What can I eat if I am at risk of bowel obstruction

Who is this information for?

The information below is for you if you have a narrowing in your small or large intestine (bowel) and are at risk of a blockage and have been having symptoms of bowel obstruction.

Why is it important for me to eat the right sort of foods with bowel obstruction?

If you have a narrowing in your small or large intestine (also known as bowel or gut), due to a stricture or mass, you may be at risk of a blockage. You may have already been admitted to hospital with a blockage.

Some foods pass through our body without being broken down properly. It can pass through in big pieces and can increase your risk of a blockage by getting caught in a narrowing.

This may also lead to symptoms such as pain, bloating, feeling full, feeling sick and tightness across your abdomen (tummy). You may also find it harder to pass a bowel motion.

You have been given this booklet because changing your diet can lower your risk of a blockage.

What can I eat and drink?

The amount of dietary changes you need to make depends on your individual situation. This booklet is divided into 4 stages and your specialist nurse, doctor or dietitian can advise you which stage you should be following, as well as when to move to the next stage.

You may find that you have to go backwards and forwards through the stages depending on your symptoms.

Nutritional Supplements

It may not be possible to meet your nutritional needs on liquids and diet alone. Therefore you are likely to need to use nutritional supplement drinks at certain times to make sure that you are meeting your nutritional needs. Your dietitian or doctor will prescribe nutritional supplements.

The 4 stages are as follows:

Stage 1	Clear fluids only
Stage 2	ALL thin liquid
Stage 3	Smooth or purée foods, also low in fibre (level 4/5)
Stage 4	Soft moist foods, also low in fibre (level 6)

Please ask for help if you are concerned.

What can I drink for Stage 1?

When your bowels start to open regularly again following a blockage you will be encouraged to start to sip on CLEAR LIQUIDS only.

Examples are:

Water
Black tea
Black coffee
Squash
Smooth clear fruit juice e.g. apple, cranberry juice
Herbal and fruit teas
Clear consommé soup (no bits)
Hot cup of Marmite® or Bovril®
Jelly

Try to sip on small amounts of drinks through the day. This is the easiest way to increase your intake of liquids. It will help to stop you getting dehydrated.

What can I drink for Stage 2?

If your bowels have been opening regularly, you will be advised to move to Stage 2. This means that you can have ALL forms of thin liquids.

The liquids need to be a thin consistency i.e. no thicker than whole milk
The liquids need to be completely smooth with no bits
The liquids need to be low in fibre e.g. thin smooth fruit juice with no bits – no smoothies

The following drinks provide energy, protein and vitamins and minerals.

Always use whole milk where possible.

Whole milk / milk with Nesquik® or Milo®
Milky coffee / latté / cappuccino
Yoghurt drinks
Hot chocolate
Thin milkshakes
Horlicks® / Ovaltine®
Thin smooth soups
Thin smooth fruit juice (no bits)
Thin custard
Jelly / milky jelly
Ice cream

You can also include the clear fluids from Stage 1.

Try to sip on small amounts of drinks throughout the day. This is the easiest way to increase your intake of liquids. It will help to stop you getting dehydrated.

What do I do if my symptoms return?

If you start to experience any of the following, please contact your doctor or dietitian immediately.

Nausea (feeling sick)
Vomiting
Feeling full after drinking
Your bowels do not open for more than 2 days
A feeling of ‘tightness’ across your stomach
Abdominal (tummy) pain

These symptoms could be a sign that your bowel may be blocked. If you are unable to speak to anyone immediately, return to Stage 1 and clear fluids only.

What can I eat and drink for Stage 3?

If your bowels are opening regularly and you are not in any pain after several days of Stage 2 drinks, your dietitian or doctor will ask you to move to Stage 3.

This means that you can start to eat SMOOTH OR PURÉED FOODS, (level 4/5) as well as all liquids.

Always eat small portions several times during the day rather than the usual three meals per day
Aim for 3 small meals and 3 snacks daily
All food needs to be smooth – no hard lumps
All food should be able to ‘fall off’ a spoon easily
All food should be swallowed without needing to chew it
All food should be low in fibre
You can have one portion of fruit and one portion of vegetables each day ONLY

Some fruit and vegetables must be completely avoided. See below for a list of foods allowed and foods to avoid.

