Dietary recommendations for people with ostomy

Indications

Ostomy is not a common surgical procedure. Most often, specialists look for other ways to solve the problem.

An ostomy is performed only if there are serious medical indications. The operation is performed only if it is not possible to use another method.

An artificially created hole in the wall of the abdominal cavity is performed in case of severe malignant disease, which has caused intestinal dysfunction.

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A stoma is applied for organ injuries, nonspecific or ischemic colitis, and various types of incontinence.

Removal of a part of an organ is carried out in cases of intestinal obstruction, the presence of diseases that have caused a disruption in the functioning of the excretory system is established.

A stoma can be installed only in cases where there are no other ways to solve the problem.

The stoma procedure is always the final stage of another procedure in which the surgeon clears the obstruction or removes part of the affected organ.

The patient is prescribed a colonoscopy, blood and urine tests, fluorography, and an electrocardiogram. An examination by a therapist and, if necessary, other specialists is also indicated. Before the procedure, it is necessary to cleanse the intestines. An enema is prescribed for this.

If the patient is in serious condition, exhaustion or anemia is observed, plasma and blood transfusions are performed before the operation, and the water-salt balance is restored.

Minimal preparation is used in emergency cases when the patient rapidly develops intestinal obstruction. In this case, the location of the stoma is selected by the doctor. Most often it is placed higher than necessary.

Surgery, diet and complications when closing a colostomy

With some types of intestinal diseases, physiological defecation through the anus becomes impossible. To solve the problem, a colostomy is used - a bag-shaped device attached to the abdominal wall.

With its help, accumulated feces and gases that inevitably form during the digestion process are removed. After the patient’s condition improves, an operation to close the colostomy can be performed - in the article we will analyze its features.

A colostomy, or artificial anus, is formed in the operating room for patients who cannot independently defecate through the opening of the rectum. The procedure is performed for health reasons and may be required for diseases such as:

• colitis (inflammatory bowel disease);
• familial polyposis;
• Hirschsprung's disease;
• abnormalities of the gastrointestinal tract;
• anorectal incontinence;
• neoplasms;
• intestinal injury.

A colostomy is installed temporarily (in which case it can be removed) or as a permanent device for removing fecal fragments.

Why is surgery needed?

Life after a colostomy requires constant care of the artificial opening for excretion of feces, but if the recommendations of the attending physician are followed correctly, it can be relatively comfortable: a diet is followed, psychotherapy is carried out, and means are used to mask the unpleasant odor of the discharge. However, people who have undergone a temporary ostomy with the prospect of normalizing their condition resort to surgery.

Closing a colostomy allows you to:

• increase the level of living comfort;
• reduce the stress associated with having a stoma;
• eliminate skin irritation;
• reconstruct the section of the gastrointestinal tract that is “switched off” from the digestive chain;
• restore intestinal continuity.

It should be taken into account that the operation requires repeated stress on the body, and there may be complications. However, all the nuances are discussed with the attending physician individually, and there are many successful outcomes of the intervention.

FAQ (Frequently Asked Questions)

The operation to close the stoma is performed with a temporary artificial anus several months after the opening is formed.

In some cases, intestinal reconstruction is not possible (tumors, removal of a large part of the organ, risk of bleeding).

The nuances of the intervention depend on the underlying disease, the patient’s condition, and the results of laboratory and instrumental examinations.

When is an artificial anus closed?

Having an ostomy in the colon area is certainly a serious stress for the patient.

Despite the perfection of technology, such a device entails the need for continuous and careful care, the cost of disposable materials, and the need to monitor the condition of the digestive tract, including through a strict diet. Therefore, if it is possible to restore natural bowel movements, the colostomy is closed.

Reconstructive surgery is performed in a colorectal surgery department, usually 2-6 months after the initial intervention.

In general, experts believe that stoma removal is best done during the first year after the formation of an artificial opening for defecation, between 3 and 12 months. But everything is individual, and the waiting interval may be shortened.

What should be the preliminary preparation?

Closing the artificial opening on the abdominal wall is carried out after consulting the attending physician. If the patient has undergone surgery for a tumor, it is necessary to clarify whether there is a relapse or metastasis. The standard diagnostic examination package includes:

1. General blood test, biochemical.
2. Urine examination.
3. Blood type, Rh factor.
4. Test for syphilis, HIV, hepatitis B, C.
5. Coagulogram.
6. Electrocardiography (ECG).
7. Ultrasound of the abdominal organs.
8. Endoscopy of the upper gastrointestinal tract and intestines.

Additionally, ultrasound of the kidneys, pelvis, CT (computed tomography), irrigoscopy, consultation with an infectious disease specialist, therapist, or cardiologist may be prescribed. The patient follows a diet and, in the absence of contraindications, is hospitalized in the hospital department where intestinal reconstruction will be performed.

