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For patients with severe, chronic digestive disorders, surgical procedures to bypass the injured part of the digestive tract can be a lifesaving option. In an ostomy surgery, the surgeon creates an artificial opening in the body to allow digestive matter to pass into an external bag, called an ostomy bag.

For the thousands of patients every year who undergo lifesaving ostomy surgery, their first questions are often about diet.

To answer these questions, we sat down with Therezia Alchoufete, a registered dietitian nutritionist (RDN) specializing in gastrointestinal diseases at the UPMC Inflammatory Bowel Disease (IBD) Center.

Q: How does a patient’s diet change immediately after ostomy surgery?

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A: Immediately after surgery, your intestines need time to heal, so you’ll usually be sent home on a diet of clear liquids. As you recover, your colorectal surgeon will decide how to advance your diet and when to return to eating solid foods. It’s important to work with your dietitian to avoid foods that are high in fiber for about four to six weeks, or until your doctor determines that you are ready to go back to a normal diet.

Q: Does a patient with an ostomy bag need to change their long-term diet?

A: After recovery, you can often return to your pre-surgery diet with some minor modifications, but keep in mind that these changes may differ for each person. When managing your diet, the goal is to avoid blockages in the new opening, reduce gas and odor, improve stool consistency, and balance fluids and electrolytes.

At the UPMC IBD Center, we work with each patient individually to determine which foods they can tolerate and which foods cause discomfort. Common foods that patients with an ostomy should stay away from include:

  • Cauliflower
  • Onions
  • Garlic
  • Dairy
  • Beans
  • Carbonated beverages like soda or seltzer water

Chewing gum and drinking out of straws can increase bloating and gas, so you should avoid them. Sticking to a regular meal schedule that prevents long breaks between meals also can be helpful.

Additionally, after surgery, it’s important to stay hydrated and have a balanced intake of fluids with electrolytes. Some helpful foods, such as melons, tomatoes, cucumbers, peaches, and lettuce, have high water content with some electrolytes. You may need to peel some cucumbers and tomatoes to avoid the skins. Caffeine and alcohol can make it difficult to stay hydrated, so remember to sip these drinks in moderation and keep drinking plenty of water.

Although you may be able to handle foods that you could not eat prior to surgery, new foods should be introduced in small portions every three to five days, so you can keep track of which foods you can tolerate.

Q: How can a patient with an ostomy bag reduce the chance of a blockage?

A: All patients who have undergone ostomy surgery should do what they can to avoid blocking the new opening. For patients with an ostomy bag connected to the end of the small intestine (called an ileostomy), this can be especially challenging because the small intestine is very narrow, so food can get stuck and lead to discomfort.

Eating foods that are high in certain fibers in large quantities can cause blockages, so patients should be cautious with the following:

  • Raw fruits with skins and seeds
  • Vegetables with skins and seeds
  • Popcorn
  • Nuts and seeds

Remove skins and seeds and chew extra thoroughly to make sure your food is broken down and to prevent large particles from passing through your intestines. If you experience severe cramping, pain, swelling, no stool, or watery stool with a bad odor, contact your doctor immediately.

Q: How do dietitians support patients with an ostomy bag?

A: There is no one-size-fits-all diet for patients living with an ostomy. Every patient is unique and requires a personalized plan to fit their illness, their lifestyle, and their eating preferences.

A dietitian can help you develop a highly personalized nutritional plan that is supported by scientific data but is tailored to your individual needs. A dietitian also can help you to track your diet to discover which foods you may have trouble tolerating so you can minimize your digestive discomfort.

For more information or to schedule an IBD nutrition appointment with Therezia Alchoufete, visit the UPMC Inflammatory Bowel Disease Center or call 412-647-4194. Patients without an IBD diagnosis who would like to discuss dietary management with a nutritionist may visit and contact UPMC Nutrition Services.

About Digestive Disorders

The UPMC Digestive Disorders Center cares for a wide range of gastrointestinal conditions and diseases, from diagnosis to treatment. Upon referral from your physician, we coordinate your testing and treatment. If you have a complicated condition, we can refer you to one of UPMC’s digestive health centers of excellence. Most of our office visits and outpatient procedures take place at UPMC Presbyterian or UPMC Magee-Womens Hospital in Oakland. We also provide inpatient care at UPMC Montefiore or UPMC Presbyterian in Oakland.