Tips for following a soft smooth/purée diet

Equipment: Using a hand blender is the simplest way of producing puréed foods.
Puréed foods can look more appetising if they are presented separately e.g. separate a puréed meat casserole from the (allowed) vegetables and potatoes.
Colour is also important e.g. try serving brightly coloured vegetables such as puréed carrots with mashed potato and puréed chicken and sauce/gravy.
Cooked foods should be cut into small pieces then liquidised, blended or mashed, and if necessary sieved to a smooth consistency.
You will need to add extra liquid to most foods before or after they have been puréed. To improve the taste and nutritional value; add whole milk, melted butter, cream or creamy soup instead of water.
Remove tough skins and large seeds before blending.

TIP – Portion out and freeze in small Tupperware/ice cube blocks to reheat later

Foods to avoid during Stage 3

Some foods need to be completely avoided (even if puréed).

See below under which foods can increase my risk of a blockage.

Breakfast ideas for Stage 3?

‘Soggy’ cereal e.g. cornflakes or rice krispies soaked in whole milk
Puréed sweetened fruit - tinned pears, stewed fruit, fruit compote (one portion of fruit per day)
Full fat smooth yoghurt or fromage frais
Glass of fruit juice (no bits)
Milkshake
Smooth scrambled egg.

Add sugar, syrup, honey, jam, cream, butter or whole milk to add extra nutrition.

Dried skimmed milk powder can also be added to the liquids used in blending, or in the sauces added over foods. This adds extra protein.

Meal ideas for Stage 3?

Meat and alternatives

Purée cooked meat before adding liquid, to avoid a grainy texture and then add gravy
Try one of the following to add flavour: redcurrant jelly, mint jelly, soy sauce, tomato sauce, Worcestershire sauce, smooth mustard
Chopped, cooked meat such as ham can be added to sauces before blending
Puréed fish with added white sauce, parsley sauce, cheese sauce or tartar sauce
Eggs e.g. scrambled egg with added grated cheese
Bowl of smooth creamy soup (homemade or tinned)
Smooth egg mayonnaise

Use whole milk when preparing sauces or blending foods and try adding grated cheese into dishes such as fish pie and mashed potato. Yoghurt or cream cheese can also be stirred into soups or vegetables after blending.

Starchy Foods and Vegetables

Cook and mash potatoes, sweet potato, and butternut squash with butter, yoghurt, grated cheese and/or whole milk
Add to stews and soups before blending
Purée pasta, ground rice, white couscous, polenta with a sauce (e.g. a smooth tomato, cheese or curry sauce)
Add extra butter, olive oil, cream, grated cheese, coconut milk, crème fraiche or whole milk
Purée or mash (allowed) vegetables with a sauce or a little extra liquid

Dried skimmed milk powder can also be added to the liquids used in blending, or in the sauces added over foods. This adds extra protein.

Pudding ideas for Stage 3

Smooth milk puddings e.g. custard, ground rice pudding, semolina, tapioca
Sponge blended with plenty of cream, custard or ice cream
Blancmange, mousse, fruit fool, milk jelly, Angel Delight®, instant whip
Tinned and stewed fruit, fruit crumble blended to a smooth consistency with added cream, yoghurt, ice cream or custard (one portion of fruit per day)
Full fat smooth yoghurt, fromage frais, egg custard, crème caramel
Smooth ice cream, sorbet, frozen yoghurt

Add sugar, syrup, honey, seedless jam or marmalade, lemon curd, treacle, cream, custard, ice cream, crème fraiche, evaporated or condensed milk to add extra nutrition.

Dried skimmed milk powder can also be added to the liquids used in blending, or in the sauces added over foods. This adds extra protein.

Snack ideas for Stage 3?

Puddings can be eaten at any time of the day as a snack. Choose ‘full fat’ products for extra nutrition.

‘Dunked’ plain biscuits in a warm milky drink e.g. rich tea, custard creams
Sponge cake puréed with chocolate sauce
Ready-made smooth desserts, chocolate mousse, ground rice pudding
Bowl of cornflakes or rice krispies soaked in whole milk
Crisps that ‘melt-in-the-mouth’ e.g. Skips®, Wotsits®, Quavers® and smooth dips e.g. sour cream, guacamole, taramasalata.

Additional drinks for Stage 3?

It is important to drink plenty of fluid each day to prevent dehydration and aid bowel action.

You can choose any of the liquids listed in Stage 1 or Stage 2.

What do I do if my symptoms return?

