Ileoanal Pouch Surgery
DIETARY GUIDELINES FOR ILEOANAL POUCH
By Linda B. Hurd, RN, MSN and Maryann King, RD
- Good nutrition plays an essential role in gaining and
maintaining health and vitality. Patients and family members generally have many questions
about diet and nutrition following ileoanal surgery. Below are listed guidelines that can
assist you in maintaining good nutrition and enable your body to adapt as easily as
possible to it's new anatomy and digestive system.
- Please keep in mind that each individual responds to surgery and the recovery process
differently and therefore will need to find a diet approach that works best for them. For
example, a food that causes a problem to one person may not cause a problem for another.
There is quite a bit of trial and error that takes place during these months. Try to be
patient and assure yourselves that eventually you will find a diet that works for you!
- Below are listed some general dietary tips for ileostomy/ ileoanal pouch patients:
- 1) Eat a balanced diet. (i.e. sensible flood choices from all food groups, break
(starches), fruits, vegetables, and proteins)
- 2) Eat slowly and chew your food well.
- 3) Drink plenty of fluids each day. (i.e. more than 8 cups of fluid per day)
- 4) Add foods to your diet gradually to see how your body responds.
- 5) *Watch food that are high in fiber, sometimes these foods can cause blockages.
- 6) *Avoid nuts seeds and corn.
- *(These items pertain to patients with an ileostomy and to patients during the several
months following ileostomy closure.
DIETARY MODIFICATIONS AFTER THE FIRST SURGERY:
(with a temporary ileostomy)
- Ileoanal surgery is generally performed in two stages. The following will outline
dietary considerations for each of these stages.
During your first surgery your colon (large intestine) is removed.One of the primary
roles of the colon is to absorb fluids. With the large intestine gone, larger quantities
of fluid are lost with the stool from your ileostomy. Your body will adjust to the absence
of the large intestine as your small intestine learns to absorb more fluids. In the
meantime, you will need to increase your fluid intake to make up for the fluid loss and
avoid becoming dehydrated.
The initial post-operative diet will be clear liquids and gradually advanced to a low
residue diet. Many patients can eventually tolerate a normal diet; however, some
adjustments may be required to prevent obstruction, watery ostomy output, excessive odor
and gas. The advantage of this stage for many patients, particularly for those who have
been very ill or on a very restricted diet prior to surgery, is that once again they can
enjoy eating and include foods they have missed for a long time!
Again, because of the large amounts of fluids that are lost through the ostomy,
particularly during those early weeks following surgery, patients need to be aware of the
symptoms of dehydration. Symptoms to watch for are:
- Extreme thirst
- Dry mouth and dry skin
- Shortness of breath
- Decreased urine output or urine that is dark in color
- Nausea or abdominal cramping
If you feel you are dehydrated, notify your doctor immediately.
Tips to prevent hydration:
- Drink at least 6 to 8 glasses of fluids a day. Drink a combination of water and
beverages which contain sodium and potassium including Gatorade, Pedialyte or other drinks
that contain electrolytes.
- In warm weather and during exercise, drink extra fluids.
- Add a beverage to each meal. This allows food to pass through the intestine more easily
and can prevent obstruction.
- Drink caffeine containing beverages in moderation- excessive caffeine can have a
"diuretic effect" and cause dehydration.
Include foods that are high in sodium and potassium.
(i.e. Sodium: broths/bouillon, soups, crackers, pretzels, salted spices, bacon, ham,
tomato and vegetable juice, buttermilk, soy sauce)
(i.e. Potassium: bananas, orange juice, apricot juices, tomato juice, grapefruit juice,
squash, potatoes, tomato sauce, peanut butter (smooth)
Several weeks after surgery, your physician may indicate that you may eat what-ever you
can tolerate. Remember...
1) Add new foods one at a time: by this we mean try only one new food at a time. This
way if a problem is identified, you can eliminate this food from your diet for the time
being. This doesn't mean that you won't be able to eat this food eventually only that you
should wait awhile before trying that food again.
