Digestive ostomies: diet therapy and other tips

General Description

An ostomized person is that one who, due to a surgical intervention, undergoes a procedure that communicates a hollow organ (stomach, small bowel, large bowel, urinary bladder, etc.) to the outside in a different point from the natural orifice. That new opining created is denominated stoma.

Provide a personalized dietetic plan and counseling to ostomy patients, is one of the nutritional goals to accomplish to maintain them good habits of alimentation and a healthy diet which also helps them to achieve a favorable evolution of their new condition, and preserve their quality of life.

It is important to remember that ostomy patients present specific physic and psychological particularities that usually affect their relatives and provoke a high level of anxiety and changes in the life style.

Learn to live with an ileostomy (small bowel stoma) or a colostomy (large bowel stoma) can seem like a big challenge, but it must be look like any important change that patients have in their life, for what is necessary teach them to live with their ostomy and thus avoid its complications. At first the patient will have to get used to the new aspects of this experience, and this takes time, his/her social life can be as active as it was before the surgery, a positive attitude towards life, patience and sense of humor are the key to adjust to any change in life.

Nutritional intervention for ostomized people

These food measures are important to achieve an optimal nutritional state and a right stoma function, where it is necessary to cover two essential objectives:

1. Maintain a nutritional state in the best conditions.

2. Provide a proper alimentation so that the ill organ can recover the soon as possible.

Objectives of a proper nutrition:

* Provide a balanced nutritional support.

* Prevent the deficit of nutrients.

* Support the metabolism.

* Avoid complications related with nutritionals requirement.

* Prevent clinic pictures of dehydration.

 * Achieve an acceptable body weight.

Digestive ostomies

These consist in a surgical intervention, in which a segment of small bowel (ileostomy) or when the colon is exteriorized (colostomy) which according to its function and the reason why it was done they can be temporal or definitive.

Ileostomies

This surgery is more demanding in its preparation because the ileal content is more liquid and very abundant in enzymes (intestinal liquid) which damages the skin when exposed to this. The feces (content) are usually yellow in color, liquid or semi-liquid in consistency and they can contain non-digested particles of food, sometimes gas passes through the stoma, which can vary depending on patient´s diet. The daily volume of stool eliminated through ileostomies ranges between 500 and 800 ml in 24 hours.

The indications for ileostomies are:

* Anastomotic protection (suture in the bowel).

* Inflammatory bowel disease (ulcerative colitis, Crohn´s disease, familial adenomatous polyposis, enterocolitis, fulminant amebic colitis).

Dietetic recommendations to the ileostomized people

In principle, the patient can eat all that he/she ate before the intervention, taking into account the following recommendations:

* The first three month, the patient has to eat with caution and increasing in a progressive way the alimentary regimen, the patient should introduce the foods little by little and in small amounts. 

* Do not introduce new foods until verify that the previous are tolerated.

* Do meals with regular schedules.

* The patient must eat slow and chew well, with the mouth closes to avoid the formation of gases.

* Avoid fast and skip meals (omit meals increases the incidence of watery stools and gases). 

* Know that some foods like onion, garlic, fish and eggs may cause offensive odor.

* Drink an enough quantity of water (2 to 3 L per day), especially between meals.

* Drink natural yogurts and avoid carbonate drinks.

* Use fats moderately.

* Avoid or decrease caffeine intake. 

* The milk must be skim. 

* In case of gases or smells use butter, yogurt, parsley and avoid nuts, onion, green peas. 

* In case of diarrhea, abundant liquid must be drunk, eat potatoes, pasta, carrots, apple, lemon juice and derivatives.

Colostomy term is used to refer to the opening of the large bowel towards the exterior part of the abdomen.

The most frequent indications of colostomy are:

      • Colon cancer.

      • Diverticulitis.

      • Colonic fistulas to neighboring.

      • Traumas.

      • Hirschprung´s disease.

      • Imperforate anus in children.

General dietetic recommendations for people with colostomies

The alimentary measures in a colostomy patient are important to get an optimum nutritional state and a correct functioning of the stoma, since the people who have had a sigmoid colostomy (left colostomy) do not need alimentary restrictions, foods that produce a high quantity of stool must be avoided in them.

* It is usually started with a low fiber and residue diet, until establishing a normal diet, foods should be gradually introduced and in small amounts. 

* Add a new food every 3 days, to have a more exact control of tolerance points.

* Keep a varied diet which has all the nutrients (proteins, fats, carbohydrates, fiber, vitamins and minerals).

* Try always maintain a schedule of meals, with the objective of regularize the bowel emptying.

* Eat slowly and chew well the foods.

* Drink an enough amount of water (2 to 3 L per day).

* Distribute the foods of 24 hours in 5 or 6 times, little by little it will be accumulate the volume and reducing the number of meals.

* Avoid the drinks like the coffee, fruit juice, cola drinks, soft drinks, alcoholic drinks.

* Avoid the diarrhea and constipation with a balance diet.

How can diarrhea be avoided in a patient with a colostomy?

* Some foods and drinks can cause diarrhea, if this happens, you should find out what they are and avoid them.

* It is necessary the rehydration with liquids.

* Drink an enough amount of water (2 to 3 L) especially between meals.

* Drink tea or other type of infusion without sugar and drinks (avoid those ones which contain gas).

* Eliminate vegetables from the diet, especially chard and spinach, legumes (beans, lentils and chickpeas).

* Avoid drinking alcohol, coffee and eating fried foods, as well as remember that antibiotics can provoke diarrheas.

* Astringent foods: pastas, white bread, potatoes, bananas, apple and boiled rice.

How to control constipation in patients with colostomies?

 * Add fibers to the usual diet (vegetables, fresh fruits, whole wheat, oatmeal cereals).

* Drinks plenty of liquids (2 to 3 L a day).

* Increase physical activity (walk 1 hour a day at least).

* Do not use laxatives without consult with your doctor before.

How can excessive production of gases and bad smells be avoided in digestive ostomies?

* Eat food in a regular form.

* Avoid go to sleep after eating food.

* Reduce foods like: asparagus, avocado, cucumber, onions, beans, cauliflower, legumes, milk and some fermented cheeses. 

* The yogurt must always be natural.

* Do not chew gum.

* Avoid foods like eggs, cabbage, some fermented cheeses, cucumbers, onions, garlic, pork meat, dairy, soft drinks and coffee.

* Fish and shellfish, as well as some fatty nuts (walnuts, almonds and hazelnuts) also can produce unpleasant odors.

* The add parsley in meals can help to reduce odors.

Others:

* Use a smell proof bag.

* Verify that the bag is fixed to your skin.

* Empty the bag frequently.

* Spread deodorant liquids and tablets on the bag to avoid unpleasant smells.

* Take some medicines like: (chlorophyll tablets, Devrom, bismuth subgallate and bismuth subcarbonate).

Conclusions

By way of conclusions it must be emphasize that it is necessary a greater understanding of nutritional aspects of ostomized people to be able to give them an interdisciplinary assistance of high quality and a better quality of life to the colostomized people, facilitating them good alimentary habits in their diet and getting an optimum nutritional state to achieve a favorable evolution of their disease.