A stoma is a surgically created opening on the abdomen that allows waste to exit the body, typically connecting to the digestive or urinary system. While many individuals with a stoma express concerns about weight loss or difficulty gaining weight after surgery, achieving and maintaining a healthy weight is possible. Understanding the factors that influence weight and implementing appropriate strategies can support this goal.
Why Weight Fluctuates with a Stoma
Individuals with a stoma may experience weight fluctuations due to several physiological and practical reasons. Malabsorption is a significant factor, especially with ileostomies where the large intestine, responsible for absorbing water and some nutrients, is bypassed or removed. This leads to less efficient nutrient absorption.
Increased stoma output is another challenge, as a higher volume of fluid and stool is expelled. An output exceeding 1500 mL per day is considered high, potentially leading to dehydration and nutrient depletion.
Dietary adjustments and restrictions also play a role, as individuals may initially limit food intake due to fear of complications or to manage output. The underlying medical condition that necessitated the stoma, such as Crohn’s disease or ulcerative colitis, often causes significant weight loss even before surgery. Post-surgical recovery and ongoing medical issues can also affect appetite, and metabolism might decrease after surgery.
Achieving Healthy Weight Gain Through Diet
Achieving healthy weight gain with a stoma involves strategic dietary choices focused on maximizing nutrient intake. Prioritize calorie-dense, nutrient-rich foods that provide substantial energy in smaller portions. Examples include healthy fats, complex carbohydrates, lean proteins, full-fat dairy products, cream added to meals, biscuits, cakes, tender meats, fish, eggs, nut butters, and protein-rich breads or cereals.
Eating small, frequent meals throughout the day can be more manageable and improve nutrient absorption, helping to avoid feeling overly full. Aim for five to six smaller meals daily. Hydration is important, but fluid intake should be managed carefully; it is often advised to drink fluids between meals rather than with them to prevent premature fullness. For those with high stoma output, oral rehydration solutions are especially beneficial for replacing lost electrolytes.
Nutritional supplements can provide additional calories and nutrients if dietary intake alone is insufficient. Oral nutritional supplements, such as pre-made drinks or protein powders, can be mixed into foods or beverages to boost caloric and protein content. When managing fiber, a low-fiber diet might be recommended immediately after surgery. Gradually reintroduce fiber-containing foods, chewing them thoroughly, and note that some foods like rice, pasta, cheese, and bananas can help thicken stool output.
Support from Healthcare Professionals
Navigating weight gain with a stoma is best achieved with the guidance of a multidisciplinary healthcare team. Registered Dietitians (RDs) are instrumental in creating personalized meal plans tailored to individual needs and specific stoma types. They assess nutrient intake, identify deficiencies, and provide detailed guidance on food tolerance.
Stoma nurses, also known as Wound, Ostomy, and Continence Nurses (WOCN/ET Nurses), play a key role in managing stoma output and addressing issues that might hinder weight gain. They offer practical care advice and ensure the stoma appliance fits correctly, which is important as weight changes can affect its fit and function. Physicians and gastroenterologists contribute by managing underlying medical conditions and overseeing overall health, ensuring medical stability for weight gain efforts. They also evaluate any significant or persistent unintended weight loss.
Psychological support is also beneficial, as emotional aspects like anxiety or body image concerns can influence eating habits. Mental health professionals can help individuals cope with these challenges, fostering a healthier relationship with food and their body.