Ileoanal Pouch Surgery
Dietary Guidelines

Dietary Guidelines for Ileoanal Pouch surgery (Main article)

Dietary Modifications after the first surgery

Dietary Suggestions after second surgery

Foods and Beverages that may cause loose stools

Foods thet may cause gas and odor

Foods that may increase output

Foods which may decrease output

Foods which may contribute to anal irritation

References

 

DIETARY GUIDELINES FOR ILEOANAL POUCH SURGERY

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:

 

Tips to prevent hydration:

 

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 ileoanal/ileostomy patient.

To prevent obstruction:
Approach the following foods with caution:
  • corn on the cob
  • lettuce
  • bean sprouts
  • peas
  • citrus fruit membranes
  • nuts, coconuts, peanuts
  • tough meats, shrimp, lobster
  • fruits with seeds
  • raw fruits
  • celery
  • coleslaw
  • bamboo shoots
  • tomatoes
  • pineapples
  • mushrooms

Foods and beverages that may cause loose stools:
Approach with caution potential problem foods including:

  • apple juice
  • prune juice
  • baked beans
  • green beans
  • spinach
  • highly spiced foods
  • beer
  • milk
  • cabbage
  • raw fruit
  • broccoli

Foods that may cause gas and odor:
These should be tried again at intervals:

  • asparagus
  • dried beans and peas
  • mustard
  • cabbage family
  • onions
  • carbonated beverages
  • eggs
  • radishes
  • pickles
  • beer
  • fish
  • cucumbers
  • strong flavored cheeses
  • melons
  • 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.

 

TIPS:

 

DIETARY SUGGESTIONS AFTER SECOND SURGERY FOR
ILEOANAL POUCH:

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.

SUGGESTIONS:

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 empty.

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

•  spicy foods

•  beer

•  alcohol

•  caffeine containing beverages

•  chocolate

FOODS WHICH MAY DECREASE POUCH OUTPUT :

•  applesauce

•  bananas

•  boiled rice, pasta

•  cheese

•  creamy peanut butter

•  tapioca pudding

•  potatoes (without skins)

FOODS WHICH MAY CONTRIBUTE TO ANAL IRRITATION:

•  certain raw fruits and vegetables (e.g., oranges, apples, coleslaw, celery and corn)

•  popcorn

•  Chinese/oriental vegetables

•  nuts

•  coconut

•  dried fruits (e.g. raisins, figs)

•  food with seeds

•  spicy foods

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 lifestyle.

References:
1.) Hurd, Linda. Presenting a patients guide to ileoanal reservoir procedure. Ostomy/
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 System.

3.) Zeman, Francis. Clinical Nutrition an Dietetics. 2nd Edition. NY: Macmillan. 1991; 272-274.

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. Calgary
District Hospital Group. Montreal: Convatec.
* Health Products *
Health Products used to aid the digestive system include Apple Pectin,
Fiber Food, and Chitosan. Others are Bromelain and Psyllium husk.

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