If you start to experience any of the following, please contact your doctor, specialist nurse or dietitian immediately.

Nausea (feeling sick)
Vomiting
Feeling full after eating or drinking
Your bowels do not open for more than 2 days
A feeling of ‘tightness’ across your stomach
Abdominal (tummy) pain

These symptoms may be a sign that your bowel may be blocked. If you are unable to speak to anyone immediately, return to Stage 1 and clear fluids only.

What can I eat and drink for Stage 4?

If your bowels are opening regularly and you are not in any pain after several days on Stage 3 consistencies, your dietitian or doctor will ask you to move to Stage 4. This means that you can start to eat SOFT MOIST FOODS (Level 6), as well as all liquids.

Always eat small portions several times during the day
All food needs to be soft and sloppy
All food should be chewed well before you swallow each mouthful
Make sure all your meals have additional sauce or gravy to moisten them
All food should be low in fibre
You can have one portion of fruit and one portion of vegetables each day ONLY

Some fruit and vegetables must be avoided. See below under which foods can increase my risk of a blockage.

Tips for following a soft, moist diet/level 6

Taking foods little and often is advisable
Aim for small frequent meals and snacks, rather than 3 meals per day
Using sauces, butter, gravy, cream or custard can help to soften foods and keep them moist
Foods can be softened by chopping, mincing and mashing
Small sips of a drink can help with swallowing foods
Avoid foods that need a lot of chewing or do not break down well when chewed, such as bread, meat and pastry

Foods to avoid during Stage 4

Some foods need to be completely avoided. Please look at the lists to follow for more details.

Breakfast ideas for Stage 4?

‘Soggy’ cereal e.g. cornflakes or rice krispies soaked in whole milk
Ready Brek® with plenty of whole milk
Puréed sweetened fruit - tinned pears, stewed fruit, fruit compote (one portion of fruit per day)
Full fat smooth yoghurt or fromage frais
Glass of fruit juice (no bits)
Milkshake
Omelette, scrambled, poached or soft boiled egg.

Add sugar, syrup, honey, jam, cream or whole milk to add extra nutrition. Dried skimmed milk powder can also be added to the liquids used in blending, or in the sauces added over foods. This adds extra protein.

Main meal ideas for Stage 4?

Meat and alternatives

Shepherd’s pie, cottage pie, corned beef hash (no onions). Always add gravy
Minced cooked meats (no onions) with plenty of gravy or sauce
Poached fish in sauce (check for bones)
Quorn or soya mince dishes with plenty of gravy
Fish pie, fish mornay
Tinned fish (tuna, salmon) with plenty of mayonnaise or sauce
Scrambled egg, cheese omelette, egg mayonnaise
Fillings from quiche (no onions), soufflés
Cheese sauce (e.g. cauliflower cheese, macaroni cheese, carbonara)

Starchy Foods

Mashed or boiled potatoes, or instant mashed potato
Mash the inside of a jacket potato with butter and soft filling (no skin)
Tinned spaghetti or ravioli
Pasta with a smooth creamy sauce
White rice with plenty of sauce

Add butter, spread, cream, grated cheese, cream cheese or crème fraiche to add extra nutrition. Dried skimmed milk powder can also be added to the liquids used in blending, or in the sauces added over foods. This adds extra protein.

Pudding ideas for Stage 4?

Milk puddings e.g. custard, rice pudding, semolina, tapioca
Sponge pudding or cake with cream, smooth ice cream or custard to soften
Blancmange, mousse, fruit fool, trifle, milk jelly, Angel Delight®, Instant whip
Stewed fruit, fruit crumble softened with cream, custard or ice cream (one portion of fruit per day)
Smooth yoghurt, fromage frais, egg custard
Smooth ice cream, sorbet

Add sugar, syrup, honey, seedless jam or marmalade, lemon curd, treacle, cream, custard, ice cream, crème fraiche, evaporated or condensed milk to add extra nutrition.

Dried skimmed milk powder can also be added to the liquids used in blending, or in the sauces added over foods. This adds extra protein.

Snack ideas for Stage 4?

Sweet snack ideas for between meals for Stage 4

‘Dunked’ plain biscuits in a warm milky drink e.g. rich tea, custard or bourbon creams
Fruit fools, mousses, instant whips or crème caramel
Milky puddings e.g. custard, rice pudding
Yoghurt or fromage frais
Smooth ice-cream, mini ice-creams, choc ices, frozen yoghurt
Cornflakes or rice krispies soaked in milk
Smooth chocolate bars

Savoury snacks ideas for between meals for Stage 4?

