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Ileostomy

An ileostomy is when an opening is made in the small intestine through the stomach. In ileostomies, your stool is eliminated practically all day long and these are usually liquid (with a more yellowish colour) or have a porridge-like consistency, as they have not been able to pass through the large intestine properly (where water is absorbed, and the stools harden). In addition, they contain digestive enzymes which can irritate the skin around the stoma.
The normal amount of passed stools (also called output) is between 500 and 1,000 ml per day, which corresponds to about one or two half-full stoma bags (depending on the type of bags used).

When the amount of passed stools is within these limits, the ileostomy is considered normal-functioning, and a low-fibre diet is recommended, whilst keeping an eye out for foods that stimulate bowel movement; use light cooking methods and low-fat and ensure adequate water intake.

When the amount of passed stool is greater than 1.5 litres per day (3-4 bags per day) it is considered a high output ileostomy and a diet very low in fibre and foods that stimulate bowel movements, using low-fat and light cooking and adequate water intake is recommended.

WHAT DO WE RECOMMEND?

Eat in a relaxed environment, keeping your mouth closed and chewing well to avoid excessive formation of gas and large bits of food coming out of the ostomy (chewing too little increases the risk of obstruction).

Fasting or skipping meals increases the elimination of liquid stools and gas.

This may interfere with the proper fit of the pouching plate.

Being an ileostomy carrier entails a higher risk of dehydration, as a daily volume of fluids and minerals are lost through the ostomy that would normally be reabsorbed in the colon. For losses of more than 1.5 l/day, follow the recommendations for diarrhoea and make sure to keep well hydrated: drink water, isotonic drinks (with low sugar content) or oral saline, strained fruit juices, smoothies, or herbal teas frequently, but in small sips and preferably in between meals, so as not to confuse the texture of the stool after eating. Limit peristalsis-stimulating drinks (coffee, unstrained juice) and take rehydration drinks. Homemade jellies are also a good option to stay hydrated.

Recommended drinks in case of elevated loss through the ileostomy
recommended

  • Commercial oral serum
  • Homemade oral serum
  • Rice water

In less quantity than the previous ones:

  • water
  • Strained vegetable or chicken broth
 not recommended

  • Coffee (caffeinated)
  • Tea (with tein)
  • Acidic fruit juice (orange, grapefruit…)
  • alcohol
  • Caffeinated drinks (cola and energy drinks)

Some suggested recipes:

Peach jelly

After surgery, it is advisable to test your tolerance to lactose gradually. Start with a low-lactose diet, based on lactose-free milk and fresh or Cottage cheese and fermented derivatives, such as yoghurt or hard cheese (already low in lactose). If these foods are well tolerated and ostomy output does not increase, lactose-containing dairy products can be gradually incorporated, starting with cheeses and yoghurts, and finally milk, in small quantities.

In the case of high-output ileostomy (more than 1.5 l/day or 3-4 stoma bags), follow a very low-fibre diet, with foods that do not stimulate bowel movements, using low-fat and light cooking.

Example menu plan in case of high output ileostomy
Recommended foods example
Breakfast/mid-morning snack/ Mid-afternoon snack DAIRY: lactose-free milk or fresh cheese, yogurt, low-fat cheese.
NON-WHEAT CEREALS: bread, toast, biscuits, breakfast cereals (maize, rice), maria biscuits.
FRUIT:

  • Cooked: apple, pear, peach in syrup, quince.
  • Raw: ripe banana.

COMPLEMENTS: Sweet ham, turkey, salty ham.
Virgin olive oil.
Infusions (tea or diuretic infusions should be avoided).
Vegetable drink made from rice, oats, coconut or soy.
Decaffeinated coffee or Eko® soluble cereals.

To have breakfast
A glass of lactose-free milk and a decaffeinated coffee.
Toasted bread with oil and sweet ham.
Apple in the microwave with cinnamon.
Midday
Natural or flavored yogurt.
Lunches/dinners NON-Wholegrains: pasta, rice, couscous, rice noodles, semolina, bread…
PROTEIN FOODS

  • Meat: white.
  • Fish: white
  • Eggs: omelette, boiled.

