Patient Information High output stoma dietary information The information contained within this diet sheet is intended to be used alongside the tailored dietary advice provided by your dietitian Author: Dietetics and Nutrition Produced and designed by the Communications Team Issue date Jan 2016 - Review date Jan 2019 - Expiry date Jan 2020 Version 2 Ref no. PILCOM1737
Having a high output stoma can mean that nutrients and fl uids pass rapidly through your bowel, which can lead to poor absorption of nutrients, fluid and salts. Over time, your bowel may begin to absorb nutrients more efficiently and your output may begin to thicken. A high output stoma can lead to severe dehydration and weight loss. Learning about the types of food and fl uid you should take and in what quantities can help successfully manage your stoma output. 2
Food Fibre Foods that are high in fi bre are often diffi cult to digest and can increase your output, lower fi bre foods are therefore recommended. Below is a table showing the type of foods to have and those to be avoided. Low fibre foods White varieties of rice, pasta and bread Tinned fruit Ripe fresh fruit without skin, pith, pips or seeds Peeled well cooked or pureed vegetables including passata Fruit juices with no pulp - in moderation Dairy foods - plain cheese, yogurts, milk (including yoghurt with fruit puree) Lean meat, fi sh and eggs Foods to avoid Brown/whole varieties of rice, pasta and bread Hard fruits, e.g. pineapple Unpeeled fruit, pips, stalks, seeds and pith Vegetable skins, pips, stalks, seeds and pith Peas, pulses (e.g. lentils, dahl); beans (e.g.kidney beans, mung, chickpeas) Flours made from pulses (e.g. gram fl our) Raw vegetables and windproducing vegetables (e.g. Brussel sprouts, cabbage, onions) Sweetcorn, celery, coconut, mushrooms, tomatoes Dried fruit and nuts Cheese and yoghurts with added fruit and/or vegetables Well-cooked meat (e.g. pulled pork, meat in casseroles) Highly spiced meats When your stoma has settled after surgery you may want to re-introduce fibre but always in small quantities, ensuring that the foods are well cooked and chewed. 3
Salt Salt is lost through a high output stoma, which we can replace in the food we eat. Sprinkle a little salt on your meals ½-1 teaspoon every day Try cooking your meals with salt Eat salty foods such as cheese, bacon, ham, sausages, smoked fish (kippers), shellfi sh, canned fi sh in brine or sauce (tuna, sardines, salmon), meat paste, fi sh paste, tinned foods such as spaghetti and ravioli, meat extracts, yeast extracts, salted crisps, savoury or salty biscuits Meal Pattern Try to develop a regular eating pattern Smaller but more frequent meals may be better Take your time over your meals and chew foods well Avoid heavy meals or snacks before bedtime Avoid alcohol and caffeinated drinks before bedtime e.g. coffee, tea, cola Opt for decaffeinated drinks where possible Try not to eat and drink at the same time 4
Fluids A large amount of fl uid lost through the stoma can lead to dehydration. Fluids may need to be replaced intravenously (fl uid straight into the blood) whilst you are in hospital. The following will help prevent dehydration: Restrict the amount you drink, as drinking a high amount of normal fluid can make your output higher, the amount you should drink will be advised by a doctor Start to take your oral rehydration solution as directed by your doctor, dietitian or nutrition nurse (see below) If you are feeling thirsty having a small volume of water with a salty snack may help Avoid drinking around mealtimes If applicable take your anti-diarrhoeal medication 30 minutes before your meals and at night as prescribed Oral Rehydration Solution (ORS) In some cases the dietitian, doctor or the nutrition team may advise you to take a special drink called an oral rehydration solution or St Mark s solution. This is a salty sugary drink, which helps your bowel absorb water and salts from the food and fl uid you consume. This drink will help to reduce your stoma output and keep you hydrated. It is best if you chill the drink. Do not add ice cubes to it, as it will dilute the drink. The drink can be fl avoured with a small amount of squash or cordial. Some people prefer the drink when taken through a straw. 5
Recipe for St Mark s Solution: 6 heaped 5ml teaspoons of glucose 1 level 5ml teaspoon of salt Half a heaped 5ml teaspoon of sodium bicarbonate Stir all ingredients into 1 litre of water and chill 6
Key points Avoid fibre-containing foods, seeds, pips and skins Add salt to foods and have salty foods when you are drinking fl uid Avoid drinking large amounts of plain water, squash, tea or coffee 7
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