Nutrition 411: Nutritional Care of the Ostomy Patient
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Nancy Collins, PhD, RD, LD/N, FAPWCA, is founder and executive director of RD411.com and Wounds411.com. For the past 20 years, she has served as a consultant to healthcare institutions and as a medico-legal expert to law firms involved in healthcare litigation. Colleen Sulewski is a senior dietetics and nutrition student at Florida International University, Miami, FL. She is the Editor-in-Chief of the Student Dietetic Association newsletter and a future registered dietitian. Correspondence may be sent to Dr. Collins at NCtheRD@aol.com. This article was not subject to the Ostomy Wound Management peer-review process.
Ostomy patients face an array of challenges due to the uniqueness and consequences of their procedure. Day-to-day life can be a struggle as patients deal with fears of excessive gas, bloating, constipation, spillage, and blockage, as well as changes in their self-image. A recent news headline described the humiliation experienced by one traveler with an ostomy during his airport security check.1 The pat-down procedure broke the seal on his urostomy with embarrassing results. Unfortunately, some situations may be out of our control, but patients can be taught certain nutritional tactics in order to control some ostomy-related concerns. This article reviews the effect ostomies have on nutrient absorption, outlines key nutrients for the ostomate, and provides tips to manage dietary concerns.
Introduction to Ostomies
In order to formulate sound nutritional advice for patients with an ostomy, it is first necessary to understand how the digestive tract functions and what occurs when an area is bypassed or removed. In a normally functioning digestive tract, the stomach produces enzymes required to break down ingested food particles into available nutrients. The intestine is responsible for the absorption of these nutrients, which then are sent to the liver for processing and utilization by the rest of the body.
There are three common ostomies: colostomy, ileostomy, and urostomy. In a colostomy, only a portion of the large intestine is removed or bypassed, allowing most of the nutrients to be absorbed.2 Patients with a colostomy typically produce partially formed stool. With an ileostomy, the entire colon, rectum, and anus are removed or bypassed, resulting in a significant decrease in nutrient absorption.2 This causes a very soft, liquid-like stool. A urostomy completely removes or bypasses the bladder. This procedure has minimal effects on dietary absorption2; thus, it will not be discussed in this article. In each case, the exact location of the stoma determines the patient’s ability to absorb specific nutrients. Additionally, the amount of remaining intestine is a determining factor in the efficiency of the absorption process.
In addition to physiological disturbances, psychological factors affect the nutritional status of ostomates. The fear that eating will negatively affect the amount, odor, or consistency of their stoma output prompts many ostomates to restrict their daily oral intake. This behavior should be discouraged because it is the type, not the amount, of food that affects the nature of the stool. Furthermore, restricting nutritious foods may cause deficiencies and compromise overall health and well being. The healthcare team should aim to become familiar with foods commonly known to be problematic and advise patients accordingly. It is important to keep in mind that not everyone will respond the same way to each food; an individualized approach is needed.
Colostomy. A colostomy is created when a portion of the colon or the rectum is removed and the remaining colon is brought to the abdominal wall. This ostomy can be temporary or permanent.