IBD, Nutrition

Post-Surgery Diet Recommendations for Ostomies and Internal Pouches

Immediately after intestinal surgery, it’s recommended to follow a bland, low fiber diet for 2 to 6 weeks. The lower fiber reduces the frequency and volume of stools so the gut is allowed to rest and heal. 

While following this low fiber diet, it’s best to avoid: 

  • Raw fruits or vegetables 
  • Tough fruit and vegetable skins 
  • Whole grains 
  • Beans 
  • Mushrooms 
  • Whole kernel corn 

You may also want to avoid spicy, fried, or greasy foods as they can be irritating to the gut. During this time, it’s recommended to limit fiber to around 7–10 grams per day. 

Managing output 

The stool that collects in either the internal pouch (like a J-pouch) or external pouch appliance is often referred to as “output.” While you are healing and adjusting, you may have a higher volume of output, or it may be very watery. During this time, you can try making modifications to your diet to improve the texture, thickness, or odor of the stool output.  

You can also use these diet modifications to troubleshoot problems with output that you may experience in the future. 

Foods that increase the risk of stoma blockage 

If you have an ileostomy or colostomy, you may be at greater risk of developing a blockage in the opening in your abdomen (stoma). If you experience symptoms of a blockage such as no output for 4–6 hours with cramping or nausea, make sure you seek immediate medical care.  

Some foods have more potential to cause a blockage, so it’s recommended to introduce them very slowly and chew them very well. It’s also a good idea to start with a small amount of a more fibrous food. A high volume of a more difficult-to-digest foods (listed below) increase the risk of causing a blockage until your digestive tract has adjusted.  

  • Dried fruit 
  • Mushrooms 
  • Popcorn 
  • Tough fruit and vegetable skins 
  • Whole kernel corn 
  • Whole nuts or seeds 

Foods that might increase pouch output 

If it seems like your output is very loose or watery, you can limit these foods to see if there is an improvement. 

  • Alcohol, including beer 
  • Chocolate 
  • Coffee or caffeine 
  • Fruit juices, especially apples, grapes, or prunes 
  • Greasy or fried foods 
  • Leafy greens like spinach or cabbage
  • Milk or other high lactose dairy products if lactose intolerant or in a current IBD (Inflammatory Bowel Disease) flare 
  • Raw vegetables 
  • Spicy foods 
  • Sugar-sweetened beverages  

Foods that might increase gas 

You may want to limit these foods that can cause excess gas in your internal or external pouch.  

  • Beer 
  • Beans and legumes (lentils, split peas)* 
  • Carbonated beverages like soda, sparkling water, or seltzer 
  • Chewing gum (when you chew gum, it introduces more air into your digestive tract) 
  • Cruciferous vegetables (broccoli, brussels sprouts, cabbage, cauliflower) 
  • Garlic 
  • Onion 

*You can try an over-the-counter digestive enzyme like Beano® to see if this helps reduce gas from beans. 

Foods that might thicken pouch output 

If you find your pouch output is too loose and would like to thicken it, you can add these foods to your diet. 

  • Applesauce  
  • Bananas  
  • Creamy peanut butter 
  • Congee  
  • Hot cereals (like Cream of Wheat or Cream of Rice)  
  • Mashed or baked potatoes with no peel  
  • Marshmallows 
  • Oatmeal  
  • Tapioca pudding  
  • White bread or noodles  
  • White rice  
  • Yogurt 

Additional eating strategies 

You can also utilize some or all of these strategies to manage your output.  

Introduce foods slowly 

Introduce new foods one at a time to see how you handle them. If you try too many at once you may be eating too much fiber (which can cause symptoms) and you may not be able to pick out which one caused you a problem. Try to space out the introduction of new foods by 2–3 days. 

Remember to chew 

Chew your foods thoroughly. Chewing helps to break up fibrous foods and helps to absorb more nutrients from them as well as allowing them to pass easier through a stoma or internal pouch.  

Stay hydrated 

Make sure you drink plenty of fluids during the day, aiming for at least eight to ten, 8-ounce cups (1.9–2.4 liters total). Limiting fluids will not reduce watery output and may cause dehydration. 

Rest and digest 

Eating when you feel stressed or anxious can increase how quickly food moves through your digestive system. If you do feel high stress or anxiety when it’s time to eat, take a few minutes to do some deep breathing exercises to help shift your body into rest and digest mode.