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Stomal Therapy

'Stomal therapy' is the medical term used to describe the assistance you need if you have had surgery requiring either a colostomy or an ileostomy.

Both of these are referred to as 'stoma', and a stomal therapist is a nurse who has special training in stoma care. A stomal therapist can help you prepare to have a colostomy or ileostomy ahead of the procedure and is also able to assist you with either of these after your procedure.

The most important factor in becoming accustomed to either a colostomy or an ileostomy is 'nutrition management'. This is different, depending on which you have...

Ileostomy

Once an ileostomy has been fitted, there will be some dietary changes needed in the short term (i.e. within the first six weeks after surgery) and other dietary changes that will generally need to be adopted in the longer term. These are as follows...

Short term changes

The following food types should be limited during the first six weeks after surgery...

  • Fibrous fruit and vegetables (especially if eaten raw).
  • Whole wheat / whole grain foods.
  • Nuts / seeds.

These restrictions are due to the fact that these food types may not pass through the stoma easily in the first few weeks after surgery, due to post-operative swelling which gradually subsides. These food types can be gradually reintroduced after the initial six-week period. It is advisable to introduce these into the diet one at a time to check any response such as cramping or loose motions. During the first six weeks cooked fruit and vegetables may be eaten in small quantities, as long as these are well chewed before swallowing.

Longer term changes

Although most food types can be reintroduced after the initial six-week period, it is still advisable to follow some guidelines after this period...

  • Adequate chewing of food before swallowing.
  • Drinking 8-10 glasses of fluid daily.
  • Eating solid food and drinking fluids at separate times.

Some food types may continue to cause problems and should be avoided - popcorn for example is a common problem food.

Avoiding wind / gas

Some food types produce more gas than others, either with or without an unpleasant odour. Activities such as smoking, chewing gum, sucking on sweets/candy, drinking through a straw and chewing with an open mouth, will all increase the amount of air swallowed and will cause gas.

Where you know that a particular type of food will cause gas and / or odour, you may want to simply time when you consume these, rather than completely eliminating them from your diet.

Prior dietary restrictions

After an ileostomy has been fitted, previous dietary restrictions you had to follow before the procedure may or may not still apply -  these should be reviewed with a dietitian. A dietitian can also help with other issues, for example where there is continuing 'high output', which is where more than two litres of fluid is passing into the stoma in a 24-hour period.

Colostomy

Unlike an ileostomy, a colostomy generally does not require any change to the diet, although there may be some changes required in the weeks immediately after the procedure due to post-operative swelling. Any dietary restrictions you were following before the procedure should be discussed with a dietitian to determine if they need to be maintained.

Certain foods can cause increased wind/gas and odour when emptying the colostomy pouch, which can be a concern. You may choose to eliminate these foods from your diet, or decide when to consume these so you can anticipate when the gas/odour is likely to occur, which is generally 6-8 hours after consuming the food types that cause gas. There are also some enzyme-based medications available that reduce levels of gas (one of these is called Beano).