What is lactose intolerance?

Lactose intolerance means that your body cannot digest lactose. Milk is made up of fats, proteins and sugar (carbohydrate). Lactose is a type of sugar (carbohydrate) that is in milk and milk products.

What are the symptoms?

• Wind 
• Bloating
• Tummy ache
• Stomach cramps
• Tummy rumbling
• Nausea (feeling sick)
• Diarrhoea (loose stools)

What are the causes?

Lactose intolerance happens when your body does not make enough lactase.

Lactase is an enzyme that breaks down lactose; it is made in the lining of the small bowel. Enzymes break down sugars into smaller parts, so that they can pass from your gut into your body.

Types of lactose intolerance

There are two types of lactose intolerance: primary and secondary.

Primary lactase deficiency

Primary lactase deficiency is a lifelong genetic condition (runs in families). It is most common in people from Africa and Asia, but anyone can have it. 2 out of 3 people in the world have this. You may produce lactase as a child, but less lactase as you grow up.

Secondary lactase deficiency

Secondary lactase deficiency is usually short term. It is due to illnesses that affect your small bowel such as coeliac disease, inflammatory bowel disease (IBD), gastrointestinal infections and abdominal surgery.
Lactose cannot be broken down or absorbed without lactase. It will pass into the colon instead. In the colon it will be fermented which makes gas. Lactose also pulls water into the bowel, which is why it can also cause loose stools.

Lactose intolerance is not the same as an allergy. If you have lactose intolerance you may be able to manage some lactose in your diet in smaller amounts. However, if you have a milk protein allergy you need to strictly avoid all milk products.

Some people do not make the lactase enzyme but do not get bad symptoms. Other people can make the lactase enzyme but still have bad symptoms. Lactose may make you feel ill but it will not do any long-term harm or hurt your body. You need to work out how much lactose is right for you and your symptoms.

Diagnosis

Hydrogen Breath Test

In this test, you drink a special high lactose drink and they test how much hydrogen gas is in your breath. If your body does not break the lactose down, the bacteria that live in your colon will ferment it. This makes lots of hydrogen gas, so a high level of hydrogen in your breath means you have lactose intolerance.

The test results are not perfect. Some people have a positive breath test but no symptoms. Some people have a negative breath test but still have symptoms. Sometimes a lactose free trial is better.

Lactose free trial

This is a good choice instead of the breath test.

Stop having lactose for a short time (about 2-4 weeks). If you do not feel better, then you do not have lactose intolerance and you can start having lactose again. You can talk to your doctor or dietitian about what else could help your symptoms.

Which foods contain lactose?

Lactose is in milk, including breastmilk, cow’s milk, sheep’s milk and goat’s milk. All products containing milk or made from milk contain lactose.

Everyone will tolerate a different amount of lactose. Most people can have a low lactose diet, but some people will need to be stricter. For example, you might be able to have a splash of milk in tea, but you might have symptoms if you had a milky coffee.

• Start by strictly avoiding lactose.
• If your symptoms get better, you can slowly increase your lactose intake.
• Most people can have some lactose. Try to spread it out through the day.

The information below shows how much lactose is in different foods.

The amount of lactose in some foods can vary. There is not an exact amount of lactose in the table for these foods, but you can see which foods are lactose free, low in lactose or high in lactose.

Food groups

If you would like a printed copy of this information in a table format, please speak to your clinician.

Milk

High lactose (more than 2g /100g)

• Cow’s milk: 4.6 - 4.8g /100g
• Sheep’s milk: 5.1g /100g
• Goat’s milk: 4.4g /100g
• Condensed milk: 12.3g /100g
• Evaporated milk: 12.7g /100g
• Dried milk powder: 52.9g /100g
• Cream alternative (Elmlea): 4g /100g

Low lactose (up to 2g /100g)

• Creme Fraiche: 2g /100g
• Cream: 1.7 - 2.2g /100g
• Soured cream

Lactose free

• Oat milk
• Rice milk
• Soya milk
• Coconut milk
• Hazelnut milk
• Almond milk
• Tiger nut milk
• Lactose free milk
• Hemp milk

Other dairy

High lactose (more than 2g /100g)

• Yoghurts: 3.6 - 4.7g /100g
• Lassi: 8.6g /100g
• Fromage frais: 2.9 - 4.1g /100g
• Custard: 4.6 - 5.4g /100g
• Rice pudding: 3.9 - 4.9g /100g
• Mousse: 5.7g /100g

