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A stoma symptom and food diary for ostomates

Food diary for ostomates

What a food and symptom diary is

Post stoma-surgery, you may be experiencing a number of symptoms you want to change, such as stoma pancaking after your ileostomy or colostomy, or a solution to painful urinary tract infections after your urostomy.

A food and symptom diary is a helpful way to record what you eat and drink that may link to symptoms you’d like to improve. A food diary for ostomates is an important tool.

By keeping a note of the timings of these symptoms, as well as the timings of food, drink, and other useful information e.g. medications, you may be able to see a pattern of triggers which helps identify what changes may be valuable.

It can be helpful to fill in the diary over a few days, both when you have no or mild symptoms, and when your symptoms are worse. This variety can help highlight the differences between these ‘good days’ and ‘bad days’. It’s also helpful to see if symptoms are showing a pattern or are a ‘one off’.

Note: Symptoms can be caused by non-food and drink reasons e.g. stress, missing medications, or medication doses that could be too low or too high. It can be linked to the fit or seal of the pouch against your skin, how regularly your pouch is changed, and what products you use with it. If in doubt, please speak with your medical team.

How to complete your food and symptom diary

For each day of the week, write down what you eat and drink, and the timings. Also write down for that day what symptoms you had and the times they started and stopped. You can also add any notes e.g. if you were stressed, missed any medications, if you did more or less exercise than normal.

How to interpret your completed diary

Step 1)

Notice what symptoms you experience, how often, and if it’s at a particular time of day e.g. very loose stools once a day after breakfast

Step 2)

You can use our handy ‘common stoma problems’ table to see if it matches your symptoms and eating and drinking. If you’d like to, you can try the different steps we’ve suggested for each symptom.

Bowel Stomas & Urostomies Symptoms, Triggers & Solutions

Problem Common nutrition triggers Solutions
Pouch odour

Bowel stomas

Onions, garlic, broccoli, cauliflower, Brussel sprouts, cabbage, beans, fish, and eggs.


Dehydration, garlic, asparagus, fish and seafood.

Step 1

If you don’t already, try including dairy foods and parsley that can neutralise unpleasant odours.

Step 2

Consider some swaps e.g. use asafoetida (hing) powder instead of onion or garlic while cooking, it’s available at most supermarkets.

Pouch pancaking

Bowel stomas

  • Sticky stools due to eating high fat and greasy foods e.g. fried and creamy dishes. Sometimes due to not enough insoluble fibre.
  • Hard stools that are difficult to pass e.g. because of too little ‘soluble’ fibre or water.

Urostomies – usually non-nutrition related, although may be due to dehydration and passing less urine.

Sticky stools

swap fried foods for baked options, choose more tomato-based sauces than creamy options or use less cream.

Hard stools and sticky stools – Include foods high in ‘soluble’ fibre e.g. oats, peeled fruit and vegetables, milled seeds.  The section of this table on blockages may be helpful.

Urostomies, hard stools, and sticky stools – aim for 2L of water a day, with a glass of water with each meal or snack unless you’ve been advised otherwise.

Colour changes


Stools and urine – beetroots, red-coloured berries, red wine and tomato skins

Purple/dark blue:

Stools – blueberries and blackberries

Urine – for those with urostomies, being constipated (not enough water or fibre)

Yellow/orange/dark brown:

Stools – High fat meals e.g. creamy sauces or fried foods

Urine – Very high dose B vitamins or dehydration


Stools – High fat meals e.g. creamy sauces or fried foods


Stools – Taking iron supplements or bleeding in the digestive system; speak with your Doctor or call the NHS helpline 111 for advice.

Most colour changes are not harmful and you don’t need to change your diet.

Speak with your Doctor or call the NHS helpline 111 if:

  • There are smell, consistency or volume changes of your stools or urine
  • You have unfamiliar pain at your stoma site, digestive system i.e. from mouth to anus, or your urinary system which includes your kidneys near your lower back

Urostomies Symptoms, Triggers & Solutions

Problem Common nutrition triggers Solutions
Pain when passing urine Often due to urinary tract infections or urine crystals, which can be caused by:

  • Dehydration
  • An imbalanced diet
Aim for 2L of water a day, with a glass of water with each meal or snack unless you’ve been advised otherwise.

Choose hydrating foods e.g. fruit and vegetables, soups, and yogurts. You can use our ‘Hydration Guide’ resource.

Aim for at least 5 portions of fruits and vegetables a day. At each meal, include 1-2 portions of vegetables, a portion of starchy carbohydrate food, some protein-based food, and around 3 high calcium foods or drinks a day. See our ‘Nutritional Guide’ resource for support.

Bowel Stomas Symptoms, Triggers & Solutions

Problem Common nutrition triggers Solutions
Pouch-inflating and bloating Onions, garlic, broccoli, cauliflower, brussel sprouts, cabbage, beans, chewing gum, fizzy drinks (including beer) and eating quickly.

Step 1

Try chewing your foods very well

Step 2

Try swapping one of these common triggers at a time, e.g. e.g. green beans instead of broccoli

Undigested food and blockages Minimally chewed food.

Popcorn, bean sprouts, sweetcorn, cooked mushrooms, fruit or vegetable skins e.g. tomatoes, unpeeled cucumber, fibrous food like nuts, seeds, broccoli stalks, celery, and pineapple.

Step 1

Try having smaller portions and chewing these foods very well

Step 2

If you’ve had multiple reactions to these types of foods, swap them for another e.g. having sharp tasting peeled apples instead of pineapple.

Increased stool frequency and watery stools
  • Eating quickly
  • Caffeinated drinks (teas, coffees, cola-type or ‘energy’ drinks)
  • Having minimal starchy carbohydrate foods
  • More than 2-3 portions of fruit a day, more than 150ml of fruit juice/smoothies a day
  • Foods high in ‘insoluble’ fibre or ‘tough’ foods like broccoli stalks, celery, pineapple, whole nuts and seeds
  • Lots of chilli
  • Frequent high fluid meals or drinking lots with meals

Step 1

Try eating slowly and chewing your food more

Step 2

Swap to decaf teas and coffees, plain water, water flavoured with fresh fruit slices or ‘cold-infuse’ tea bags

Step 3

Ensure each meal has a portion of starchy carbohydrates e.g. a fist-sized potato

Step 4

Try having up to 2 or 3 portions of fruit a day, no fruit juice or smoothies, or up to 150ml a day of fruit juice or smoothies

Step 5

Swap to foods with more ‘soluble’ fibre e.g. oats, peeled fruits and vegetables, root vegetables. Swap whole nuts or seeds for ground nuts and seeds or nut butter and seed paste e.g. peanut butter and tahini

Step 6

Try using other strong-tasting herbs and spices instead of lots of chilli e.g. ginger and black pepper

Step 7

Try drinking water outside of mealtimes e.g. drink in the 15-30 minutes before eating or about an hour afterwards. Still aim for 2L of water across the day unless advised otherwise

Note: This table was created from a review of reputable information sources and Registered Dietitians’ clinical expertise. This list isn’t exhaustive nor a fool-proof guide to what’s causing your symptoms. It’s always best to seek personalised advice from your personal healthcare professional.

Extra resources:


Laura Coster is a Registered Dietitian who is passionate about helping people feel confident in managing their health and find joy through what they eat. Laura Coster