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Food with a stoma


* What are the things you should watch for?
* Fibre
* Gas and odour formation
* Discolouration of the stool
* Moisture
* Salt (sodium)
* Potassium
* Iron
* Blockage (obstructions)
* Diarreah
* A handy food list
* Gaining weight
* Extra nutrition
* Probiotics
* The dietician

What are the things you should watch for?

When Eliene heard that she would be getting a stoma, she was very worried that she would have to follow a strict diet. She also thought that there would be many things she could no longer eat. But that is absolutely not the case!! Actually with a stoma you can eat and drink everything, you just have be more aware. You must find out for yourself which products cause blockages, diarreah, gas and/or odour formation, discolouration of stools or urine etc. Everyone can react differently to certain food stuffs. One person can eat a load of onions without forming gas, whilst another only has to eat a small piece to have a lot of trouble with air. It is therefore important for you to determine yourself what you can and cannot tolerate. Keep in mind that sometimes you can tolerate the food better than another time, so keep on experimenting.


Avoid at least a bare diet. It is best to have more, smaller meals throughout the day. That way the intestines have a better chance of absorbing the useful substances from the food. It is also important to chew your food well. Otherwise you can, especially with an ileostomy, get a blockage. So take the time to eat and drink quietly and ensure regularity. It is also important to drink sufficient. If you have loose stools you should remember to: “drink whilst eating and eat whilst drinking”.

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Food fibres are important for the functioning of the large intestine. With a colostomy make sure you get enough fibre. They are available primarily in vegetables, fruit and beans. They enter the large intestine undigested where the intestinal bacteria breaks them down. The products which are released stimulate the intestinal working but can also help with diarreah. Non soluble fibres also arrive in the large intestine undigested. They ensure that the waste is removed from the large intestine. This sort of fibre also acts as a sort of sponge, absorbing and holding moisture, making a softer stool and a larger volume. These fibres sit primarily in cereal products. In constipation both soluble and none soluble fibres play a role. According to the Guidelines of Good Nutritional Health the recommendation is 30-40 grams of fibre a day. It is important to drink sufficient with the fibre. If you eat more fibre, you can suffer from flatulence at the beginning.

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Gas and odour formation

Gas formation is a normal consequence of digestion and everyone has it. It is also not completely preventable. It can be slightly reduced. Most of the gas (70%) consists of ingested air. This is mainly caused by talking and eating too fast. Chewing gum, drinking through a straw, smoking, nervousness and badly fitting dentures can also mean a lot of air is ingested. You should take this into account. You should also take account of foods that cause gas (see the Foodlist below).


An empty intestine also causes gas formation. Therefore it is pointless to skip meals to try to avoid gas formation. You can simply continue to eat products that cause gas, especially because they contain valuable nutrients. You can, of course, take this into account when you go out and then of course you won’t have any gas. One tip is that if you feel the gas coming, place your hand over the stoma. This reduces the noise. There are herbs which can reduce gas output such as dill, coriander, sage, mint, cumin, horseradish and fennel. In the Foodlist on this page you will find products which may cause a strong odour. Odour formation can be helped by taking sour milk products (such as buttermilk and yoghurt) during or after a meal.

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Discolouration of the stool

After eating certain food stuffs your stools can have a different colour than normal. That is because these food stuffs contain a (natural) dye which is not degraded by the body. This is totally not a problem, but in the early days it can give you a scare. Extra discolouration can be caused by amongst other things; iron tablets, ferrous rosehips juice, blackberries and spinach (an almost black colour) and beet (a red colour).


Picture source: Baas op eigen buik

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Moisture is important for everyone, whether you have a stoma or not. Moisture transports nutrients and waste products through the body. We also need moisture to regulate our body temperature. You can go without food for quite a while, but not long without water. If you do not drink enough in time, then you will quickly dry out. We normally notice hunger quite quickly, but with thirst it is somewhat more difficult. We often discover it too late. Because by the time we feel thirsty, the moisture content of your body is already too low. Thirst only occurs when approximately 2% of the body weight is lost; for an adult that represents a moisture deficiency of 1.5 litres. Women consist of 52% water on average and men 63%. This is called the so called moisture balance. Through drinking sufficient water you keep your moisture levels level. If the colour of your urine is yellow to dark yellow, then you have drunk too little. If the urine is almost colourless, then you have taken enough moisture onboard. With a lack of moisture the follow symptoms can occur: Lethargy, headache, inactivity, drowsiness, lack of appetite, a dry tongue and reduced urine production.