‘Melt-in-the-mouth’ crisps e.g. Skips®, Wotsits®, Quavers®
Cheese spread or cream cheese
Cheese triangles
Light ‘melt in the mouth’ crackers e.g. Ritz® crackers, TUC® biscuits, with dips e.g. sour cream, taramasalata, tzatziki (no cucumber), smooth guacamole.
Tuna, salmon or egg mayonnaise
Tinned spaghetti or ravioli
Avocado with flaked crab meat or prawns in a cocktail sauce
Scrambled, poached or soft boiled eggs.
Bowl of creamy smooth soup
Pasta mixed with sauce e.g. creamy cheese

Additional drinks for Stage 4?

It is important to drink plenty of fluid each day to prevent dehydration. You can choose any of the liquids listed in Stage 1 or Stage 2.

What do I do if my symptoms return?

If you start to experience any of the following, please contact your doctor, specialist nurse or dietitian immediately.

Nausea (feeling sick)
Vomiting
Feeling full after eating or drinking
Your bowels do not open for more than 2 days
A feeling of ‘tightness’ across your abdomen (stomach)
Abdominal (tummy) pain

These symptoms may be a sign that your bowel may be blocked. If you are unable to speak to anyone immediately, return to Stage 1 and clear fluids only.

What can I eat and drink after Stage 4?

If you bowels are opening regularly and you are not in any pain after several days on Stage 4 you may need to continue on these consistencies. However, you may be able to change your diet further.

Please speak with your dietitian or doctor before making any further changes.

Which foods can increase my risk of a blockage?

It is important to completely avoid the foods that may increase your chance of getting a blockage. We advise that you follow a strict LOW FIBRE diet because fibre is not easily digested, can pass through the intestines in large lumps, and can get stuck in a narrowing. The lists below will help you make the right choices. The foods you are allowed to eat may need to be mashed or puréed. Always check with your dietitian if you are unsure. Some of the foods on the ‘allowed’ lists may not be suitable in some of the Stages. Always check with your dietitian if you are unsure.

What fruit can I eat?

Foods allowed - limit to one portion per day ALWAYS CHECK IF THESE NEED TO BE PURÉED

Fruit juice (no bits)
Bananas
Melon, watermelon, papaya
Small amounts of fruits with the skins removed e.g. peeled apples, pears, peaches, plums, nectarines, apricots
Puréed, stewed or cooked fruit (without skins, pips or stones)
Tinned fruit (not pineapple or cherries)
Fruit sauces and coulis with pips removed e.g. sieved

Foods to avoid

Fruit juice with bits
Smoothies – unless sieved
Fruits with skins on e.g. grapes, cherries, blueberries
Citrus fruit
Coconut
Pineapple
Rhubarb
Berries and fruits with seeds e.g. strawberries, raspberries, blackberries, kiwi, pomegranate, passion fruit
All dried fruit e.g. raisins, cranberries, apricots, prunes, dates (including stewed)

What vegetables can I eat?

Foods allowed - limit to one portion per day ALWAYS CHECK IF THESE NEED TO BE PURÉED

Peeled white or sweet potatoes
Well-cooked and peeled root vegetables e.g. carrots, parsnips, swede, turnips
Butternut squash, pumpkin, peeled marrow, courgette, patty pan, aubergine
Well-cooked broccoli and cauliflower florets (no tough stalks)
Peeled and deseeded tomato, cucumber, cooked peppers
Ripe avocado
Liquidised and sieved vegetable soups
Small amounts of garlic and ginger paste
Soft/tinned, pickled beetroot

Foods to avoid

Skins of potatoes
All skins, pips and seeds
Tough stalks of vegetables e.g. cauliflower, broccoli
Raw vegetables
Asparagus
Brussels sprouts, cabbage, spring greens
Onion, garlic, leeks, spring onions
Pickled onions, gherkins
Sweetcorn
Mushrooms
Peas, sugar snaps, mangetout
Green, French and runner beans
Broad beans
Raw or cooked beetroot
Celery
Radish
Lettuce, rocket, watercress, salad leaves and spinach
Chicory, fennel
Whole tomatoes
Olives
Bean sprouts
Pak choi
Soup with whole vegetables e.g.
Minestrone