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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 fluids 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 fluid you should take and in what quantities can help successfully manage your stoma output. 2 Food Fibre Foods that are high in fibre are often difficult to digest and can increase your output, lower fibre foods are therefore recommended. Below is a table showing the type of foods to have and those to be avoided. Low fibre foods Foods to avoid z White varieties of rice, pasta and z Brown/whole varieties of rice, bread pasta and bread z Tinned fruit z Hard fruits, e.g. pineapple z Ripe fresh fruit without skin, pith, z Unpeeled fruit, pips, stalks, pips or seeds seeds and pith z Peeled well cooked or pureed z Vegetable skins, pips, stalks, vegetables including passata seeds and pith z Peas, pulses (e.g. lentils, dahl); beans (e.g.kidney beans, mung, chickpeas) z Flours made from pulses (e.g. gram flour) z Raw vegetables and windproducing vegetables (e.g. Brussel sprouts, cabbage, onions) z Sweetcorn, celery, coconut, mushrooms, tomatoes z Fruit juices with no pulp z Dried fruit and nuts in moderation z Dairy foods - plain cheese, z Cheese and yoghurts with added fruit and/or vegetables yogurts, milk (including yoghurt with fruit puree) z Lean meat, fish and eggs z Well-cooked meat (e.g. pulled pork, meat in casseroles) z 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. z Sprinkle a little salt on your meals – ½-1 teaspoon every day z Try cooking your meals with salt z Eat salty foods such as cheese, bacon, ham, sausages, smoked fish (kippers), shellfish, canned fish in brine or sauce (tuna, sardines, salmon), meat paste, fish paste, tinned foods such as spaghetti and ravioli, meat extracts, yeast extracts, salted crisps, savoury or salty biscuits Meal Pattern z Try to develop a regular eating pattern z Smaller but more frequent meals may be better z Take your time over your meals and chew foods well z Avoid heavy meals or snacks before bedtime z Avoid alcohol and caffeinated drinks before bedtime e.g. coffee, tea, cola z Opt for decaffeinated drinks where possible z Try not to eat and drink at the same time 4 Fluids A large amount of fluid lost through the stoma can lead to dehydration. Fluids may need to be replaced intravenously (fluid straight into the blood) whilst you are in hospital. The following will help prevent dehydration: z 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 z Start to take your oral rehydration solution as directed by your doctor, dietitian or nutrition nurse (see below) z If you are feeling thirsty having a small volume of water with a salty snack may help z Avoid drinking around mealtimes z 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 fluid 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 flavoured 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: z 6 heaped 5ml teaspoons of glucose z 1 level 5ml teaspoon of salt z Half a heaped 5ml teaspoon of sodium bicarbonate z Stir all ingredients into 1 litre of water and chill 6 Key points z Avoid fibre-containing foods, seeds, pips and skins z Add salt to foods and have salty foods when you are drinking fluid z Avoid drinking large amounts of plain water, squash, tea or coffee 7 Not to be photocopied Basildon University Hospital Nethermayne Basildon Essex SS16 5NL 01268 524900 Minicom 01268 593190 Patient Advice and Liaison Service (PALS) 01268 394440 E [email protected] W www.basildonandthurrock.nhs.uk The Trust will not tolerate aggression, intimidation or violence directed towards its staff. This is a smokefree Trust. Smoking is not allowed in any of our hospital buildings or grounds. 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