• Reference Number: HEY-1381-2023
• Departments: Dietetics, Nutrition Support
• Last Updated: 31 August 2023

Introduction

The aim of this leaflet is to provide dietary advice for strictures and adhesions of the bowel.

Stricture: a narrowing of the bowel that could be caused by inflammation or scar tissue.

Adhesion: a band of scar tissue that may form after surgery or due to inflammation.

Severe strictures and adhesions could lead to obstructions, which can cause bloating, discomfort or cramps constipation, abdominal pain, nausea and vomiting.

General Guidance

All food should be chewed well and eaten slowly.

With strictures or adhesions it may be difficult for some foods to pass through, which could cause a blockage. Foods that are softer and easier to digest will generally cause less symptoms. Foods high in fibre tend to be difficult to digest.

In some cases dietary changes needed may be temporary (such as inflammatory strictures) however if you have severe strictures or adhesions, you may need to make long term changes (unless you receive endoscopic or surgical intervention).

Suitable Foods

Please see below guidance on suitable low fibre, soft foods and foods to avoid.

Category of foods	Suitable foods	Foods to avoid
Vegetables	Well cooked soft or mashed vegetables, canned deseeded tomatoes, tomato puree, vegetable juice without pulp	Avoid skins, pips and seeds, tough stalks, vegetable juice with pulp, raw salad, raw vegetables such as mushrooms, sweetcorn, peppers, mushrooms, radishes, celery
Soups	Creamed, clear or strained soup	Soup containing pieces of vegetables
Fruit	Fruit juice without pulp Soft fruits, such as bananas, cooked/stewed fruits without skins Tinned fruit, pureed fruit	Berries, dried fruit, fruit skin, pips, seeds, pith and stones Fruit juice with pulp
Meat, fish and protein alternatives	Well cooked and soft lean meats and poultry with skin removed. Dishes with sauces, casseroles, stews or minced meat Fish, eggs, tofu	Tough, gristly meat or skin. Sausage skins, dried sausages with skin
Pulses	Well cooked and smooth pureed/mashed lentils	Firm beans and pulses with coarse skin such as chickpeas, kidney beans, baked beans, haricot beans, barlotti beans, soya beans
Bread and flour	White varieties of bread and baked goods such as wraps, crumpets, scones, chapattis (avoid any crusts). Plain cakes made with white flour, e.g. Victoria Sandwich, Madeira.	Wholemeal and granary bread and baked produces, fruit scones, teacakes, fruit cakes, cakes containing nuts. Rye crispbread, Crackers made with wholemeal flour or with seeds, e.g. Ryvita
Biscuits and cake	Biscuits made with white flour, e.g. custard creams, bourbon, ginger nuts, shortbread, Rich Tea, morning coffee.  Chocolate biscuits e.g. Penguin, KitKat	Biscuits containing bran, e.g. digestives or fruit, e.g. fruit shorties
Cereals	Cornflakes, Rice Krispies, Cocopops, Frosties	Porridge, Muesli,  Weetabix, Shredded Wheat, Branflakes.  Cereals containing dried fruit
Rice and pasta	White rice, pasta, and noodles	Wholegrain pasta and noodles. Brown & wild rice

Potato	Well-cooked potato, mashed potato	Potato with skin on, cold potato dishes such as potato salad
Nuts and seeds	Smooth nut butters	All nuts and seeds, crunchy nut butters, coconut
Dairy	All milk, cheese, smooth yoghurt	Yoghurts or dairy products containing fruits, nuts or muesli
Desserts and puddings	Custard, milk puddings, jelly, ice cream, mousses, sorbet, pancakes, sponge puddings, trifles, plain madeira cakes, instant whip desserts,  meringue, profiterols, chocolate eclairs	Desserts and puddings containing fruits or nuts
Sugars, preserves and sweets	Sugar, seedless jam, boiled sweets, fruit gums, peppermint, chocolate without nuts or fruit, syrup, lemon curd, fine cut marmalade, fruit pastilles	Jam with seeds/skins, thick marmalade, sweets or chocolate with fruits/nuts
Sauces and flavourings	All smooth sauces such as tomato puree and ketchup, cream and cheese sauces, brown sauce, salad cream, mayonnaise, mustard, salad dressing, salt and pepper, herbs and spices, vinegar	Sauces with pieces of vegetables, pickle, chutney, wholegrain mustard

Foods can be made soft by:

• Adding extra sauce or gravy to meat or fish
• Mincing meats
• Mashing potatoes or vegetables
• Cutting crusts off bread, dunking bread in soup or by making toast with a warm topping
• Blending meat, fish and vegetables

Poor appetite and losing weight

If you have a poor appetite or you are unintentionally losing weight, you may find the following information helpful:

• Eat little and often – try to eat 5 – 6 snacks/meals per day
• Use full fat and ‘thick and creamy’ varieties of foods, e.g. spreads for bread, yoghurts, milk and full sugar foods and drinks, i.e. avoid diet or low sugar varieties
• Add grated cheese into foods, e.g. soup, scrambled egg, mashed potatoes, sauces or sprinkle on top of foods, e.g. spaghetti bolognaise, shepherd’s pie and fish pie
• Add cream to soup, sauces, custard and desserts
• Spread butter/margarine thickly onto bread, crackers or toast
• Add jam, honey or syrup into puddings, cereal or bread

Enriching your food will help to increase your energy (calories) and protein intake during times when your appetite is poor.

You may be recommend to take nutritional supplement drinks to help increase your calorie and protein intake.

If you are struggling with your intake, your GP or practice nurse can refer you to your local community dietitians.

Will this diet cause constipation?

You may still be able to have some fibre in your diet, depending on the severity of the strictures and adhesions. Discuss with your doctor or dietitian. If you are concerned about constipation, or unable to open your bowels, please contact your doctor.

Should I take a multivitamin and mineral?

A general multivitamin and mineral may be required if you are unable to manage fruit and vegetables. Discuss this further with your doctor or dietitian.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Dietetics Department on tel no. 01482 674490

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.