Fluid does not just mean coffee, tea or water, but also for example soups, yogurt or cream. There is also water in solid food, vegetables and fruit. Burning carbohydrates also releases water, around 1 litre on average per day. What we need in addition to this depends on the sort of stoma, but also other factors. The more active you are, the more moisture you will need. An hour of moderate exercise can cause you to lose 1 litre of moisture through perspiration. Cyclists in the Tour de France sometimes drink 8 litres a day. You should also drink more to maintain your moisture levels by high temperatures, high humidity or even dry air. Above all, older people are advised to drink more. You can also lose moisture with certain foodstuffs, such as food which contains a lot of salt or protein, or alcohol.


With a colostomy too little moisture can cause hard stools, causing a high risk of constipation. It is best to drink 1.5 to 2 litres a day, which is around 10 to 15 glasses. With an ileostomy the uptake of moisture is reduced. Therefore it is very important, spread through the day, to drink 2 to 3 litres a day, which is around 20 glasses.


BWith a urostomy the bladder is no longer present and there is a shorter connection between the kidneys and the outside world, creating a chance of urinary tract infection. By drinking sufficiently, at least 2 litres a day, the composition of the urine is less concentrated. Strongly concentrated urine (alkaline urine = too high a pH (acidity) is actually a good breeding ground for bacteria. Alkaline urine also affects the adhesive strength of the base plate, which degrades quicker. Also an alkaline environment may also form salt crystals (read more about salt crystal formation on this page).

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Salt (sodium)

Salt is a natural product. It is extracted from the soil and out of the sea (sea salt). The chemical name for ordinary table salt is sodium chloride. In 1gram of salt (1000 mg) are 400 mg of sodium and 600 mg of chlorine. It also contains an anti clotting agent. Sea salt also contains some other minerals and also trace elements.


With an ileostomy you lose, because the large intestine no longer functions, in addition to moisture also a lot of salt. You also lose a lot of salt if you have diarrhoea with a colostomy. It is best to use around 15 grams of salt a day. The average Dutch person uses 9 grams of salt, which means you need to use an additional 6 grams of salt per day. A shortage of salt can lead to the following complaints: fatigue, irritability, dizziness, difficulty sleeping, rapid weight loss and muscle cramps.


In the Foodlist you can find examples of salt rich products. You can also use some extra salt in your cooked meal. Take care that you do not just choose fatty things when you need salt, for example cheese and salt herring. Salted liquorice does not help, because it does not contain kitchen salt (sodium chloride), rather ammonium chloride. There are also salt tablets and salt capsules which you can use if you cannot get enough salt in your body. Mineral waters often have salt added and there are also sports drinks which contain extra salt. Remember that the other people around you without a stoma do not need extra salt.

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Together with moisture and salt (sodium) you lose a lot of potassium with an ileostomy or diarreah. The amount of potassium in the body is affected by the amount of sodium, the two are balanced. Together they play a role in the moisture balance in the body, the transmission of stimuli in the nervous system and they make an important contribution to the regulation of blood pressure. A shortage of potassium causes nerve and muscle disturbances. You can also suffer from fluid retention (oedema), tinnitus and sleep problems. In the Foodlist you can see examples of potassium rich products.


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With intestinal problems iron deficiency (and ultimately anaemia) can develop due to the iron from your food is no longer properly absorbed. This can occur due to blood loss during an operation, inflammation or if a piece of the intestine is removed (and therefore less absorption of iron). An iron rich diet can prevent or reduce a deficit, but with a serious iron deficiency you should consult your doctor. They can prescribe iron preparations or an iron infusion. With iron deficiency amongst other things you can feel tired, dizzy, headache and pale. An adult man needs 9 mg iron a day; an adult woman needs 15mg. the iron requirements of women is higher due to the iron loss caused by menstruation. After the menopause the daily requirement is 8mg.


Iron rich foods are: meat and meat products, egg, fish, legumes, nuts and seeds, wholemeal bread and whole grain cereals, potatoes and vegetables and (dried) fruit. There are also iron enriched products such as EverGreen, MilkBreak, FruitKick and Roosvicee Ferro. Apple syrup also contains a lot of iron. It is also recommended to eat a product with every meal that contains a lot of vitamin C, because vitamin C promotes the absorption in the intestines of iron from plant products. Vitamin C rich foods are vegetables, fresh fruit, potatoes, fruit juices based on citrus fruits and juices where extra vitamin C is added. Iron from animal products, such as meat, fish and chicken, are absorbed better in the body than iron from plant foods, such as bread, vegetables and pulses.

