Diet Guidelines for People with an Ileostomy

This information describes dietary (eating and drinking) guidelines to follow while your colon is healing. It also explains how to manage common side effects of having an ileostomy.

General Eating and Drinking Guidelines

Follow the guidelines below for the first few weeks after your surgery. This will help prevent discomfort while your colon heals.

  • Eat small, frequent meals. Try to have 6 small meals throughout the day instead of 3 large ones. It’s especially important to avoid eating too much in the evening. This will help limit the bowel movements (poop) from your ileostomy during the night.
  • Eat slowly and chew your food well.
  • Drink 8 to 10 (8-ounce) glasses of liquids every day. This will help you replace the water lost through your ileostomy and keep from becoming dehydrated. Read the “Preventing Dehydration” section for more information.
  • Eat mostly bland, low-fiber foods. Read the “Recommended foods” section for more information.
  • When you add foods back to your diet, introduce them one at a time. Read the “Adding foods to your diet” section for more information.

Before you’re discharged from the hospital, a clinical dietitian nutritionist will visit you in your hospital room to talk with you about these guidelines. After you leave the hospital, your doctor and a clinical dietitian nutritionist will help you as you go back to following your usual diet.

Recommended foods

It’s best to eat mostly bland, low-fiber foods for the first few weeks after your surgery. Bland foods are cooked, easy-to-digest foods that aren’t spicy, heavy, or fried. Eating bland foods will help you avoid uncomfortable symptoms such as diarrhea (loose or watery bowel movements), bloating, gas, and swelling or tenderness at your ileostomy site.

The following tables include examples of bland, low-fiber foods. If you have questions about foods not listed in these tables, contact a clinical dietitian nutritionist.

Milk and dairy

Foods to include in your diet

  • Non-fat (skim) or low-fat (1% or 2%) milk*
  • Powdered milk*
  • Non-dairy milks (such as soy milk and almond milk)
  • Lactose-free dairy products (such as Lactaid® products)
  • Yogurt*
  • Cheese*
  • Low-fat ice cream or sherbet
  • Eggs**

Foods to limit

  • High-fat milk and dairy products, such as:
    • Whole milk
    • Regular ice cream or sherbet
  • Milk and dairy products with lactose (if you have diarrhea after having them)

* If you have diarrhea after having these products, try non-dairy milks or lactose-free cheese or yogurt instead.

** When trying eggs, start with a small amount (such as 1 egg). Eggs may cause a bad odor (smell) when you open your pouch.

 

Meats and proteins

Foods to include in your diet

  • Lean animal proteins, such as:
    • Meat without visible fat
    • Skinless poultry
    • Fish*
  • Smooth nut butter (such as creamy peanut butter)*

Foods to limit

  • High-fat foods, such as fried meat, poultry, or fish
  • High-fiber foods, such as dried or canned legumes (beans)

* When trying fish and nut butters, start with small amounts. These foods may cause odor when you open your pouch.

Grains

Foods to include in your diet

Low-fiber foods, such as:

  • White bread, pasta, and rice
  • Bagels, rolls, and crackers made from white or refined flour
  • Cereals made from white or refined flour, such as Cream of Wheat®, Rice Chex®, and Rice Krispies®

Foods to limit

High-fiber foods, such as:

  • Whole grains, such as whole wheat bread, brown rice, bran cereal, quinoa, and buckwheat

Vegetables

Foods to include in your diet

Low-fiber foods, such as:

  • Well-cooked vegetables without skins or seeds, such as peeled potatoes, peeled zucchini with the seeds removed, and peeled tomatoes with the seeds removed
  • Lettuce
  • Strained vegetable juice

Foods to limit

  • High-fiber foods, such as raw vegetables (except lettuce)

Foods to avoid

  • Foods that may cause an ileostomy blockage, such as corn

Some vegetables may cause gas or odor for some people. If a certain vegetable causes gas or odor, avoid eating that vegetable. Read the section “Guidelines for Managing Common Problems” for more information.

Fruits

Foods to include in your diet

Low-fiber foods, such as:

  • Pulp-free fruit juice (except prune juice and grape juice)
  • Cooked peeled fruit (such as a cooked peeled apple)
  • Canned fruit (except pineapple)
  • Fruits with thick skins. Examples include:
    • Soft melons, such as watermelon and honeydew
    • Orange without the membrane (the thin clear or white part around each orange section)
    • Ripe banana*

Foods to limit

High-fiber foods, such as:

  • Raw fruits
  • Prune juice
  • Grape juice

Foods to avoid

For the first 3 to 4 weeks after your surgery, avoid raw fruits with skin, such as:

  • Apples
  • Strawberries
  • Blueberries
  • Grapes

These fruits may cause blockages.