Low lactose (up to 2g /100g)

• Cheesecake

Lactose free

• Soya desserts / dairy free yoghurt style
• Lactose free yoghurts

Cheese

High lactose (more than 2g /100g)

• Cottage cheese: 3.5g /100g
• Processed cheese: 6.5g /100g
• Cheese spread, e.g. Philadelphia or supermarket own versions
• Ricotta
• Mascarpone: 4.5g /100g

Low lactose (up to 2g /100g)

• Hard cheese: 0.1g /100g
• Blue cheese: 1.0g /100g
• Ripe / rind cheeses: 0.9g /100g
• Mozzarella: <0.1g /100g
• Goat’s cheese: 0.9g /100g
• Feta: 1.4g /100g
• Halloumi: 1.5g /100g
• Lactose free cheese: <0.1g /100g
• Low / reduced fat cheese
• Brie: <0.1g /100g
• Cheddar: 0.1g /100g

Lactose free

• Dairy free cheese alternative

Cereals

High lactose (more than 2g /100g)

• Yoghurt coated cereal bars
• Porridge made with milk

Lactose free

• Breakfast cereals

Bread

Low lactose (up to 2g /100g)

• Milk bread
• Some gluten free bread contains milk

Lactose free

• All other breads

Rice

High lactose (more than 2g /100g)

• Rice pudding: 3.9 - 4.9g /100g

Low lactose (up to 2g /100g)

• Risotto

Lactose free

• Rice
• Rice cakes
• Sushi

Pasta

High lactose (more than 2g /100g)

• Macaroni cheese
• Ricotta ravioli
• Lasagne

Lactose free

• Pasta with tomato sauce
• Check free from section for dairy free white sauce, macaroni cheese or lasagne

Treats/snacks

High lactose (more than 2g /100g)

• Milk chocolate
• White chocolate
• Ice cream
• Chocolate cake bars

Low lactose (up to 2g /100g)

• Cheese and onion crisps
• Cheesy puffs / corn snacks
• Biscuits
• Chocolate coated / dipped biscuits
• Cake
• Cheese crackers: <0.3g /100g
• Fudge / toffee: <1.5g /100g
• Pastry made with butter: 3.3g /100g

Lactose free

• Most crisps
• Sorbet
• Dairy free ice cream
• Jelly

Fats

Low lactose (up to 2g /100g)

• Butter
• Ghee
• Reduced fat spreads
• Margarine

Lactose free

• Vegetable oils
• Coconut oil
• Lard
• Dairy free spreads

Meat, fish, eggs and alternatives

High lactose (more than 2g /100g)

• Omelette made with milk

Low lactose (up to 2g /100g)

• Scrambled egg made with butter / milk
• Battered fish (some does have milk in, some does not)

Lactose free

• Meat
• Fish
• Eggs
• Tofu
• Quorn
• Vegan meat alternatives

Sauces / condiments

High lactose (more than 2g /100g)

• White sauce
• Ready made custard

Lactose free

• Jam
• Marmite
• Peanut butter
• Mayonnaise (check as some brands contain milk or cream)
• Ketchup
• Vinegar
• Custard powder
• Gravy
• Spices / herbs
• Chutney / pickle

Fruit, veg, nuts, pulses

High lactose (more than 2g /100g)

• Yoghurt coated dried fruit / nuts

Low lactose (up to 2g /100g)

• Mashed potato made with butter / milk
• Instant mash
• Soup containing cream

Lactose free

• All fruit and vegetables
• Baked beans
• Pulses
• Chips, potato waffles, hash browns
• Nuts

Checking labels

It is the law that if a product contains milk products they will be listed in bold, underlined, or highlighted.

The ingredients list is in weight order, with the largest first. If it is near the bottom of the list then there is a smaller amount in the food. If milk is one of the last ingredients in a long list, it might be fine.

Vegan foods are lactose-free.

Check labels for:

• Milk
• Milk solid
• Skimmed milk powder
• Cream
• Butter
• Buttermilk
• Whey

“May contain”

Most people with lactose intolerance can have a food that says “may contain milk” or “made in a factory that handles milk” or “not suitable for people with a milk allergy”.