How is a stoma closed?

The patient is examined by the attending surgeon (the results of the examination performed the day before are necessarily evaluated), and the anesthesiologist responsible for the anesthesia technique conducts a conversation.

Immediately before the operation, blood, urine and coagulogram tests are repeated.

Eating is prohibited, you need to cleanse the intestines (this is done by washing the stoma and taking a laxative - for example, the drug "Fortrans").

The course of the colostomy closure operation includes the following stages:

• pain relief (epidural anesthesia or endotracheal anesthesia);
• abdominal wall incision;
• cleansing the edges of the intestine;
• stitching damaged areas;
• intestinal reconstruction;
• installation of drains;
• suturing.

When anesthesia is administered, the patient wakes up in the ward. A bladder catheter is used before and after the intervention. The duration of the operation is on average from 2 to 5 hours.

What complications can there be?

During the normal course of the rehabilitation period, after the stoma is closed, the damaged tissues are restored, and the intestines work fully again (of course, this does not mean giving up the diet and the absence of the risk of repeated exacerbations; the operation does not cure the underlying disease). Possible complications include:

1. Intra-abdominal abscess.
2. Infection of a postoperative wound.
3. Pneumonia.
4. Bleeding.
5. Fecal fistula.
6. Failure of the anastomosis (connection in the area of ​​​​the gastrointestinal tract that was previously brought out).
7. Intestinal obstruction.

All described consequences can be eliminated in a surgical department. High-quality preparation for surgery is also a preventive measure. It is worth noting that there are complications associated with non-compliance with the regime after the intervention (for example, an inflammatory process due to a violation of the diet).

Rehabilitation period

The recovery period initially proceeds under the supervision of medical personnel. The patient is in the ward, adequate pain relief is indicated, and proper care of the postoperative wound is required. After stabilization of the patient’s condition, they are discharged for outpatient treatment with visits to the clinic to monitor the dynamics.

Early postoperative period

Immediately after the intervention, the patient is taken to the ward, painkillers are administered every few hours, their well-being is monitored (pressure and temperature are monitored, discharge is assessed by drainage), and dressings are made.

You cannot drink or eat anything at this time, so intravenous infusion of medicinal solutions is used.

In most cases, when everything goes well, the patient experiences severe drowsiness on the first day; there is no need to suppress it, since the active regimen is contraindicated.

You need to prepare for the fact that intestinal activity does not resume immediately.

This is not a sign of complications, but a physiological law. Gases begin to gradually disappear approximately 48 hours after the intervention, stool appears, on average, after 72 hours.

Drinking water is usually allowed after a pause of 24-36 hours. Then the drainage is removed. Eating (little by little) is allowed on the third to fifth day. You can get up with caution 2 days after the intervention, walk after 3, but this is at the discretion of the attending physician. Since the ostomy has been stopped, you need to monitor the softness of the stool, otherwise pain may occur.

What can you eat?

After the doctor has given permission to eat food, you should eat 6 times a day and prepare liquid, pureed, crushed or mushy dishes:

• broth (vegetable, later unrich on lean meat);
• chicken, beef, turkey, lean fish;
• semolina porridge;
• jelly;
• mashed potatoes or other mild vegetables.

You can eat baby food. After improving digestive function, the following is additionally allowed:

1. Vegetable and lean meat soups without frying.
2. Bananas (no more than 1 per day).
3. Boiled, steamed cauliflower or broccoli (and other dull vegetables without seeds or seeds).
4. Fermented milk products - low-fat cottage cheese, kefir - according to tolerance.
5. Fruits baked without sugar.

You need to drink enough water - from 1.5 to 3 liters per day.

This is required to maintain normal bowel function. All cereals, both immediately after the operation and from the moment of discharge, are prepared in water. In this case, it is allowed to take a tablespoon orally (including on an empty stomach on the recommendation of a doctor) of vegetable oil - olive, sunflower.

Prohibited Products

The diet after ostomy closure should not include food options such as:

• hot seasonings, spices;
• fat meat;
• smoked meats;
• pickles;
• canned food;
• marinades;
• sparkling water;
• milk;
• butter;
• candies;
• baked goods;
• seeds;
• chips, crackers;
• beer, kvass, cocoa, coffee;
• legumes, garlic;
• currant;
• citrus;
• yogurt with pieces of fruit, dyes;
• raspberries;
• grape;
• citrus;
• alcohol.

You should not eat porridge prepared with milk or eat this product separately, as it can cause intestinal dysfunction. The same goes for fresh fruits and vegetables, especially those that are sour or contain small grains and seeds. You should not drink a lot of natural juices; it is better to exclude tea with additives.

Source: https://easymed-nn.ru/bolezni/narusheniya/zakrytie-kolostomy.html