VEGETABLES:
vegetables and cooked vegetables (potato, carrot).
FRUIT:

  • Cooked: apple, pear, peach in syrup, quince.
  • Raw: ripe banana
Lunch
have a snack
Dinner
Some suggested recipes:

Baked banana

Rice and fish rolls

Potato gnocchi with carrot sauce

In the case of a normal-functioning ileostomy (less than 1.5 litres of output or 1-2 bags per day), follow a low-fibre diet, with foods that do not stimulate bowel movement, using low-fat, lightly cooked foods. Tolerance to pulses is very variable, so eat them occasionally, always choosing pulses without skin and always mashed. If well tolerated they can also be eaten without mashing but keeping in mind the importance of chewing the pulses well and mixing them with cereals (rice, noodles…) or tubers (potato).

Menu example plan in case of normal-functioning ileostomy
Recommended foods example
Breakfast/mid-morning/snack DAIRY: milk, yogurt or cheese (with or without lactose, depending on tolerance).
Non-whole grain cereals: bread, toast, biscuits, breakfast cereals (rice, oats, corn, wheat), Maria cookies, homemade pastries (gingerbread, homemade muffins made with refined flour).
FRUIT

  • Raw, ripe, without skin or seeds: peach, pear, apple, mango, watermelon, cantaloupe, grape, avocado and banana.
  • Liquid: all.
  • Cooked: apple, pear, peach in syrup, quince…

COMPLEMENTS
Sweet ham, turkey, tuna, salty ham, tenderloin, anchovies, canned sardines, virgin olive oil, margarine or butter.
infusions
Coffee, decaffeinated coffee or Eko® soluble cereals.
sugar, honey
Vegetable drinks without fiber: rice, coconut, oats…

To have breakfast
A glass of milk (with or without lactose) and a decaffeinated coffee.
White bread sandwich with tomato (seedless) and virgin olive oil with turkey.
A peeled apple.
Midday
Lunches/dinners Non-whole grains: pasta, rice, couscous, rice noodles, bread.
VEGETABLES: unpeeled and pureed.
PROTEIN FOODS

  • Meat: all, avoiding tender or strong parts.
  • Fish and seafood: all.
  • Eggs: scrambled, hard-boiled, fried.

VEGETABLES:

  • Cooked: potato, carrot, courgette, onion.
  • Smoothies: carrot, tomato…
  • Commercial fried tomato sauce without chunks.

FRUIT:

  • Raw, ripe, without skin or seeds: peach, pear, apple, mango, watermelon, melon, grape and banana.
  • Liquid: all.
  • Cooked: apple, pear, peach in syrup, quince…

COMPLEMENTS:
Dairy desserts: curd, cottage cheese, custard, custard, rice pudding.
Non-spicy spices.
Extra virgin olive oil.
Sauces: mayonnaise, ketchup, balsamic vinegar, carbonara or bolognese sauce, etc.

Lunch
have a snack
Yoghurt with pieces of fresh fruit allowed.
Dinner
Some suggested recipes:

Liquefied tomato soup

Chicken skewers with apple

Pear pudding

Restricting and/or moderating the consumption of fibre-rich foods.

