Question:

Hello! I’m looking for suggestions for an elderly patient who had a lower-end colostomy in March 2023 due to a rectovaginal fistula. Despite her frailty, COPD, and cardiac condition, she recovered quite well after surgery. Unfortunately, she developed a bowel obstruction in mid-February and required a bowel resection. The surgeon reused the same stoma site.

She now weighs only 85 lbs. We’ve tried giving her Ensure as a supplement after meals, but it seems to go right through her and causes very liquid stool. Do you have any recommendations for how she can increase her calorie intake without worsening her output?

Answer:

Thank you for reaching out with your question. Supporting nutrition and weight gain in someone who has had significant bowel surgery, especially with a colostomy and other health challenges, is important and can be complex. Here are a few suggestions:

1. Ask the family physician for a referral to a dietitian. A registered dietitian can create a personalized nutrition plan based on her medical history and bowel function.
2. Contact the local home care intake programand request a dietitian consultation. Many home care services provide in-home visits, though there may be a waiting period.
3. Use protein powders available at most pharmacies. These can be easily mixed into soups, mashed potatoes, smoothies, or even beverages like milk or tea to add calories and protein without increasing volume.
4. Try protein-enhanced drinksin smaller volumes. If full servings upset her stomach, giving her 30 mL (2 tablespoons) at a time—such as with medications—can still contribute meaningfully to protein intake.
5. Add nutrient-dense snacks and fortified foods such as:
   • Protein-rich breads or cereals
   • Protein snack bars
   • Nut butters, cheese, or avocado
   • Eggs and full-fat dairy (if tolerated)
6. Explore additional food ideas online by searching for “high-calorie foods for weight gain” or “nutrition after colostomy.” Be cautious to ensure sources are reputable (e.g. healthcare institutions or government sites).
7. Consult your pharmacist about safe protein intake levels based on her weight, medications, and medical conditions.

Small, frequent meals throughout the day often work best, and avoiding high-sugar or high-fat drinks like Ensure may help minimize loose stool. Look for alternative supplements that are lower in sugar and lactose-free, if needed.

We hope these suggestions are helpful and wish her continued healing.

Answered by

Karen Bruton RN BScN MCISc-WH WOCC(C) 
Ostomy Canada (Volunteer)
Medical and Lifestyle Advisory Team Lead