Confusing ingredients

Casein and milk protein are sometimes listed within the ingredients and are proteins found in milk; you can have both of these ingredients. Some people have an allergy to milk protein, but this is not the same as lactose intolerance.

Medications

Some tablets contain very small amounts of lactose. Do not worry unless you take lots of tablets.

You can talk to the pharmacist about changing to lactose free medicine. Do not stop taking a medication without speaking to your doctor or pharmacist first. Lactulose (a laxative) is not the same as lactose.

Nutrients

Dairy products provide some key nutrients. You need to make sure you get enough of these. Remember that most cheese is low in lactose so it may be okay for you.

Vitamin B12

You need vitamin B12 to help with energy release, healthy blood and the nervous system.

Non-dairy sources of vitamin B12:

• meat
• eggs
• fortified breakfast cereal
• yeast extract (marmite)
• salmon
• cod

Calcium

You need calcium for bone health. Milk and dairy products are the main sources of calcium.

• Lactose-free milk contains the same amount of calcium as cow’s milk.
• If you use a milk alternative (oat/soya/coconut/nut milk), make sure it has added calcium.
• Organic milk alternatives do not have calcium added to them.
• Tinned fish with bones (sardines, pilchards, salmon) are very high in calcium.
• Oranges, almonds, brazil nuts and tofu also contain calcium but it is not so easily absorbed.

You may need to take a calcium tablet if your bone health is high risk such as:

• Breastfeeding mothers
• Post-menopausal women
• Coeliac disease
• Inflammatory bowel disease

Vitamin D

You need vitamin D to use calcium.

The body makes vitamin D from sunlight on your skin. In the UK there is not enough sunshine in autumn or winter to make all the vitamin D that we need.

Consider taking a vitamin D supplement daily in autumn and winter.

Vitamin D is in oily fish, red meat, offal, and egg yolks. Some breakfast cereals, margarines and non-dairy milk alternatives have vitamin D added.

Protein

You need protein for growth and repair, and to keep you strong.

Some lactose free milks have more protein than others. Lactose free cow’s milk and soya milk contain the most protein; oat and nut milks contain the least protein.

Eat 2 - 3 portions of high protein foods daily.

Non-dairy sources of protein include meat, fish, eggs, beans/pulses, tofu and nuts.

Meal ideas

Breakfast

• Cereal with lactose free milk
• Toast with dairy free spread and jam

Lunch

• Sandwich with dairy free spread and tuna/ ham/ chicken/hard cheese and salad
• Homemade soup made without milk or cream
• Jacket potato with dairy free spread, tuna/baked beans/hard cheese and salad
• Eggs or baked beans on toast with dairy free spread

Evening meal

• Meat/chicken/fish with potatoes or rice and vegetables
• Omelette/frittata with side salad
• Spaghetti Bolognese
• Curry made without yoghurt, with rice and dahl

Snacks

• Fruit
• Nuts
• Crisps (not cheese and onion)
• Oat cakes/ rice cakes/ crackers with dairy-free spread
• Tea, coffee, squash, lactose free milk
• Dark chocolate
• Biscuits

Lactase enzymes

You can buy lactase enzymes from pharmacies, health food shops and online. They may reduce your symptoms if you do eat lactose by replacing the lactase that your gut does not make. There is not much research on how well they work.

Can I ever eat foods containing lactose?

Most people find that their symptoms get better after cutting out lactose for 4 weeks. If you have secondary lactose intolerance, it can take longer.

Once your symptoms get better, try to put some lactose back into your diet. Start with a very small amount and increase slowly. Most people can manage some lactose but everyone has a different limit.

• You should start by trying foods that are lower in lactose such as hard cheese.
• Try a small amount and increase it gradually until you find the level you can manage.
• Then you can try foods that are higher in lactose, like milk.
• Start with a splash of milk in your tea/coffee or on your cereal and build it up slowly.
• When you start to get symptoms, you have found your limit.

What if symptoms don’t improve?

If you are lactose intolerant then your symptoms should get better when you take lactose out of your diet.

If you do not feel better, then you do not have lactose intolerance and you can start having lactose again. You can talk to your doctor or dietitian about what else could help your symptoms.

Risk of anaphylaxis (serious allergic reaction) when reintroducing lactose

If you have ‘atopy’ (eczema, asthma, other allergies, hay fever), there is a very small risk that you can develop an allergy to milk protein if you completely avoid it for a long time.

