Ostomies (Colostomy, Ileostomy, Urostomy)

There are 3 types of ostomies:

1. Colostomy
2. Ileostomy
3. Urostomy

 2 main stomas are the colostomy and ileostomy

 The diet, complications and side effects differ greatly from each
other (2 very different approaches)
 Ileostomy= from the ileum
 Colostomy= from the colon
 Need to know what part is being bypassed
 On the right= ileostomy
 On the left= colostomy
 Constipation and blockages are common problems that will arise
 Very important to know what is absorbed where in the body
 EARLY INTERVENTION IF POSSIBLE!
 In an ideal world, we need to intervene before they get the stoma
(common conditions include cancer, Chron’s, IBD, ulcerative colitis
and severe endometriosis)
 Pre-existing deficiencies or malnutrition should be corrected before
surgery
 Surgery= catabolic effect (increased requirements for wound
healing)
 Many time’s we can’t reach the patients requirements
 (chemo, radiation and chronic medications), may cause trouble
with oral intake, making recovery even more difficult= longer
recovery
 After surgery the pt. will have dietary restrictions (e.g. fiber)
 Stoma patients can exercise! But they are usually scared to.
 Need to motivate and encourage these patients to accept their
stoma, and not to be ashamed of it.
 Refined starches are given, to help make the consistency more
thicker to help control the output, but this leads to loss of LBM and
also increased fat gain.
 Ileostomy output= more liquid
 Colostomy= more formed stools
 The more liquid the output, the higher in acids, might burn the
patient.
 Glutamine= 30g per day (orally)
 Glutamine TPN= 0.35g per day

Step 1: identify the type of stoma: ileostomy or colostomy?

Step 2: treat the “cause of the stoma” (e.g. cancer, MVA, IBD,
Chron’s, ulcerative colitis etc.)
Step 3: Remember the micronutrients and the form of micronutrients
(tablets will not get absorbed, due to not having enough time in the
intestines to get broken down and absorbed)-look at liquid forms of
micronutrients- talk to the pharmacist
Step 4: Anthro is very important (LBM!!, use tools available) Do a
waist circumference, skinfolds, handgrip strength (needs to be
measured continuously) Inbody can also be used if available
Step 5: While in the hospital start your relationship with the pt. so they
can trust and have confidence in you
Step 6: Make optimal use of the patient’s time in the hospital. Give
them expensive supplements like glutamine, omega 3 containing sip
feeds, TPN is patients can’t reach nutritional requirements,
MICRONUTRIENTS (vitamin D) etc. (tablets vs. liquids)
Step 7: Start prepping for home (work with the caregiver at home)
❑ Mattress protector (plastic)!!
❑ Towels/linen savers to do dressing changes on
❑ Dressing station (little table with containers set up in order of
use to make changing as swiftly as possible. This table should
also be close to the bed or area where bag changes are being
made. And a jar of marshmallows!)
❑ Sharp pointed little scissor
❑ Adhesive removal spray (aerosol)
❑ Appropriate clothes- men more problematic due to pants-soft
pants with a string tie and not a zip. Women-skirts with elastic,
or low-cut pants and soft tops for over
❑ Frozen meals! will make their life much easier

Diet for prepping at home:

Start discussing home diet as soon as pt. goes on to hospital diet-
this way he/she can also start checking their own hospital food
(correctness) but also see how certain foods get tolerated by
him/herself.
 Sport drinks (Game), NOT ENERGY DRINKS (ileostomy specific)
 Avoid low-salt products (ileostomy specific)
 Marshmallows
 Bananas
 Peanut and nut butters (ileostomy specific)
 Milk powder (adds extra protein-not Cremora!)
 Psyllium (ispaghula husk)- forms a gel in the intestines
 Any needed supplements specific to patients (Fe, omega 3,
ginger)
 Meals to make beforehand at home and freeze-DIET HISTORY!

 Supportan= sip feed that is highest in omega-3

 Colostomy pt.= can give patients tablets
 Ileostomy= get a better absorbable form of the micronutrient from
pharmacist
 Take not of gas-forming foods so that the patient can try to avoid
these foods as they may cause discomfort.
 Dehydration and electrolyte imbalances are very common!
Ensure that they are hydrated at all times
 No caffeine drinks= caffeine=dehydration
 Marshmallows (plain ones) slow down the transit time in the gut!!
Give 30min before you change the bag. Gives time to change
the bag, Very NB for ileostomy patients (peanut butter can also
slow down transit time-eat 2 tbsp before changing the bag)
 Use brand names, tell pt. which products to go buy
 Potassium disturbances are common
 At least 2-3L of fluid per day
 Colostomy= constipation is common= prolapse can occur!!
 Ileostomy= fluidy stools, give pyshillium husk to form stools
Step 8: Ready for discharge
 Any continuous or anticipated micronutrient deficiencies?
 Related to stoma and underlying illnesses (Fe, Vit C)
 Form of micronutrient supplements as well as meds!
 Discuss with Dr. (pain meds and chronic (slow release)
 TTOs (to take out)? Glutamine, sip-feeds (find out if there are any that we can give from our side to them)
 Home diet!

Home diet: 4 focus areas!

1. Electrolytes! (signs and symptoms)- Potassium levels can be low (advise them to eat bananas/avo etc)
2. Hydration (signs and symptoms)
3. Fiber (difference between stomas)-this will have an effect on both high stoma and blockages
4. Treatment of side effects: nausea, vomiting, LOA, Diarrhoea, constipation etc. (wound healing-keep in mind)
5. Chew, chew, chew! (less digestion needed, easier absorption)

Ileostomy diet:
Be sure to avoid/minimize:
 Nuts
 Raw fibrous vegetables
 Rusks
 Fibrous fruits
 Mushrooms
 Popcorn
 Celery
 Legumes
 (Permanent ileostomy pt.=at risk for kidney stones-minimize high oxalate foods)

When doing a bag change:

 Pancaking (happens with a colostomy)-treat with lubricant or olive oil + up fluid intake
 Burnt skin (Give Vitamin A, Zinc, glutamine and protein)