* For the first 3 to 4 weeks after your surgery, don’t eat more than 1 small ripe banana per day. Eating too much banana may cause a blockage. For more information, read the section “Preventing Ileostomy Blockage.”

Fats

Foods to include in your diet

  • Foods cooked with a small amount of fat (such as olive or canola oil)

Foods to limit

  • High-fat foods, such as fried foods

When eating fats, start with a small amount. Fats may cause discomfort.

 

Drinks

Drinks to include in your diet

  • Water
  • Decaffeinated coffee or tea
  • Drinks that aren’t carbonated
  • Sports drinks (such as Gatorade® and Powerade®)
  • Rehydration drinks (such as Pedialyte® or a homemade rehydration drink)

Drinks to limit

  • Carbonated drinks, because they may cause gas
  • Alcoholic drinks

Reading Nutrition Facts labels

You can find the amount of fiber that’s in your food by looking at the Nutrition Facts label (see Figure 1). Nutrition Facts labels can help you compare the nutritional information in different foods.

Figure 1. Fiber information on a Nutrition Facts label

Figure 1. Fiber information on a Nutrition Facts label

 

Adding foods to your diet

After your surgery, you may have some food intolerances that you didn’t have before surgery. A food intolerance is when eating a certain type of food causes uncomfortable symptoms such as diarrhea, bloating, gas, or odor. Sometimes, food intolerances go away as your colon heals.

When you add foods back to your diet, introduce them one at a time. If a specific item of food causes uncomfortable symptoms, avoid eating it for a few weeks, then try it again. No two people will react the same way to food. You will learn through experience which foods, if any, you should avoid.

For more information about managing food intolerances and other common problems, read the “Guidelines for Managing Common Problems” section.

High-fiber foods

During your first appointment after surgery (about 2 weeks after your surgery), your doctor will tell you if you can start slowly adding high-fiber foods back into your diet. Doing this will help make your stool bulkier (more solid).

When you start adding high-fiber foods to your diet, do so gradually, by adding one food at a time. Make sure you’re also drinking enough liquids. Aim to drink 8 to 10 (8-ounce) glasses every day.

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Preventing Dehydration

When you have an ileostomy, you lose much more salt, potassium, and water than usual. This can lead to dehydration.

Throughout the day, keep track of how much liquid you drink (your liquid intake) and how much liquid comes out of your ileostomy (your ostomy output). Record your liquid intake and ileostomy output. You can use the table in the resource Liquid Intake and Ostomy Output Log. Your nurse will give you a measuring cup before you leave the hospital.

Contact your doctor if your output is more than 1000 milliliters (about 34 ounces) per day or is watery. They may recommend a fiber supplement or medication.

 

Signs of dehydration

Being dehydrated, even for less than 24 hours, can lead to kidney failure.

‌  If you have any of the signs of dehydration listed below, contact your doctor right away. If it’s after 5:00 pm, a weekend, or a holiday, call 212-639-2000 and ask for the doctor on call (covering) for your doctor.

 

  • Dizziness
  • Dark, amber-colored urine (pee)
  • Headache
  • Muscle cramps
  • Dry mouth or cracked lips
  • Urinating (peeing) less than usual
  • Feeling thirstier than usual
  • Heart palpitations (a fast, irregular heartbeat)
  • Loss of appetite
  • Emptying your ostomy pouch more often than usual (such as every hour)

Guidelines for preventing dehydration

Follow the guidelines below to help keep from becoming dehydrated.