Foods allowed and not advised in the diet low in moderate fiber
Food group Allowed foods Unadvised foods
Refined cereals and derivatives
White rice, rice noodles, rice semolina, wheat pasta (noodles, macaroni, couscous, semolina…), tapioca, polenta, white bread, toast…
Maria or butter cookies, gingerbread, muffins, fiber-free breakfast cereals, etc.
All whole grains (with fiber).
Legumes occasionally If you have a good tolerance to legumes, eat them unpeeled, mashed. All (beans, lentils, chickpeas, fava beans, peas…).
Dried fruit or dried fruit none All (walnuts, hazelnuts, almonds, prunes, dried figs…).
Vegetables and tubers Without skin or seeds and very cooked: potato, carrot, pumpkin, courgette and grated onion.
Sifted tomato.
Strained vegetable broths.
liquefied 		The remaining.
fruits Raw, ripe, without skin or seeds: apple, pear, melon, watermelon, banana, avocado and grapes.
Liquid: all.
Cooked: apple, pear and peach. 		The remaining.
Meat, fish and eggs Everything well cooked: meat, fish, egg, seafood, surimi. It is necessary to avoid the consumption of meat with tender and/or strong parts.
Milk and derivatives Milk, natural or flavored yogurts, cheeses, custards, custard, curds, ice creams. Milk with fiber, yogurt with pieces of fruit or muesli.
fats All: extra virgin olive oil, sunflower oil, margarine, butter…
Drinks Water, liquefied fruit juices, instant coffee, infusions, soft drinks, isotonic drinks. Natural ground coffee, juice with pulp.
sweets Sugar, honey, jams without peel or chunks, caramels, cocoa powder, chocolate without chunks. Jams and preserves with pieces and peel.
Dressings Salt, vinegar, lemon juice, mild spices and aromatic herbs (chopped and in small quantities), mayonnaise, ketchup, mustard. Strong and spicy spices.

It is important to know which foods can cause constipation, diarrhoea, flatulence, or changes in the colour of your stool so that adjustments can be made quickly to remedy the different situations.
When having an ostomy, the intake of certain foods or changes in diet can lead to modifications.
It is important to gradually introduce foods and methods of preparations to assess their effect and tolerance. Individual tolerance to each food can be very different. Symptoms that may indicate poor tolerance are nausea, vomiting, bloating or increased liquid bowel movements through the ostomy. A good alternative is to use a food diary.

Situations and foods to consider when having an ostomy
Situation/Symptom Food recommendation
DIARRHEA Foods that can cause diarrhea:

  • Spicy foods and spices (chilli, curry, pepper, garlic…).
  • Foods rich in fiber or stimulants of peristalsis:
    legumes (peas, fava beans, lentils, beans, chickpeas).
    Bread, pasta or whole grains.
    Raw fruits and citrus juices.
    Raw vegetables and cooked green leafy vegetables (spinach, Swiss chard, cabbage, cauliflower, broccoli…).
    Milk and fresh cheese (due to the lactose content).
    Dry and dessicated fruit.
    Alcoholic drinks, with caffeine or theine.
  • Foods rich in simple sugars: candy or sweets, fruit nectar, simple sugar or honey, chocolate, sugary drinks.
Foods that can help with diarrhea:
Bread, toast, breakfast cereals, pasta or semolina, oatmeal, rice (all non-wholegrain).
Potatoes/sweet potatoes, boiled carrot.

Ripe banana, cooked apple, peach in syrup, baked quince.
Lactose-free dairy products.
STINK Foods that intensify the smell of stool: fish, eggs, garlic and onion, vegetables (cabbage, cauliflower, pumpkin, broccoli, asparagus), legumes, fermented cheeses. Foods that help reduce the smell of stool: butter, yogurt, lemon juice, orange, blueberries, parsley, mint.
CHANGE IN THE COLOR OF THE FACES Foods that can change the color of the stool: beets, red fruits, iron supplements, tomato sauce, food dyes, licorice. Tip: If the color of the stool appears reddish and none of the above foods have been consumed, you should consult your referring doctor or nursing staff.
GASES Foods that can generate gas:

  • Legumes (peas, fava beans, lentils, beans, chickpeas).
  • Vegetables: cabbage, cauliflower, broccoli, pumpkin, onion, leek, asparagus, radishes, cucumbers, spinach.
  • Nuts and dried fruit.
  • Whole foods
  • Fruit peels.
  • eggs
  • Carbonated drinks
  • Rocafort type cheese.
 Tip: Tolerance to certain foods varies between patients, so it is recommended to avoid only foods that cause gas repeatedly.
OBSTRUCTION OF THE OSTOMY Foods that can cause obstruction:

  • Legumes
  • Nuts and dried fruit.
  • Fruit and vegetables: celery, mushrooms, corn, sprouts, peels and seeds of fruits and vegetables, green salad, raw pineapple, coconut.
  • Popcorn corn.