To avoid this risk you should try to keep some low lactose dairy products in your diet such as hard cheese.

This page will provide you with information about longer term feeding tubes. The page will tell you what to expect before, during and after your operation. 

A member of the medical team, your dietitian or your speech and language therapist can answer any further questions you may have.

What is a feeding tube?

A feeding tube is a small tube that passes through the skin into your stomach. This allows special liquid feed, water and medicines to be passed into the stomach. It can help to meet your dietary needs.

The three different operations used in North Bristol Trust are:

• Percutaneous Endoscopic Gastrostomy (PEG) – uses a flexible camera (endoscope) that passes into your stomach.
• Per-oral Image Guided Gastrostomy (PIGG) – the tube is placed using x-ray.
• Radiologically Inserted Gastrostomy (RIG) – the tube is placed using x-ray.

The most common tube is the PEG. You may have a RIG or PIGG tube if you cannot have sedation or if the camera cannot access your stomach.  We will discuss with you which type is best. 

Why do I need a feeding tube?

There are many reasons why you may need a feeding tube. We will discuss this fully with you. You may consider a feeding tube when:

• You are losing weight.
• You cannot eat or drink enough.
• Eating and drinking leads to choking or discomfort.
• Your breathing function is reduced or you get chest infections.
• It takes a long time to eat and it is no longer enjoyable for you.
• You have been getting nutrition through a tube in your nose for many weeks (nasogastric tube (NG)).
• The feeding tube in your nose keeps coming out.
• It is unsafe for you to eat or drink.

Sometimes feeding tubes are placed if you have problems with swallowing.

Will a feeding tube stop me eating and drinking?

What are my other choices if I decide against having one?

How do I prepare for a feeding tube?

Are there any risks?

How is the tube placed?

If you are having a PEG

This is done in the Endoscopy Department. You will be given a local anaesthetic to your stomach, some throat spray, and light sedation (to make you feel relaxed). An endoscope (a flexible tube with a light and camera at one end) is passed down into your stomach and lit up.

A small cut is made in your stomach where the light shines and the tube is then passed through. The operation usually takes around 20 minutes.

You will be in the unit for some time before and after the operation.

This is what a PEG tube looks like: 

If you are having a PIGG

This is done in the Interventional Radiology Department. A narrow tube is passed through your nose into your stomach. Air will be passed into your stomach through the tube to make it visible on X-ray.

Local anaesthetic will numb your stomach. A small cut is made in your stomach and a wire is passed through to your mouth. The feeding tube is then passed through.

This operation typically takes 30 minutes.

This is what a PIGG tube looks like:

If you are having a RIG

This is done in the Interventional Radiology Department. A narrow tube is passed through your nose into your stomach. Air will be passed into your stomach through the tube to make it visible on X-ray.

Local anaesthetic will numb your stomach and stitches are placed to hold the stomach close to the wall of the abdomen. A small cut is made near the stitches and a feeding tube is passed through into the stomach.

This operation typically takes 30 minutes.

This is what a RIG tube looks like:

What happens afterwards?

If there is:

• Leaking of fluid around the tube.
• Pain on feeding.
• Prolonged or severe pain after the operation.
• New bleeding. 

Stop feed immediately

Phone your community feeding team or visit your local accident and emergency department for urgent advice

How do I look after my feeding tube? 

PEG / PIGG

RIG

What help is available once I leave hospital?

Your ward dietitian will refer you to the community feeding team or an alternative service in your area. The community feeding team are known as the home management services (HMS).

The team comprises of dietitians, home enteral feeding nurses and a delivery company. They will contact you to arrange a monthly delivery of feeds and plastic equipment, such as syringes.

We may send you home from hospital with a small supply of feeds and equipment.

Your ward dietitian will explain your home feeding plan and provide contact details for the HMS team. Your GP may also be involved in the management of your tube.

What do I do if the tube becomes blocked?

How long will I need the tube?

What if the tube is accidentally removed? 
 

For PEG/PIGG tube

For RIG tube

Common questions

Further information

Nutricia website provides information on specialist feed and using a feeding pump. There is also information on the nursing team who help people with feeding tubes: 

• Nutricia Flocare - Infinity Training
• Nutricia UK | Homepage for Patients & Carers

PINNT helps people on enteral and parenteral nutrition providing advice and local help groups.

