• Reference Number: HEY-1382-2023
• Departments:
• Last Updated: 31 August 2023

What is an Ileoanal Pouch

An ileoanal pouch is made by using the ileum (the lower end of the small intestine), which is joined to the anus following removal of the larger bowel (colon). The aim of the pouch is to replace the function of the rectum, and store stool until it can be passed out of the body in a bowel movement.

What to expect post-operatively

It takes time for your pouch to adapt and you may experience loose, frequent stools for several weeks.  During this time, you may lose more fluid, salts than is normal, and therefore are at risk of becoming dehydrated.  To prevent this, you should ensure that you have an adequate fluid and salt intake:

• Aim for at least 6-8 cups/glasses/mugs of fluid per day (1½ to 2 litres) including water, tea, coffee and squashes.
• Add extra salt to your meals. Half to one teaspoon of salt spread evenly throughout the day should be adequate.

Over time as your pouch settles, your stool will thicken and become less frequent.

A low fibre diet may help with symptom management in the adaptation stage.

Foods high and low in fibre

Food Group	Low in Fibre	High in Fibre
Meats	All other meat products: lean, well cooked meats may be best tolerated.	Meat products made with wholemeal pastry, breaded meat products.  Processed products and meats high in fat may make diarrhoea worse.
Fish	All other fish products.	Fish products made with wholemeal pastry, breaded fish products.  Oily fish such as mackerel, sardines may make diarrhoea worse.
Dairy Products	Plain yoghurt, cheese, milk, eggs, margarine, butter, custard.	Yoghurts containing fruit pieces, cereal, added fibre or nuts. Cheeses containing fruit or nuts.
Bread and Cereals	White varieties of bread and baked goods such as chapattis, crumpets, scones. Plain cakes made with white flour e.g. Victoria Sandwich, Madeira. Plain crackers, crispbreads and rice cakes. Plain varieties of biscuits e.g. rich tea, morning coffee, custard creams, bourbon, ginger nuts, shortbread, chocolate biscuits (penguin, club, KitKat). White rice, pasta, noodles, couscous. Cornflakes, Special K, Rice Crispies, Coco Pops, Sugar Puffs.	Wholemeal and granary bread and baked products, fruit scones, teacakes. Fruit cakes Crackers made with wholemeal flour or with seeds e.g. Rye crispbreads Biscuits containing bran (e.g. digestives) or fruit (e.g. fruit shorties). Wholemeal pasta, brown rice. Wheat biscuits, Shredded wheat, Muesli, Granola, All Bran, Porridge.
Puddings	Milk puddings, Ice cream, Jellies, Meringue, Fruit crumble, plain sponges, Custard.	Puddings made with wholemeal flour or dried fruit.
Drinks	Tea, coffee, milkshakes, milk, hot chocolate, fruit squashes, fruit juice without bits.	Pure fruit juice with bits, smoothies.
Other	Oils, smooth soups and sauces, jam with no bits, honey, shredless marmalade, boiled sweets, chocolate, toffee, crisps.	Pickles, highly spiced foods, chocolate or sweets containing fruit or nuts, nuts.

What about fruit and vegetables

Fruit

Where possible avoid skins and seeds. Try small portions initially to assess tolerance. The guide below outlines fruits lower in fibre.

• Tinned fruits such as pears, peaches, mandarins, lychees
• Mango
• Melon
• Ripe bananas
• Peeled apples, pears
• Satsumas, oranges with pith removed
• Stewed fruits without pips.

Please note dried fruits, coconut and pineapple should be avoided due to their high fibre content.

Vegetables

Where possible avoid skins, seeds and stalks.  Try small portions initially to assess tolerance.  The guide below outlines vegetable lower in fibre:

• Well-cooked carrots, swede, squash
• Courgettes
• Aubergines
• Boiled spinach
• Well-cooked cauliflower and broccoli

Please note salad vegetables, peas, beans, sweetcorn, mushrooms, celery, Chinese vegetables (e.g. bean sprouts, bamboo shoots) should be avoided due to their high fibre content.

All potato varieties are suitable on a low fibre diet provided the skin is removed.

What if my appetite is reduced?

Following your surgery, you may experience a reduction in your appetite.    If this is the case, the following measures may help:

• Eating small amounts more frequently
• Fortifying meals with foods high in calories such as full cream milk, cream, cheese, butter, jam, sugar
• Ensuring protein rich foods are included at each meal to aid healing these include meat, fish, cheese, milk, yoghurts and vegetarian alternatives such as Quorn, Tofu and tempeh
• Including high calorie snacks such as biscuits, cakes, crisps, cheese and biscuits, yoghurts, mousses, milk puddings
• Including nourishing drinks such as milk and milkshakes

If you are struggling to meet your requirements with food alone your medical team/dietitian can prescribe nutritional drinks/products to increase your intake.

What should I eat post surgical recovery?

Once your pouch has adapted and you are confident with its function, you should be able to reintroduce food with the aim of a healthy balanced diet as outlined in The Eatwell Guide.

 Fruit and vegetables (Green Section) 

• Excellent source of vitamins and minerals
• Aim for five portions per day, 1 portion =80g
• If some fruit and vegetables upset you aim to stick to lower fibre varieties

Starchy Foods (Yellow Section)

• Provide energy, vitamins and fibre
• Includes breads, breakfast cereals, potatoes, rice, pasta and other grains
• Should make up a third of what you eat and be the basis of each meal
• Starchy foods are reported to help thicken stool and reduce bowel frequency

Beans, pulses, fish, eggs, meat and other proteins (Pink Section)

• A good source of protein, vitamins and minerals
• Aim for 2 portions of fish per week if eaten– 1 oily, 1 white 

Dairy and alternatives (Blue Section)

• Great source of calcium, protein and vitamins
• Colitis increases the risk of bone thinning and as such a daily calcium intake of 700mg is recommended
• If you are using dairy alternatives check they are fortified with calcium

Oils and Fats (Purple Section)

• Try and choose healthier unsaturated fats usually from plant sources e.g. vegetable oil, sunflower oil or olive oil
• Use in sparing amounts

Foods and associated symptoms

Some foods can be associated with bowel symptoms.  Please be aware that this can be very individual and what affects one person may not affect another.  If you are unsure about a food try in small amounts to assess tolerance.

Symptom	Associated Foods
Passing undigested food	Beans, peas and lentils, sweetcorn Mushrooms, pineapple, coconut, Chinese vegetables such as beansprouts and water chestnuts, celery, fruit and vegetable skins, seeds, nuts, dried fruit.
Wind, bloating and gas	Brussel sprouts, cabbage, broccoli, cauliflower, beans and pulses, onions and garlic, leeks, chewing gum, fizzy soft drinks,  beer, lager ,fizzy wines
Decreased stools	Bread, pasta, rice, potato, banana
Increased stood odour	Fish, onions, garlic, eggs, brussel sprouts, cabbage, broccoli and cauliflower

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Dietetic Department on tel no: Hull Royal 01482 674490 Castle Hill: 01482 461941, Queens Centre: 01482 461135

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

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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.

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