Bowel Removal and Nutrition (Nutrition Booklet)

Bowel Removal and Nutrition (Nutrition Booklet)

For clinical issues you must seek the advice of a QUALIFIED Healthcare Professional

Bowel Removal and Nutrition

The digestion and absorption of food takes place mainly in the small intestine, (jejunum and ileum).  Enzymes break down the larger molecules.

The colon is where fluids and some salts are absorbed.  The digestive enzymes in the small intestine have added more fluid to the consistency, (which is why our faeces after bowel removal are more pungent and caustic).  The colon would at this point also remove that fluid, taking it back into the body to be used, and leaving behind the semi-solid mass (faeces).    The bacteria that live in the large bowel will aid the final stages of breaking down materials.  Of course for those with bowel removal this doesn’t happen so efficiently.


Focus on Iron:

Why iron uptake is inhibited:

Red blood cells are damaged easily on their journey transporting oxygen around the body, so they only have a lifespan of about 120 days.  Therefore these cells have to be replenished continuously.


Iron deficient anaemia is the result of low iron levels in the body.  Haemoglobin is the oxygen carrying pigments in red blood cells.  So if these cells don’t carry enough oxygen the person may get symptoms such as fatigue, pale skin and shortness of breath.

Points to consider:

  • Iron needs vitamin C to latch on to aiding absorption and minimising output issues.
  • Iron from animals is more easily absorbed into the body than iron from plants.
  • Iron tablets can change ‘consistancy’, which could be a problem.

Techniques to maximise intake of iron from plants:

  • Juice and add to cooking or drinks.
  • Liquidise or chop finely.
  • Add to cooking but then remove the chunks before eating.

Examples of higher iron foods:

  • Parsley
  • Liver – Put in a casserole, fry, chop and finely and add to a curry, mince with beef for burgers, make into a pate.
  • Blackstrap Molasses – 1tsp out of the jar a day or use in place of syrup in flapjacks.

Focus on B12:

Megaloblastic anaemia is the result of abnormally large blood cells, which prevents the cells from dividing correctly and carrying the oxygen efficiently.

B12 is absorbed at the end of the ileum.


The symptoms of this can be tingling in the hands and feet, (nerve damage), inflammation of the tongue and mouth, and could possibly lead to dementia.

Points to consider:

Your local health clinic or doctors surgery may provide regular B12 injections.

Examples of higher B12 foods:

  • Dairy products
  • Eggs
  • Seafood

Focus on Sodium:

Salt is sodium and chlorine combined = sodium chloride which is a solid.  These ‘ions’ are separated when they come into contact with water, (dissolved), so that they are responsible for fast transmission of impulses along nerves and in the brain.  They also have a role in contracting muscles.


Symptoms of sodium deficiency can be cramp

Examples of higher salt foods:

  • Salt – Add to your plate when serving food.  Look at using a good quality salt.
  • Make Salty Lassi drinks using bio yogurt and a nut milk.
  • Marmite – love or hate it!
  • Smooth peanut butter – not chunky, particularly with an ileostomy!
  • Crisps – the usual hospital recommendation, but not such a healthy option.


Focus on Hydration:

Water is needed in every cell of the body.

When someone with a large bowel has diarrhoea we tend to be aware of the dangers of dehydration.  After large bowel removal we are basically living with that scenario daily.  The ‘ions’ from sodium are flushed out the system along with the essential fluid.

Particularly during exercise, strenuous activities and in hot weather.


If you drink pure water/unsalted drinks, salt is passed from the blood into the gut until the concentrations are equal (and this makes the blood more dilute, corrected by losing water from the kidneys, resulting in a loss of blood volume, causing low blood pressure and weakness).

Therefore after drinking 1.5 litres of normal fluids, those with large bowel removal need to take further fluid which has the same ‘salt’ content as blood. Glucose should also be present as this is an active process requiring energy.

Dioralyte is too dilute and would need to be taken at double strength.


Energy loss, dryness and headaches.

Examples of hydrating drinks: (Up to 1.5 litres in a day)

  • Drink juiced fruit and vegetables, (maybe dilute with some water if to strong).
  • Drink water.

                        After 1.5 litres of ‘normal’ fluids:

  • Double strength Dioralyte.
  • St Mark’s electrolyte mix.

E-MIX RECIPIE (Frederick Salmon Ward,  St Marks Hospital)

Glucose      6 x 5mls level

Table Salt  1 x 5mls level

Sodium Bicarbonate    1 x 2.5mls heaped

1 Litre of Water

Download a Copy

Download a copy of this page to read on your iPad or computer: Iron, Sodium and Hydration (857)

Download a copy of  this booklet to read on your iPad or computer: Nutrition Booklet (1586)


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