By Kimberly Brown, MS, RD, LD
Patients undergoing surgery for a colostomy or ileostomy face many challenges. One of the biggest, though, is the nutritional needs of the patient immediately following surgery. Fortunately, dietitians help to remedy these concerns and help patients overcome ostomy complications.
Location, location, location
Absorption of nutrients, fluids, and electrolytes will differ based on where the stoma is placed.1 Colostomies can be placed in the descending, sigmoid, transverse, or ascending colon. Colostomies typically allow for normal defecation with stools ranging from semi-liquid to hard, and incur minimal to no nutritional losses.2 On the other hand, ileostomy stool output is liquid to semi-liquid and has a higher chance of causing patients to have difficulty in absorbing fluids, electrolytes, and nutrients.2 In order to provide the best care, review the patient’s chart to determine where the stoma is located, length of proximal bowel remaining, and what nutrients are likely to become deficient in the patient.2 Even though these changes may only be temporary, postoperative education provided by a dietitian can help the patient to be successful in navigating common ostomy nutrition-related complications.
Immediate Postoperative Care
Immediately following surgery, the bowels will be swollen.3-4 It is imperative that during this time, patients follow a fiber-restricted diet to allow the bowels to heal as well as to avoid excess gas, abdominal cramping, and possible bowel obstruction.1,3-4 A fiber-restricted diet provides less than 13 grams of fiber per day but may even go lower than 8 grams per day based on the patient’s symptoms.3-4 Foods rich in fiber can be slowly added back into the diet within 4 to 6 weeks after surgery.1 Have patients slowly add in fiber-rich foods alongside an increase in fluids to avoid constipation.
Meeting Hydration Needs
Hydration is vitally important and can help to prevent patients from being readmitted with dehydration. Patients should aim for 64 to 80 ounces of fluid per day.1,3-4 Since fluids are mainly absorbed within the colon, patients who have had a large portion of the colon removed or bypassed may notice greater fluid losses.5 Educate patients on signs and symptoms of dehydration, including dark or strong-smelling urine, dry mouth, light-headedness, urinating less than normal, fatigue, and frequent feelings of thirst.1,3-4 Of note, fluid intake will need to be higher during times of heavy sweating (hot weather or exercise) or when ostomy output is ≥1,800 milliliters per day.3-4 To prevent further exacerbation of dehydration, have patients avoid drinks high in sugar, alcohol, and caffeine.3-4
Coping with High Ostomy Output
As mentioned earlier, ostomy output ≥1,800 milliliters per day is considered high ostomy output.3-4 If patients experience high ostomy output, oral rehydration solutions should be provided to prevent dehydration and electrolyte depletion. Oral rehydration solutions can be purchased; however, that is not always feasible nor readily available for patients when they are recovering at home. Easily accessible oral rehydration solutions to maintain electrolytes and fluid include coconut water, vegetable juices, and low–calorie sports drink or regular sports drinks that have been diluted.1,4 If ostomy output is more severe and higher electrolyte content is needed, patients can purchase oral rehydration salts/solutions such as DripDrop®, Hydralyte®, Pedialyte®, or the World Health Organization’s Oral Rehydration Salts.1 Patients may also make homemade oral rehydration solutions from inexpensive ingredients.
Reducing the Risk of Blockage
Stoma blockage is a concern for both ileostomies and colostomies. However, patients with ileostomies are at greater risk due to smaller stoma diameter and larger food particles at this point in digestion.1 Postoperative inflammation of the bowels further complicates matters and increases the likelihood of a blockage.1 To decrease the risk of a blockage forming, have patients follow the low-fiber diet, avoid fruits and vegetables with skin, avoid raw fruits and vegetables, and remind them to chew foods thoroughly.1 An easy way to have patients determine if they are chewing adequately is to have them take note of contents in their ostomy pouch. If chunks of food are visible in the ostomy pouch then they are not chewing well enough.1
Registered dietitians can be a valuable part of the team when it comes to helping patients with colostomies and ileostomies overcome postoperative symptoms. Providing tools and educational materials can help patients be successful with their recovery in the hospital and at home. Living with a stoma is challenging enough; dietitians can help eliminate fears of managing patients’ nutritional needs during the postoperative phase.
Kimberly Brown, MS, RD, LD is a clinical dietitian currently working at a 1000+ bed facility in Oklahoma. She has spent a majority of her career working in intensive care, including Level 1 trauma/burn, cardiothoracic, and medical ICU. She is passionate about nutrition support and ensuring that each patient’s nutritional needs are being met. In her free time, she enjoys running, traveling, painting, and keeping up with her three children.
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Burgess-Stocks J. Eating with an Ostomy: A Comprehensive Nutrition Guide for Those Living with an Ostomy. 1st ed. United Ostomy Associations of America; 2020. https://www.ostomy.org/wp-content/uploads/2020/07/Eating_with_an_Ostomy_2020-07.pdf. Accessed November 1, 2020.
de Oliveira AL, Boroni Moreira AP, Pereira Netto M, Gonçalves Leite IC. A Cross-sectional Study of Nutritional Status, Diet, and Dietary Restrictions Among Persons with an Ileostomy or Colostomy. Ostomy Wound Manage. 2018;64(5):18-29.
Academy of Nutrition and Dietetics. Nutrition Care Manual. Colostomy nutrition therapy. http://www.nutritioncaremanual.org. Accessed November 1, 2020.
Academy of Nutrition and Dietetics. Nutrition Care Manual. Ileostomy nutrition therapy. http://www.nutritioncaremanual.org. Accessed November 1, 2020.