• Phone 020 3004 619
• PINNT: Advocacy & support for people on home artificial nutrition (HAN): parenteral, enteral & oral nutritional supplements. | PINNT

References

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT002346. 

Forms, Booklets and Leaflets

You can get physical copies of these booklets and leaflets from the Macmillan Wellbeing Centre based at Southmead Hospital. Please come and visit.

Referral Forms:

Self-referral form

Professional referral form 

Eating well:

Healthy Eating and Cancer – Macmillan Healthy eating and cancer

Healthy Eating – British Dietetic Association Healthy eating 

Healthy Snacks – British Dietetic Association Healthy snacks

Difficulty with eating:

Eating Problems and Cancer – Macmillan Eating problems and cancer

Building Up Diet – Macmillan The build up diet

Weight management after cancer treatment:

Managing Weight Gain After Cancer Treatment – Macmillan  Managing weight gain

Weight loss - British Dietetic Association  Weight loss advice

Portion sizes - British Dietetic Association Portion sizes

Appetite and health

Having a good appetite is important to make sure your body gets all the nutrients it needs to stay healthy.

As you get older or become unwell, your appetite can disappear.

This page offers tips to help you eat better.

Some of the information may be different to typical ‘healthy eating’. However, when you are ill healthy eating may be harmful for your health.

Once you are well or a healthy weight you can return to healthy eating.

Possible side effects of having a small appetite

• Higher risk of infection
• Higher risk of falls
• Lower mood
• Lower energy levels
• Loss of muscle and reduced strength
• Nutrient deficiencies
• Hospital treatment may be less effective
• More hospital admissions and longer hospital stays

Tips for eating better with a small appetite

• Eat ‘little and often’.
• Have 2-3 small snacks or milky drinks in between meals.
• Try not to skip meals. Skipping meals often can cause low appetite.
• Choose full fat/full sugar versions of food/drink rather than the ‘diet’ alternatives.
• Try to eat more on the days and times you feel well.
• Aim to have 1 pint of milk a day. This can be in tea, coffee or milkshakes.
• If following a plant based diet, try and include alternative milky drinks and puddings (e.g soya, oat milks etc).
• Have a pudding after meals.
• Eat in a peaceful environment. You may find turning on the TV or eating with friends and family helpful.
• If cooking/shopping is too much, consider meals on wheels e.g. Wiltshire Farm Foods, Oakhouse or Cook.
• If you have access to the internet you may also find home delivery helpful. Age UK and Red Cross can help with shopping.

Which foods should I snack on?

Foods with lots of energy and protein are a good source of fuel. They also help fight infection.

High protein foods include:

• Meat, fish, poultry
• Cheese, milk, eggs
• Tofu, beans, lentils
• Yoghurt, cream and milky puddings
• Nuts and seeds
• Milky drinks e.g. hot chocolate, ovaltine
• Fortified drinks and food
• If on a plant based diet - dairy free milks and puddings

High energy foods include:

• Biscuits
• Crisps
• Cakes
• Chocolate
• Puddings
• Cream
• Butter
• Fruit juice and smoothies

Choose full-fat versions of these foods whilst you are unwell.

Snack ideas

Aim for 2-3 snacks every day.

Savoury

• “Cream of” soups - have 1 x tin or 1/2 tin with croutons
• Handful of Bombay mix or nuts
• Matchbox size portion of cheese and crackers
• 1x bag of crisps
• Slice of quiche
• 3 x cocktail sausages
• 2 x mini sausage rolls
• 1 x small pork pie
• 1 x slice of toast with butter
• 1 x crumpet or bagel with butter

Sweet

• 1 x slice toast with butter and jam/marmite/peanut butter/chocolate spread
• Scone with jam and cream
• Rice pudding
• Cereal bar
• 1 x tea cake
• 1 x slice malt loaf
• Individual puddings e.g. trifle, custard, cheesecake, mousse
• 1 x bar of chocolate
• Full fat yoghurt
• 1 x handful of dried fruit
• 1-2 x scoop of ice cream

Nourishing drinks

If you struggle to have extra snacks try to have 1-2 nourishing drinks instead.

Aim to have 1 pint of milk a day. Use in cereal, tea, coffee and other nourishing drinks listed below.