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Blockage (obstructions)

A blockage can occur amongst other reasons, as a result of an undigested wad stuck in the opening of your stoma. The wad can develop through not chewing sufficiently well certain food stuffs. You have the most chance of a blockage with an ileostomy. During a severe blockage you may have no stools coming from the stoma for several hours. You often then have a strong abdominal pain, cramps, a turned up stoma and you can also be sick. Drinking a lot and massaging the abdomen around the stoma can help. You can also rinse the stoma with water, in the hope of loosening the wad.


It is important to eat slowly, to cut the food finely or to peel it, remove the seeds from fruit for example and to chew everything well. Take care if you eat something like a Bounty for example, that you drink with it, because the coconut swells. One tip that I got for a blockage was to drink a glass of wine, which would stimulate the intestines so that they start working again. If the blockage persists for too long you should contact your GP or stoma nurse.

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Diarreah is, certainly with an ileostomy, very difficult. You lose an extra amount of fluids replace this or you will dehydrate. You can do this through drinking at least 1 litre of ORS (oral rehydration solution, a solution of salts and (grape) sugar or starch in water) or drinks which can be well absorbed by the intestine such as bouillon, tomato juice and others. Add to this with water and other drinks up to 2 to 2.5 litres. Eat easily digested food. Think also about your salt and potassium intake. If you show the signs of dehydration (very thirsty, nauseous, drowsy, dark coloured urine, weight loss etc) then warn your doctor. If you cannot drink enough yourself you will need to have an infusion in the hospital.

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A handy food list

Do not be afraid of how many products are below. You can eat anything with a stoma. You should just take more care with certain products. But what causes a blockage for one person may cause no problems at all for another. The same goes for products that cause gas, odour etc. You must therefore find out for yourself which products suit you and which don’t. This list should be viewed as a practical advisor.


Products that cause odour formation
           Products that cause gas       Products that thicken stool       Products that thin stool     
Products that can cause blockage
Salt-rich products
-rich products
asparagus  beer  potatoes  aspartame/ sorbitol  almond paste  bread Avocado


beans apple sauce beer pineapple crisps potatoes
beans  chocolates bananas leaf vegetables apples egg cocoa
broccoli  broccoli rusks beans  asparagus cheese crisps
chocolate  mushrooms bread broccoli mushrooms soy sauce fruits (eg bananas)
 eggs chinese & Indian dishes crackers chocolate  citrusfruits chicken vegetables (e.g. spinach)
some cheeses eggs boiled milk fried food peas (large) pizza cucumber
 garlic peas cheese spicy food  grapes soup/ broth milk products
brassica  beaten egg whites bacon cubes` plums  dried fruit tomato juice nuts
fizzy drinks garlic gingerbread raw vegetables  coarse uncooked food fish (e.g. herring) legumes
melon  coffee pasta fresh fruit coconut salted meat tomatoes (juice/ puree)
 nuts and peanuts cumcumber peanut butter fruit juice  brassica meat(e.g. ham &smoked meats fruit juice
pulses brassica  rice   maize  dairy products sunflower seeds
 leeks   fizzy drinks salted items    nuts and peanuts’s    
plums chewing gum  yoghurt   french fries    
sharp spices and herbs alcohol     pulses    
brussels sprouts melon     popcorn    
 tea (for urostomies)  new potatoes     purslane    
onion nuts and peanuts      leeks    
 fish immature fruit     rhubarb    
 Vitamin B tablets paprika      rice    
   pulses     raisins    
  leeks       celery    
  radishes     bean-sprouts     
  sharp spices      tough and fibrous meat    
   soya bean products     carrot    
  brussels sprouts      seeds    
  onion     sauer-kraut    
   fresh bread          

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Gaining weight

With a stoma and/or disease it may be that your weight is too low. It is important to eat sufficient and healthily. A hamburger diet or excessive snacking can cause cardiovascular disease. Eat every two hours and do not miss meals. Because you need more energy, it is wise to eat regularly. Do not eat heavy products which fill you up too much. Also eat something before going to bed. It is preferential to choose foods which give you plenty of energy. For example, whole milk and milk products, full fat cheese, fatty meats and sugar-rich products. You can make your food energy richer by adding, for example, unbeaten cream, crème fraiche or sour cream. Also through using extra butter, margarine (such as melting a lump in vegetables), oil or adding sugar or fruit syrups. Products with 0% fat, low fat and sweeteners instead of sugar are best avoided, as they offer little or no energy. Drink fruit juice, milk or sports drinks instead of water. Water fills the stomach and has no calories. Do not drink just before your meal. Have snacks in addition to the three main meals. Perhaps have a cup of soup during lunch? Take it with you, and not as a replacement for sandwiches. Take the time to eat; stress also has a negative effect. Lastly make sure you have sufficient variety in your food and drink.