  • Aim to drink 8 to 10 (8-ounce) glasses (about 2 liters) of liquids every day.
    • Don’t drink more than 4 ounces (½ cup) of liquids with meals. Avoid drinking any liquids for 1 hour before and 1 hour after meals. This helps make your bowel movements bulkier.
    • It’s important to keep drinking lots of liquids, even if your bowel movements are watery. Drinking less liquid won’t help your bowel movements be less watery, and it can lead to dehydration.
  • Drink sports drinks (such as Gatorade® or Powerade®) and oral rehydration solutions (such as Pedialyte®), especially if your ileostomy output is high (more than 1000 milliliters (about 34 ounces) per day). These drinks will help replace your fluid loss quickly. If you don’t have any sports drinks or oral rehydration solutions, you can follow the recipe below to make your own.
    • 4 cups (32 ounces, which is about 1 liter) of water
    • 1 cup (8 ounces) of orange juice
    • 8 teaspoons of sugar
    • 1 teaspoon of salt
    Put all ingredients into a cup with a lid. Shake well so the sugar and salt dissolve.
  • Limit or avoid the following foods and drinks. They can cause diarrhea or watery bowel movements, which makes you more likely to become dehydrated.
    • Limit liquids with caffeine (such as caffeinated tea and coffee) and liquids that are high in fat (such as regular milk) to 1 cup (8 ounces) a day.
      • If you drink coffee, choose a dark roast instead of a light roast. Dark roast coffee usually has less caffeine than light roast coffee because some caffeine is lost during the roasting process.
    • Limit the amount of alcohol you drink for the first 3 weeks after your surgery. Alcohol can cause you to lose more fluid. Talk with your healthcare team for more information.
    • Avoid sugary drinks, such as juice and soda. If you want to drink juice, choose 100% fruit juice and dilute it by adding 1 part water to 1 part of juice to reduce the sugar (for example, 4 ounces of juice mixed with 4 ounces of water).
    • Avoid artificial sweeteners, such as sorbitol and mannitol. Artificial sweeteners are often found in sugar-free drinks, candies, gum, and cough drops.
     
  • Eat foods that contain electrolytes. Electrolytes, such as sodium and potassium, can help prevent dehydration. Read the table below for examples of foods that are high in sodium and potassium.
    Foods High in Sodium Foods High in Potassium
    • Broth
    • Buttermilk
    • Pureed canned soups
    • Cheese
    • Commercially prepared or processed packaged foods (such as TV dinners)
    • Salted crackers
    • Salted pretzels
    • Soy sauce
    • Table salt
    • Tomato juice
    • Bananas
      • Don’t eat more than 1 small ripe banana per day for the first 3 to 4 weeks after your surgery. Eating more than this may cause an ileostomy blockage.
    • Broccoli
    • Coconut water
    • Chicken, fish, and veal
    • Oranges without seeds or membrane (the thin clear or white part around each section)
    • Orange juice without pulp
    • Potatoes without skin
    • Soy milk
    • Tomato or vegetable soup
    • Turkey
    • Yogurt
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Preventing Ileostomy Blockage

An ileostomy blockage (also called a bowel obstruction) is when your intestine is partially or completely blocked. It can be caused by food, scar tissue, or a twist in your intestine. If you have an ileostomy blockage, food, liquids, and gas won’t be able to move through your intestine as they usually do.

‌  If there’s no gas or bowel movements coming from your stoma for 6 hours and you have cramps, pain, nausea (feeling like you’re going to throw up), or all 3, call your healthcare team right away. These things are signs of an ileostomy blockage.

 

Guidelines for preventing an ileostomy blockage

Follow the guidelines below to help keep your ileostomy from becoming blocked.

  • If you have cramps, pain, or nausea, try following the tips below. They can help move food and gas along your intestine. Remember to call your doctor’s office if you haven’t passed gas or had a bowel movement in 6 hours.
    • Take a warm bath to relax your abdominal muscles (the muscles in your belly).
    • Change your position, such as drawing your knees up to your chest while you’re lying down.
    • Don’t take a laxative. This can make the problem worse. Talk with your doctor before taking any medications.
  • Avoid eating the following foods. They can cause an ileostomy blockage.
    Foods that may cause an ileostomy blockage
    • Apples with the skin
    • Bean sprouts
    • Cabbage, raw
    • Celery
    • Chinese vegetables
    • Corn
    • Cucumber
    • Dried fruit
    • Grapes
    • Green peppers
    • Mushrooms
    • Nuts
    • Peas
    • Popcorn
    • Relishes and olives
    • Salad greens
    • Seeds and nuts
    • Spinach
    • Vegetable and fruit skins
    • Whole grains
 
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Guidelines for Managing Common Problems

This section has guidelines for changing your diet to help manage common problems. You don’t need to follow these guidelines unless you’re having the problems listed.

If certain foods caused discomfort before your surgery, they will still cause discomfort after your surgery.

Diarrhea

Diarrhea is having loose or watery bowel movements more than 4 times in 1 day. Diarrhea can be caused by:

  • Certain foods
  • Skipping meals
  • Food poisoning
  • An infection in your intestine
  • Antibiotics and other prescription medications
  • A blockage in your intestine

If you’re having diarrhea, follow the guidelines below.