• Full cream milk (aim for 1 pint per day)
• Milkshakes
• Hot chocolate
• Malted drinks
• Milky coffee and tea
• Smoothies
• Sugary fizzy drinks e.g. lucozade, cola
• Fruit juice
• Soya drinks e.g. Provamel, Alpro Soya

Fortifying foods

This can be helpful to make food more nourishing, without having to eat a larger portion.

Fortified milk

• Whisk 4 heaped tablespoons of milk powder (e.g. Marvel or supermarket own brand) into 1 pint full fat milk.
• Use this fortified milk in cereal, porridge, milky drinks, tea/coffee, puddings, soups and sauces.

Fortified mashed potato

• Add 1 x heaped tablespoon of butter and 1 x tablespoon of cheese to a scoop of mashed potato.
• Use fortified milk.

Fortified yoghurt/custard/milk pudding

• Add 1 x heaped tablespoon of milk powder to one serving of yoghurt/custard/milk pudding.
• Add toppings such as jam, syrup, honey, seeds or fruit.

Fortified sandwiches

• Use spreads (e.g butter/margarine) generously.
• Use lots of mayonnaise or salad cream.
• Choose nutritious fillings such as peanut butter, egg mayonnaise, ham, tuna or cheese.

Fortified soups

• Add cream, fortified milk, evaporated milk, creme fraiche, cheese or cooked meat.
• Have croutons or bread.
• Choose creamy varieties e.g. cream of tomato.
• If using cuppa soups, make with fortified milk.

Fortified sauces

• Use enriched milk to make white, cheese or packet sauces.
• Add meat juice to gravy.
• Add grated cheese, oil or 1 x teaspoon milk powder to one serving of tomato based sauces.

Fortified vegetables and salads

• Try frying or roasting vegetables instead of boiling/steaming.
• Add butter or grated cheese to vegetables.
• Have cheesy or creamy sauces with vegetables.
• Add cheese, nuts, eggs, beans, tofu or lentils to salads.
• Use generous helpings of oil/creamy dressing and croutons/potatoes.

What about diabetes?

If you have diabetes and a poor appetite it may not be helpful to follow the usual ‘low fat, low sugar’ healthy eating advice.

However, once your appetite has returned to normal, you can return to healthy eating.

Meal ideas

Breakfast

• Creamy scrambled egg with buttered toast
• Porridge/cereals with honey/sugar
• Crumpets with butter and jam
• Muesli with whole cream milk and natural yoghurt

Lunch/lighter meals

• Beans on buttered toast with grated cheese topping
• A buttered jacket potato with tuna mayonnaise filling.
• Ham or cheese omelette, chips and salad with mayonnaise
• A creamy soup with added grated cheese and croutons

Main meals

• Shepherd’s pie with grated cheese topping and vegetables with added margarine or butter
• Chicken curry or dahl with rice or chapatti spread with oil, butter or margarine
• Cauliflower cheese made with fortified milk with grated cheese topping
• Fish in cheese sauce with creamed potatoes and vegetables with added margarine or butter

Puddings

• Milk pudding e.g. rice/tapioca/semolina
• Baked egg custard
• Crumble with ice cream
• Trifle with cream
• Jelly made with fortified milk

Nutritional supplements

Some people may be prescribed nutritional supplements from their doctor or dietitian.

Supplements are drinks that are high in energy and protein and can be helpful for some people whilst unwell. They are available on prescription. Your doctor or dietitian will discuss these with you if they think you may need them.

You can buy other supplements such as Complan or Meritene from local chemists. You may find these helpful if you cannot make nourishing drinks at home.

Where now?

For further information you may find the following resources useful.

Brotherton et.al (2010). ‘Malnutrition Matters: Meeting Quality Standards in nutritional Care.’ A report on behalf of the BAPEN Quality Group

Diabetes UK

www.diabetes.org.uk

Cook Food - freezer meals with delivery service

www.cookfood.net

Parsleybox - cupboard meals with delivery service

www.parsleybox.com

Wiltshire Farm Foods

www.wiltshirefarmfoods.com

Oakhouse Foods

www.oakhousefoods.co.uk

Eating well in later life - Malnutrition Task Force

www.malnutritiontaskforce.org.uk/eating-well

Food enrichment - BAPEN

www.bapen.org.uk/nutrition-support/nutrition-by-mouth/food-first-food-enrichment

Malnutrition fact sheet - British Dietetic Association

www.bda.uk.com/resourceDetail/printPdf/?resource=malnutrition

The Red Cross - offering help with shopping

www.redcross.org.uk

AgeUK - offering help with shopping

www.ageuk.org.uk

How to contact us 

Dietetic Department: 0117 414 5248

© North Bristol NHS Trust. This edition published April 2023. Review due April 2026. NBT002833

