Surgery and Nutrition

Pre-Operative (Before Surgery)

Nutrition Screening

Before you have surgery, like creating an ostomy, a j-pouch, or removing part of your intestine, it’s important to check your nutrition. This means looking at what you eat and making sure you’re getting enough nutrients to stay healthy.


There are a few things that can affect your nutrition:

  • Eating less: Maybe you’re avoiding certain foods, not feeling hungry, or experiencing pain or nausea.
  • Losing nutrients: This could happen if your body isn’t absorbing nutrients well, if you have a lot of liquid bowel movements, or if you have openings (fistulas) between parts of your digestive system or other organs.
  • The need for more nutrients: Your body might need more nutrients because of inflammation from a disease, certain medicines affecting nutrient absorption, or healing from surgery or an infection (1).

The process of checking your nutrition can be different for each person. You might be asked questions like:

  • Have you lost weight without trying?
  • Is your appetite different or less than before?
  • Are you eating less than usual?


Your medical team might check the following to see how healthy you are:

  • Measure your handgrip strength: This checks how well your muscles are working and helps to show if you’re getting the right nutrition.
  • Ask questions about your diet: This might help to figure out if you need more calories, protein, or other nutrients.
  • Check for recent unintended weight loss: Losing weight without meaning to is common when you’re dealing with a sickness. Before surgery, your team will try to keep your body weight stable to help you heal better.
  • Conduct blood tests for nutrition: They might collect blood to check your vitamin B6, B9, B12, and iron levels. These are important for different body functions, like carrying oxygen in your blood. If these nutrients are too low, you could develop problems like anemia. Making sure these levels are good before surgery can help with your recovery.

After this screening, you might need to see a registered dietitian (RD) to make sure you’re eating the right things for your surgery. (2,20)


What should I expect my nutrition to look like leading up to surgery?

Normally, unless your doctor or RD tells you something different, you should try to eat a balanced diet. Also, it’s a good idea to avoid smoking because it can slow down the healing process. Also stay away from alcohol, as it can increase your chances of complications after surgery. If these changes are tough for you, let your doctor know so they can help you. (3)


Sometimes, people can’t eat before surgery because of their sickness, health condition, or doctor’s orders. If that’s true for you, your medical team should have a dietitian advise you on the best way to get the nutrition your body needs before surgery.


Your surgeon’s office will give you instructions on how to prepare your bowels (if needed) and what to eat before surgery. Following these instructions can make your surgery safer and more successful. You might be told to have a clear liquid diet or a low-fiber diet during or before getting ready for your surgery.


Examples of foods allowed on a clear liquid diet:

  • liquids that are fully clear at room temperature
  • fruit juices without pulp (e.g., apple juice)
  • broths
  • tea or coffee, plain without cream or milk
  • water, ice, ice pops*
  • gelatin*
  • sports drinks*
  • gummy bears* (4,5)

*Check with your healthcare team regarding which colors/flavors are recommended or prohibited


Examples of foods allowed on a low-fiber diet:

  • eggs
  • refined grains (pastas, white breads, cereals such as cream of wheat, corn flakes, crisped rice)
  • white rice
  • seafood and poultry
  • applesauce
  • peeled and cooked vegetables or fruits
  • creamy nut or seed butters (4,5)

Before your surgery, in addition to getting your bowels ready, your doctor might tell you to drink a special drink that’s clear and full of carbohydrates. This drink can be a safe way to help your body handle the stress of surgery and ease your recovery. Your doctor might give you a drink that’s already prepared, or they might tell you to have 50 grams of carbohydrates (for example, 16 ounces of apple juice or 12 ounces of grape juice) the night before your surgery, and then 100 grams of carbohydrates (for example, 32 ounces of apple juice or 24 ounces of grape juice) the day of your surgery.


It is important to note that these directions might not be safe if your doctor has told you to limit how much you drink, you have certain health conditions like congestive heart failure (CHF) or end-stage renal disease, or you have diabetes or previously had weight loss surgery. Always follow your doctor’s advice. (6)

Post-Operative (After Surgery)

What should I expect my nutrition to look like after surgery?

