Nutritional Support after Gastrointestinal Surgery by Donato Francesco Altomare & Maria Teresa Rotelli

Author:Donato Francesco Altomare & Maria Teresa Rotelli
Language: eng
Format: epub
ISBN: 9783030165543
Publisher: Springer International Publishing

7.5.2 Nutritional Support in Patients with Colostomies

One of the main aims of the colon is the resorption of the water contained in the feces that leave the ileum. It is estimated that only 40–400 mL of fluids are found in the feces out of 800–1800 mL that enter the colon daily. In addition, it also has the function of reabsorbing electrolytes, especially sodium, vitamin B12, and vitamin K, particularly in the right colon.

Consequently, in the left colon ostomies, the colonic functions are almost completely preserved. Therefore, minimal nutritional advices are required in the daily diet.

In order to have regular bowel movements, these patient should drink adequate quantity of water (1500–2000 mL) and high fiber diet; the amount of fibers to be ingested, however, should be adjusted case by case in order to prevent the passage of high volume stools requiring frequent changes of the bag.

Soluble fibers could be added in the diet in order to reduce the absorption of carbohydrates and to provide nutrients to the microbiota. Soluble fibers are found mainly in fruit eaten with peel (the richest part of pectin is the white layer below the peel, called albedo, then removing the peel often eliminates pectin), in legumes, in chicory, and in oily fruit. Insoluble fiber-rich foods are present in whole foods, in the outer part of legumes, and in fibrous vegetables.

The choice of one type or the other type of fibers will depend on the occurrence of concomitant diseases (diabetes, dyslipidemia, use of anticoagulants) and the transit time, by the state of hydration of the patient and the amount of oil assumed. Therefore, sometimes the introduction of the fibers alone cannot correct constipation.

Stomas performed on the cecum or right colon should be managed like patients with distal ileostomies. However, this type of colostomy is going to be abandoned in favor of a terminal ileostomy.

In patients with documented lactose intolerance, the consumption of containing lactose foods like milk should be limited or better replaced with “milk” of vegetable origin (soy, rice, oats, almonds or other), while soy derivatives can be used instead of cheeses.

In any case, it is necessary to suggest the patient to make a good chewing of all the foods, in order to make the nutrients more easily absorbable, while the fibers, both insoluble and soluble, are reduced to pulp and do not increase gas production or alterations of the bowel motility.

Water intake should be preferred between meals, in small and frequent portions, about 80–120 mL for 12–10 times a day; this quantity should be increased if the feces become fluid and abundant.

Another problem related to the nutritional support in patients with a colostomy is the occurrence of abnormal meteorism with consequent inflate of the stoma bag. In these cases, chewing gum, carbonated drinks, and foods that induce the production of gases such as brassicas (cabbage, cauliflower, turnips, broccoli, etc.) should be avoided.

If consumed with a complementary food such as cereals, legumes are a good source of high biological value proteins and contain both soluble and

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