostomy is created, it may be harder to digest foods that are high in fiber, such as raw vegetables, popcorn, and nuts. Eaten in large amounts, these foods can clump together. Then they get stuck in the small intestine, causing a blockage. You need to know the signs of a blockage and what to do if you have one.

Signs

A blockage can be an emergency. That’s because you can become dehydrated quickly. The intestine can also rupture. You need to know the signs just in case you do have a blockage:

  • At first, you may have an almost constant spurting of very watery stool. Your intestine is taking water from your body to try to get rid of the blockage.
  • You may feel bloated or have cramping. The stool may have a strong odor. The stoma or the skin around the stoma may swell.
  • If the blockage remains, the flow of stool will stop totally. Then you’ll have increased pain, often leading to nausea and vomiting.

What to do

You can try one or more of the following:

  • Put on a pouch with a larger opening.
  • Gently massage your belly with the palms of your hands.
  • Lie on your back. Pull your knees to your chest and rock from side to side.
  • Take a hot bath for 15 to 20 minutes.
  • Do not eat any solid food.
  • Do not take any laxatives or stool softeners. They cause your body to lose more water.

When to call healthcare provider

Call your healthcare provider or enterostomal therapy (ET) nurse, or go to the nearest hospital emergency room if:

  • You have increased pain and cramping with nothing produced from your stoma in 2 hours or more.
  • You start to vomit.

Ways to help prevent a blockage

Sometimes a blockage happens no matter what you do. But you can help prevent a blockage:

  • Drink at least 8 to 12 cups (2 to 3 quarts) of fluids, such as water or juice, each day.
  • Chew your food slowly and thoroughly.
  • Eat only small amounts of foods that are high in fiber or cellulose. These include raw vegetables, unpeeled fresh fruits, bamboo shoots, bean sprouts, cabbage, celery, coconut, corn, mushrooms, pea pods, dried fruits, nuts, seeds, popcorn, and hot dogs and other meats in casings.
  • Go easy on bran and other high-fiber grains, such as granola.

More Helpful Dietary Information

The impact of food and drink on your stoma is hard to predict as diet is very individual. Various surveys suggests that foods can affect people in different ways after stoma surgery. While many people find that they can eat just the same diet as before their surgery, some find there are things that can have an adverse effect on the activity of their stoma. They may then choose to avoid those foods, or include them in their diets and be prepared for the effects.

Many people report that a good way to ascertain which foods and drinks are suitable for them is to keep a food diary so that patterns between diet and stoma output can be identified. You can then base your diet on what you have observed to be agreeable in terms of stoma output. There may be a certain degree of trial and error, especially in the first few months after your stoma is formed when the bowel is swollen. This swelling (or oedema) is the reason why a stoma may look puffy initially and can cause problems digesting food that would otherwise not occur, so it’s sometimes worth trying a food again later on before deciding whether to eliminate from your diet completely.

Information about diet and healthy eating for the general public is often conflicting and difficult to interpret. Add to this a stoma and many people feel confused about what they should and shouldn’t be eating.

Most people with stomas do not need to change their diets and should follow a normal healthy eating pattern like the rest of the population. If you have recently had your surgery or have been unwell, ensuring that you get all the essential nutrients from your diet is even more important and putting unnecessary restrictions on your diet could slow down your recovery and healing.

The purpose of the following information is to offer general information, for further information about diet, ask you physician to refer you to a dietician in order to explore any important factors to take into consideration regarding your individual stoma management and general wellbeing.

A balanced diet is made up of:

  • Starchy foods such as potatoes, rice & grains, bread and pasta, for energy. Try different varieties, including wholemeal vs refined/white rice and pasta.
  • Fruit and vegetables provide a wide range of vitamins and minerals and both soluble and insoluble fibre. Soluble fibre is found in the flesh of fruit & veg and can help lower cholesterol as well as make stool thicker, softer and easier to pass (helpful for those with a colostomy or ileostomy who wish to thicken their output). Insoluble fibre is found in the skins of fruit & veg and helps move waste through your bowel, so can help with constipation (helpful for those with a colostomy who experience pancaking and anyone who experiences constipation). If you have a colostomy or ileostomy, immediately after surgery foods containing insoluble fibre may make your stoma behave unpredictably, so you may wish to avoid or limit your intake of them. As your bowel adjusts you can re-introduce them and see how they affect you.
  • Protein rich foods for growth and healing. Protein comes from meat, fish, eggs, soya and it is the substance we use to heal wounds and regain muscle.
  • To promote general wellbeing, fatty foods should be limited. However, if you are recovering from surgery or have a small appetite and need to gain weight, including more of these foods in the short term is a good idea.