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Extra nutrition

Sometimes it is necessary to have special additional food. For example, if your disease asks too much of your calorie intake and you consequently lose weight too quickly. Or because eating doesn’t go well for whatever reason. In such a case it is important to work with a dietician to look at what can be improved in your diet. Often additional nutritional drinks are a solution. This is also very wise in the run up to an operation because a good nutritional status improves the recovery.


Brand: Nutricia


Two to three packs a day, in addition to the normal diet, leads to improvement after six weeks to three months. If the dietician prescribes it, then it is often refunded by insurance. They can request a so-called flavour package for you. There are all types and flavours in this. You have a drink supplement based on milk, on yoghurt and on fruit. But you can also have desserts and soups. The first provides primarily more energy, the other more protein. You can decide for yourself which you find the tastiest and which suits you the best, and then you can order it yourself form the supplier. There is a special variant of liquid supplement for children. Finally you have supplements in the form of an energy rich powder which you can mix into your food.  

Brand: Nutricia


When you cannot or may not eat, extra nutrition may be necessary. Via a tube through the nose, a thin liquid food enters the gastro-intestinal tract. This special nutrition can completely replace the daily food, or be an addition to it. There are various types of special nutrition, your doctor or dietician will decide which is the most appropriate for you. There are polymeric food stuffs which have to be broken down in the intestines. Monomeric food (colloquially known as “astronaut food”) consists of products which are already partially digested. This food is for people who have complaints of malabsorption. Hereby there is a disturbance in the digestion, absorption and the movement of food stuffs in the intestines. If you lose too much fluid or have large wounds, then you will be given a protein food. With broken bones or a large loss of energy, you will get an energy rich supplement. Finally, with faeces problems, there is a supplement with extra fibre and little fat. Above all you do not taste it, so different tastes are pointless with extra feeding!


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Probiotics (from the Greek pro bios “a favourable life”) are products which contain large amounts of live micro-organisms, such as lactic acid bacteria. These micro-organisms, such as for example bifidobacteria lactobacilli, can survive in the stomach acid and thereby reach the intestine alive. There they join the good bacteria and help to keep the gut flora in balance. A balanced intestinal flora provides for a good natural resistance and offers protection against infections, diseases and intestinal problems.




The Japanese doctor and scientist Dr.Minoru Shirota thought in 1921 already that it would do good to add good bacteria to ourselves via our diet. Finally in 1930 he was the first to add lactic acid bacteria which could survive the stomach acid. This unique bacterial strain was named after him: the Lactobacillus casei Shirota (LCS). Since he wanted everyone to have access to the LCS, he developed a drink: Yakult. This was one of the first Probiotics to come on the market. Beneath you can see one of the first bottles of Yakult on the market.


Nowadays you can have many different Probiotics: including the fermented milk and yoghurt products Yakult, Vitamel, Activia, Actimel and capsules containing probiotics, which includes Orthica Orthiflor, Aciforce from Vogel and Acidophilus from Previt. Simple yoghurt and cottage cheese also contain lactic acid bacteria, but because these cannot survive the “acid” stomach, they are not part of the probiotics. The bacteria from the probiotics that do survive the stomach acid do not do it that well: barely 10% survive the journey to the intestines. Since a handful of bacteria do nothing, bacteria drinks, powders or capsules must contain at least 100 million, and preferably a billion, live bacteria to have any impact.


There have been many studies done on the effects of probiotics and the results are varied. Some are very positive but others believe that more research is necessary. Recently there were two health claims made by Yakult, which were accepted by the Code of conduct for the scientific substantiation of heath claims, which is managed by the Nutrition centre. Yakult may improve the output in people sensitive to constipation. Yakult may also contribute to a balanced gut flora by increasing the number of lactobacilli. What is scientifically proven is that the probiotics VSL-3 reduce the risk of pouchitis (inflammation of the pouch) in people with ulcerative colitis who had previously had the large intestine removed. There is also evidence hat using probiotics at the same time as antibiotics, reduces the chance of diarreah and infections. Further it is shown that probiotics can be beneficial during diarreah, but also with (chronic) constipation.

Everyone reacts differently to probiotics; one person may get many benefits and another person may get intestinal complaints. Therefore you should try it for yourself, and consult with your doctor, if it doesn’t benefit, then it doesn’t harm either.

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The dietician

A dietician can help you with your nutrition and diet. They take account of your illness, your treatment or surgery and your individual needs and capabilities. They check your diet is correct and can give you tips to improve it. Most hospitals will send a dietician to see you if you get a stoma, but you can also make an appointment yourself. They are employed in the hospital, in home care and in private practice.






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