Chew foods very well:
The following are lists of foods to be considered when preparing diets for an
- To prevent obstruction:
Approach the following foods with caution:
- corn on the cob
- bean sprouts
- citrus fruit membranes
- nuts, coconuts, peanuts
- tough meats, shrimp, lobster
- fruits with seeds
- raw fruits
- bamboo shoots
Foods and beverages that may cause loose stools:
Approach with caution potential problem foods including:
- apple juice
- prune juice
- baked beans
- green beans
- highly spiced foods
- raw fruit
Foods that may cause gas and odor:
These should be tried again at intervals:
- dried beans and peas
- cabbage family
- carbonated beverages
- strong flavored cheeses
- spiced foods
- fatty foods (pastries/deep fried foods)
- whips and meringues
Other general guidelines: avoid chewing gum,
Do not use a straw, Chew with mouth closed,
Eat regular times; Add cranberry juice, yogurt, and buttermilk.
- When a food causes a problem, it should be eliminated temporarily, and then tried again
at a later date. There is some adaptation in time.
- Boiled milk, rice, creamy peanut butter, and potatoes may be used as "binding"
in some patients
- Some foods that can help thicken your stools are: applesauce, bananas, buttermilk,
cheese, marshmallows, pretzels, toast, yogurt, and tapioca pudding.
- The goal of your diet should he to maintain a well balanced diet and make food choices
from all the food groups.
DIETARY SUGGESTIONS AFTER SECOND SURGERY FOR
- For the months following surgery (up to one year) the pouch will go through a period of
adaptation. The pouch storage capacity will increase and the number of bowel movements per
day will decrease. Stool consistency thickens over time. Diet and medication can help to
improve pouch function. You may find that by altering your diet a bit it can help to slow
down bowel function and prevent perianal irritation.
- 1 ) Follow the same diet you were on previously to slow down the digestive process and
allow the pouch to enlarge; this will decrease the number of bowel movement.
2 ) When adding new foods to your diet, you may want to refer to potential problem list
and initiate slowly. If a particular food is not tolerated, try it again at a later time.
3 ) Continue to drink six to eight glasses of fluid each day.
4 ) High potassium foods will be needed in the presence of diarrhea.
5 ) Limit the intake of foods high in simple sugars since these can aggravate diarrhea.
6 ) Eat regularly, don't skip meals. Remember, increase gas is produced when bowels are
7 ) Eat small frequent meals.
8 ) Sometimes eating rice, potatoes, or pasta once per day may help reduce stool frequency
and perianal irritation.
FOODS THAT MAY INCREASE POUCH OUTPUT:
The following foods can affect ileoanal pouch functioning:
raw fruits and vegetables (especially broccoli, beans and spinach)
leafy green vegetables
caffeine containing beverages
FOODS WHICH MAY DECREASE POUCH OUTPUT :
boiled rice, pasta
creamy peanut butter
potatoes (without skins)
FOODS WHICH MAY CONTRIBUTE TO ANAL IRRITATION:
certain raw fruits and vegetables (e.g., oranges, apples, coleslaw,
celery and corn)
dried fruits (e.g. raisins, figs)
food with seeds
Once again you will find that diet and food tolerances are very individual.
The lists above are not meant to make your diet selections a chore, rather
to assist you in modifying your selections should you encounter some difficulties.
Patience is a virtue during the early weeks following your second surgery.
Keep in mind though that you are well on your way to good nutrition and healthy
- 1.) Hurd, Linda. Presenting a patients guide to ileoanal reservoir procedure.
- Wound Management 1992; 38(5)2-60.
2.) Providence Medical Center Nutrition Services. Nutrition and Dietary Guidelines
for use with the ileoanal reservoir (booklet). Sisters of Providence Health
3.) Zeman, Francis. Clinical Nutrition an Dietetics. 2nd Edition. NY: Macmillan.
4.) Rolstad, Bonnie Sue and Rothenberger, David. Ileoanal reservoir: a patient
resource Minneapolis: The Upjohn Company.
5.) Chapman, Georgina. A patient handbook for the ileoanal reservoir procedure.
- District Hospital Group. Montreal: Convatec.