Individual Differences

The vast majority of people with a urostomy (a stoma that passes urine) find that their food intake is unaffected by having a stoma, however some food and medications can make urine discoloured or smelly (e.g. beetroot can make your urine pink and antibiotics and asparagus can make it smell strange).

Importance of chewing

It sounds very obvious, but it is vitally important to chew food thoroughly when eating. Chewing is the first stage of digestion and in doing this we make more nutrients available from our food. Foods that contain cellulose such as nuts, grain, fruit & vegetables (particularly the skins) cannot be completely broken down in the digestive system. So, you may notice these coming through your stoma looking the way they did when you ate them. Immediately after bowel surgery, your bowel is swollen and this narrows the passageway for food to pass along.

                        Fluid Intake

It is essential for everyone to drink enough to keep their kidneys healthy and flush out the chemicals that build up in the blood. You should aim to drink enough throughout the day that your urine is a light straw colour. The following information is for the specific stoma types but does not take into account other medical conditions. If you have been given different information from your healthcare professionals please check with them before making any changes.

People with urostomies enjoy a few glasses of water a day. This will help to prevent infections.

If you have a colostomy, your fluid intake can remain as normal unless you are experiencing constipation or pancaking. If you have this problem, increasing your fluid intake can be really helpful.

People with ileostomies, particularly if the stoma is formed higher up in the bowel, can have more difficulties with their fluid intake. This is because it is the role of the large bowel to absorb water (and salt) and for people with ileostomies this is no longer being used. The small bowel will, with time, adapt to absorb more water and more salt, however careful attention should be paid to ensure that you are drinking an adequate, varied fluid intake to maintain kidney health. Remember, you are aiming for light straw coloured urine.

For those who are more active it is even more important to pay attention to your fluid intake. Fluids are lost through sweating that contains electrolytes.

Everyone should bear in mind that alcohol is a dehydrating fluid and caffeinated drinks such as tea and coffee cause you to lose more fluid in your urine. The majority of your fluid intake should therefore be from fluids such as water and fruit cordials.

                        A little of what you fancy….

Of course, every now and again you will want to enjoy a treat like cake or ice cream and there is no reason why you can’t indulge once in a while! Healthy eating is about moderation and after stoma surgery it is also about trial and error. Take your time to explore how different foods affect your stoma, chew your meals, maintain a varied fluid intake and, most importantly, enjoy your food!

Some foods effect output. The effects may vary.

Basic Food Reference Chart

Stoma Obstructive                                                      Gas Producing

Apple peels                                                                 Beans

Cabbage raw                                                               Soy

Corn, whole kernel                                                      Cabbage

Coconut                                                                       Carbonated beverage

Dried fruit                                                                    Cauliflower

Mushrooms                                                                 Cucumbers

Pineapple                                                                     Dairy products

Popcorn                                                                       Nuts

Seeds                                                                           Onions

Radishes

 

Odour Producing                                                       Colour Changes

Asparagus                                                                   Asparagus

Baked beans                                                                Beets

Broccoli                                                                       Food colour

Cod liver oil                                                                Iron pulls

Eggs                                                                            Strawberries

Fish                                                                             Tomato sauces

Garlic                                                                          Coffee

Onions                                                                         Cooked fruits

Peanut butter                                                               Increased Stool

Strong cheese                                                              Whole grains

Odour Control                                                            Bran cereals

Buttermilk                                                                   Fresh fruits

Cranberry juice                                                           Green, leafy

Tomato juice                                                               Milk

Yogurt                                                                         Prunes

Raw vegetables

Diarrhea Control

Applesauce

Bananas

Peanut butter

Tapioca