Short bowel syndrome is when you have had surgery to remove part of your bowel, or your bowel may not be working as it should.
When large amounts of small bowel have been removed, or the small bowel is not working normally you may not be able to stay hydrated by drinking fluids alone. You may need to have fluids given via a vein, this is called intravenous fluid.
High losses/output from the bowel or stoma increases the risk of dehydration due to water and salt losses. High output is anything more than 1500ml a day.
You may also need to have nutrients and calories given via a vein if you cannot absorb enough nutrients from your bowel and you are losing weight. This is called parenteral nutrition. Your fluid and diet will be discussed and tailored to you by the dietitian.
Fluids
- Drink 1000ml (volume may be more) of a glucose/salt solution per day. For example, Dioralyte (8 sachets in 1000ml) or St. Marks oral rehydration solution.
- Restrict other fluids to around 1000ml a day (see list)
- Drink between meals instead of with meals
Note: Check with your clinical team as to the correct volumes of fluid you need.
Recipe for St. Marks solution
- 20g/six level 5ml spoonfuls of glucose
- 3.5g/one level 5ml spoonful salt
- 2.5g/one heaped 2.5ml spoonful sodium bicarbonate
- Dissolve in 1000ml water.
- Keep chilled in the fridge.
- Flavour with a small amount of squash or cordial.
(You can get a 2.5ml/5ml measuring spoon from your pharmacist
From this list, do not drink in total more than 1000ml each day
- Diluted juice/Pure fruit juice
- Milk
- Tea, Coffee
- Water
- Diet drinks
Caffeinated drinks (e.g. tea/coffee/energy drinks) may increase your stoma output.
Try decaf versions instead or naturally caffeine-free hot drinks e.g. red bush tea, camomile/peppermint tea, hot chocolate or malted drinks.
Diet
You will be asked to follow a low fibre diet, this helps to reduce stoma losses.
Avoid the following foods
- Fruit (including dried)
- Nuts
- Pips
- Pith
- Seeds
- Raw vegetables
- Vegetable skins.
You may be able to try the following fibrous foods after discussion with your dietitian:
- Peeled fruits
- Tinned fruit in juice
- Stewed or baked fruit
- 150ml fruit juice
- Well cooked vegetables.
Choose low fibre starchy carbohydrates:
- White bread, rolls, chapattis, naan breads, pitta breads, brioche
- Rice based cereals, corn flakes, frosted flakes, coco / rice crispies
- Potatoes without skins, e.g. chips, mashed potatoes, inside jacket potato
- White pasta, rice, semolina, tapioca
- Dishes which contain maize, millet or cornmeal
These foods will help thicken your stoma output and give you energy.
Include some protein in your diet
- Meat, fish, eggs, cheese
- Check with your dietitian which protein foods are suitable for you.
Snacks
Savoury
- Cheese and crackers (avoid wholemeal), corn-based crisps, cottage cheese.
Sweet
- Ice cream, jelly, rice pudding, plain scone with butter, sponge pudding, yoghurt.
It is important you discuss the above with your nutrition team/dietitian to make sure you have a balanced diet.
Example meal ideas
| Breakfast | Cornflakes / rice crispies with milk White bread / toast with butter and/or smooth jam Soft boiled eggs with white toast |
| Lunch | Egg mayonnaise sandwich (white bread) Tuna and cheese toasted panini Soft cheese or fish / duck pâté with crackers Ham and cheese in white bread roll |
| Evening meal | Roast beef with mashed potatoes and gravy Tuna pasta bake Poached salmon with boiled potatoes (peeled) Sweet and sour sauce with egg fried rice Mince and dumplings Mild chicken curry (no vegetables) and white rice Beef burger in white bun, with chipped potatoes Macaroni cheese |
| Snacks/Desserts | Smooth yoghurt Jelly and ice cream Rice pudding pot Flavoured rice cakes Plain cottage cheese Treacle sponge pudding and custard |
Cooking tips
- Use garlic/onion powder to flavour food rather than fresh
- Mild herbs and spices e.g. dried oregano, mild curry powder and paprika
- 1-2 tablespoons tomato puree can add flavour to pasta dishes
- Freeze low-fibre meals in single portions for days when you don’t want to cook
Medication
The following medications are prescribed to help to reduce stoma output:
- Loperamide – take this at least 30 minutes before food
- Codeine phosphate
- Lansoprazole/omeprazole
You may need additional medications or supplements including:
- Magnesium
- Calcium/Vitamin D
- Iron
- Vitamin B12 injections (hydroxocobalamin)
- Multivitamins.
Your pharmacist/clinical team will advise on the dose and frequency of these medications
For further information
Contact details
Dietitians
Lisa Gemmell, Colette Kirk and Emma Priestley, Dietitians
Tel: 0191 223 1231
Email: [email protected]
Nutrition nurse specialists
Hayley Leyland, Stacey Vass, Jess McDonald and Sally Watts
Tel: 0191 223 1100
Email: [email protected]
The Patient Advice and Liaison Service (PALS) can offer on-the-spot advice and information about the NHS. You can contact them on freephone 0800 032 02 02 or e-mail [email protected]
Useful websites
If you would like further information about health conditions and treatment options, you may wish to have a look at the NHS Choices website at www.nhs.uk.
Patients On Intravenous & Nasogastric Nutrition Therapy (PINNT) support group run by patients to provide practical support for day-to-day living with artificial nutrition at home.