  • Contact your doctor’s office. They may give you a medication to help.
  • Drink 8 to 10 (8-ounce) glasses of liquids throughout the day. Drink sports drinks (such as Gatorade or Powerade) or an oral rehydration solution (such as Pedialyte), if you can.
     
  • Avoid the following foods and drinks. They may cause diarrhea.
    Foods that may cause diarrhea
    • Alcohol (such as beer and wine)
    • Bran
    • Broccoli
    • Brussels sprouts
    • Cabbage
    • Caffeinated drinks (especially hot drinks)
    • Chocolate
    • Corn
    • Foods with artificial sweeteners (such as mannitol, sorbitol, and xylitol)
    • Fried meats, fish, and poultry
    • Fruit juice (such as prune, apple, grape, and orange juices)
    • Green leafy vegetables
    • High-fat foods
    • High-sugar foods
    • Legumes (such as cooked or dried beans)
    • Licorice
    • Milk and dairy products with lactose, if you’re lactose-intolerant
    • Nuts or seeds
    • Peas
    • Spicy foods
    • Stone fruits (such as apricots, peaches, plums, and prunes)
    • “Sugar-free” canned or dried fruits
    • Tomatoes
    • Turnip greens
    • Whole grains (such as wheat bread)
  • Eat more of the following foods. They may help thicken bowel movements.
    Foods that may help thicken bowel movements
    • Applesauce
    • Bananas
    • Barley*
    • Boiled white rice
    • Cheese
    • Creamy nut butter (such as peanut butter)
    • Marshmallows
    • Oatmeal*
    • Pasta
    • Potatoes without the skin
    • Pretzels
    • Saltine crackers
    • Tapioca
    • White bread
    • Yogurt
    * These foods are whole grains. It’s okay to eat them if you’re having diarrhea, because they may help thicken your bowel movements.
 

Constipation

Constipation is having fewer than 3 bowel movements per week, having hard bowel movements, having a hard time passing bowel movements, or all 3. Constipation can be caused by:

  • Certain pain medications
  • Certain anti-nausea medications
  • Not eating enough fiber
  • Not exercising enough
  • Not drinking enough liquids

If you’re constipated, follow the guidelines below.

  • Contact your doctor’s office. They may give you a medication to help.
  • Try drinking hot water with lemon or lemon juice, coffee, or prune juice.
  • Do light exercise (such as walking), if you can.
  • Ask your doctor if eating high-fiber foods or taking a fiber supplement will help.
 

Gas and odor

For the first few weeks after your surgery, it’s normal to have gas in your pouch and odor when you open your pouch. You may have more gas if you had a robotic surgery.

If you’re having problems with gas or odor, ask your wound, ostomy, and continence (WOC) nurse for suggestions. You can also follow the guidelines below.

  • Avoid the following things. They can cause gas.
    • Chewing gum
    • Drinking with a straw
    • Smoking or chewing tobacco
    • Eating too fast
    • Skipping meals
  • Ask your doctor or nurse if you can take an over-the-counter medication such as Beano® or simethicone before meals to help prevent gas.
  • Eat less of the following foods. They may cause gas, odor, or both.
    Foods that may cause gas, odor, or both
    • Asparagus
    • Alcohol, especially beer
    • Broccoli
    • Brussels sprouts
    • Cabbage
    • Carbonated drinks (such as soda)
    • Cauliflower
    • Corn
    • Dried beans and peas
    • Eggs
    • Fish
    • Garlic
    • Grapes
    • Leeks
    • Milk and dairy products with lactose, if you’re lactose-intolerant
    • Onions
    • Peanuts
    • Prunes
  • Eat more of the following foods. They may help prevent gas, odor, or both.
    Foods that may prevent gas, odor, or both
    • Buttermilk
    • Cranberry juice
    • Kefir
    • Parsley
    • Yogurt
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Call Your Doctor if You Have:

  • Any signs of dehydration.
  • No gas or bowel movements coming from your stoma for 6 hours and cramps, pain, nausea, or all 3.
  • Diarrhea and a fever above 100.4 °F (38 °C).
  • Diarrhea and vomiting (throwing up).
  • Diarrhea that doesn’t stop after 24 hours.
  • Diarrhea and smelly discharge, cramps, or forceful liquid output from your stoma.

If you have questions about your diet, call 212-639-7312 to speak with an outpatient clinical dietitian nutritionist. You can reach a staff member Monday through Friday from 9:00 am to 5:00 pm.

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