Where a stoma - a colostomy or ileostomy - has been fitted after surgery to the colon/bowel or rectum, 'stomal therapy' is the guidance and assistance given to the patient so they are able to understand how to live, either temporarily or permanently with a stoma.
Stomal therapists are nurses who have been specially trained in stoma use and care. They provide assistance both before he procedure and afterwards in the hospital and then at home.
With both types of stoma, an important consideration is nutrition management, that is making sure that you are eating the right combination of different foods that enable good nutrition for the body and allow the stoma to function well.
Here are some of the guidelines:
The fitting of an ileostomy will necessitate dietary changes, some of which are only necessary in the first six weeks after surgery, and some which will need to be carried on indefinitely while the stoma is fitted.
First Six Weeks
Some types of food are difficult for the stoma to process immediately after surgery, due to post-surgical swelling, which does settle gradually during the first six weeks. The foods to limit or avoid are:
- Fibrous foods – for example fruit and vegetables, particularly uncooked (cooked fruit and veg in small quantities and well chewed before swallowing should not be a problem).
- Grains - especially whole wheat and whole grains.
After the initial six-week period, these may be gradually reintroduced into the diet. It is a good idea to introduce these food types one at a time, just in case there is any reaction, such as cramping or any looseness in the motions.
After the First Six Weeks
Once the initial six-week period is over, most foods can be reintroduced into the diet (there are one or two that may continue to cause problems – popcorn for example). It is still advisable to make sure that all food is well chewed before swallowing and that adequate fluid intake is maintained (8-10 glasses per day). Eating solid food and drinking fluid should ideally not occur at the same time.
Wind / Gas
Gas or odour can be an unpleasant side effect of some foods, and this is amplified where a stoma is fitted. The following recommendations will help:
- Avoid things that naturally increase the ingestion of air, such as using a straw to drink, chewing with an open mouth, chewing gum / sucking on candy, smoking
- Working out which foods cause odour / gas – if you like these foods, you can simply choose when to eat them to minimise any issues, rather than giving them up entirely.
If there were any diet restrictions in place before the fitting of the stoma, it is possible they may no longer apply. Another common issue is 'high output', where a high quantity of fluid (more than 2 litres in a 24-hour period) passes through the stoma. In addition to talking with a stomal therapist, a dietitian can help you review these, and any other nutrition management issues that may arise from the stoma.
A colostomy is generally more straightforward than an ileostomy regarding dietary restrictions – there are rarely any changes required, however post-surgical swelling does also occur and so some temporary changes may be needed.
Wind / Gas
Gas and odour can also be an issue after a colostomy is fitted. Some food types tend to create more gas and/or odour, and you can choose to eliminate these from the diet or choose when to eat these food types, with the gas / odour likely to occur 6-8 hours after ingestion. There are also some products available to help lessen the effects of these foods – one popular product is an enzyme-based wind reduction treatment known as 'Beano'.