After surgery, how you eat will depend on the type of surgery you had and your care plan. Usually, it’s okay to start eating again within 24 hours after surgery. Eating within this time frame has been linked to:

  • Lowering the chances of problems from surgery, like leaks.
  • Helping the muscles in your stomach and intestines work better.
  • Aiding in the healing process.
  • Possibly reducing feelings of sickness, throwing up, and bloating.
  • Maybe cutting down the time you need to stay in the hospital. (7,8)

Important: Talk to your surgeon and dietitian before you start eating again after surgery. Don’t decide on your own. They’ll let you know when it’s safe for you. If you’re wondering when it’s okay to go back to your usual eating habits after surgery, ask your doctor.


When can I return to eating like I used to before surgery?

After surgery, how you eat is usually personalized, and it’s important to talk with your care team about it.


Right after surgery, the way you eat is not meant to be the same forever. If you’re having trouble adding different foods back into your diet safely, ask your surgeon to connect you with a dietitian who knows about surgeries for inflammatory bowel disease (IBD).


If your care team thinks you need extra nutrition help after surgery, like total parenteral nutrition (TPN) or enteral nutrition, they’ll work on this toward the end of your time in the hospital, ensuring you have the right medical formulas to aid your recovery.


If getting better is hard physically, ask your doctor if physical therapy could help. Physical therapy has been shown to reduce pain and help people recover after some colorectal surgeries. (9)


Lastly, if you’re finding it tough to cope with life after or during surgery, talk to your doctor about getting support from mental health providers who know about IBD.


Hydration and GI surgery

Hydration means having the right balance of fluids and electrolytes in your body. (16) Most of the nutrients your body needs are absorbed in the small bowel, while the large intestine or colon is responsible for absorbing most of the fluids and electrolytes, taking water out of stool. Have a chat with your doctor or dietitian about how much water you personally need after your surgery.


If you’ve had part or all of your colon removed, your ostomy output might be more liquid. To stay hydrated, you might find oral rehydration solutions (ORS) helpful. ORS is different from typical sports drinks because it’s made to work with your body’s sodium-glucose cotransport system, which helps maintain hydration. Compared to regular sports drinks, ORS has the right balance of sodium to carbohydrates for proper hydration. Drinking commercial sports drinks without diluting them with water can lead to more bowel movements, especially for those with ostomies or j-pouches, possibly causing dehydration. Drinking ORS slowly throughout the day is the best way to support your digestive system’s comfort and overall hydration. (17)


You can make your own ORS with ingredients like water, table salt, sugar, and fruit juice. (18) However, there are some important things to consider:

  1. Ostomy location: If your ostomy is higher up in the digestive system, the balance of electrolytes might need careful adjustment with guidance from a specialized GI team experienced in inflammatory bowel disease nutrition.
  2. TPN (total parenteral nutrition): If you’re on TPN and are allowed to eat or drink, let your care team know if you’re using ORS so they can adjust the electrolytes in your TPN if needed.
  3. Kidney health: If you have kidney disease or are on dialysis, your electrolytes may need extra monitoring with personalized adjustments prescribed by your nephrologist and renal dietitian.
Nutrient absorption after surgery

 After GI surgery, it's important to keep and eye on three nutrients:

  1. Vitamin D: The organ in the GI tract that absorbs vitamin D can slow down after surgery, and reduced bile acid absorption also affects vitamin D absorption. If you’ve needed steroids before, ask your doctor for a bone mineral density scan. Checking your vitamin D levels and getting a bone mineral density scan are essential for understanding your overall nutrition, especially with IBD and after surgery.
  2. Vitamin B12: Vitamin B12 is crucial for having enough oxygen in the body. You can talk to your GI doctor or surgeon about monitoring your vitamin B12 levels before and after surgery, especially if your surgery involves the organ responsible for absorbing vitamin B12.
  3. Iron: Ask your GI doctor for an “iron panel with ferritin” to check your iron status. Even though iron is mostly absorbed higher up in the GI tract (jejunum) than where j-pouch surgery occurs (ileum), people who have had j-pouch surgery often face iron-deficiency anemia. (19)



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