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

If you’re an overseas visitor, you may need to pay for your treatment or you could face fraud or bribery
charges, so please contact the overseas office: Tel: 0117 414 3764 Email: overseas.patients@nbt.nhs.uk

Information for GP's

The implementation of the Faecal Immunochemical Test (qFIT) testing for occult blood for the detection of colorectal cancer in patients in the SWAG cancer alliance area

Individual CCGs (Gloucester, BNSSG, BSW and Somerset) within the SWAG Cancer Alliance have funded FIT testing for the early detection of colorectal cancer.  Originally this was for low risk patients but indications have been expanded and updated. 

For further information on the requesting indications, process and reporting guidelines please refer to the relevant page on the REMEDY website: https://remedy.bnssg.icb.nhs.uk/adults/gastroenterology-and-colorectal-surgery/fit-test/

Information about qFIT testing is presented in this video made when the service was first introduced. Although some of the indications have been expanded the essence of the video is still applicable https://youtu.be/zb1o8ykvS6U

The team comprises clinical scientists and trainees who work closely with urology, gynaecology, consultants, physiotherapists and dietitians, enabling a holistic service.

As well as performing diagnostic tests the team also attends MDTs, conducts research and provides teaching to other healthcare professionals.

Rachel Tindle
Clinical Scientist/Lead Clinical Scientist for NBT

Amie Sutton
Trainee Clinical Scientist

Sarah Massa
Clinic Co-ordinator

Alex Bacon
Clinical Scientist

Laura Thomas
Department manager/Clinical Scientist

The Research office is located within the Learning & Research building here at Southmead Hospital.

Just a stone’s throw away from the Brunel building where most of our patients are treated, Learning & Research is home to an array of facilities that provide medical and healthcare training, teaching accommodation and dedicated study space, as well as a full suite of research facilities.

The building was completed in 2014, alongside the redevelopment of Southmead Hospital, and features sleek interior spaces and a vibrant external design by Avanti Architects. This purpose-built facility represents the Trust’s ongoing commitment to research and is shared between NBT staff and the medical students of Bristol University.

Alongside our office base in Learning & Research, we also manage the adjacent Clinical Research Centre. If you’re taking part in one of our research studies, one of our staff may direct you there as a part of your visit. Our Clinical Research Centre enables us to:

• Look after our research participants in a tranquil and calm environment outside of the main building.
• Bring together researchers from all disciplines from across the Trust, enabling them to work more closely and share best practices.
• Develop the next generation of registered nurses and allied health professionals.
• Give our research participants the best possible experience of taking part in a research study at the same time being given additional advice and support about their diagnosis.

Our team strives to be welcoming, friendly and offer the best possible experience of taking part in research. We look forward to your visit.

Travel information can be found by visiting the Our Hospitals page of our website.

Communication partner training

This training session is for anyone who is a communication partner with a person using AAC of any age. You could be a parent, partner, family member, personal assistant, carer, teacher, teaching assistant, speech and language therapist etc. 

This training session will cover:

• What is communication and why do we communicate?
• How using AAC affects communication
• General communication strategies to support people who use AAC
• How to apply these strategies to your communication partner and choose one to ‘take away’

Resources

For further resources to help you, see AAC implementation resources in: 

• Adults with aphasia 
• Alphabet users (child or adult) [link coming soon] 
• Symbol users (child or adult)

This page has been provided to give you information about the reversal of your small bowel stoma (ileostomy) or large bowel stoma (colostomy).

Your stoma is a connection between the bowel and the skin, which was formed temporarily at your previous bowel surgery.

Temporary stomas are created for a minimum of six weeks. It takes this time to allow for the swelling of the tissues to settle down. Some stomas may not be reversed for several months for various reasons including your general health and recovery from the surgery. If your operation was performed for cancer, further treatment such as chemotherapy may also delay the reversal.

Closing or reversing the temporary stoma is no doubt something you are eagerly awaiting. Many people see it as an indication of getting back to normal. Whilst this operation may be more straightforward and much shorter than your initial operation, there are still a few things to consider before surgery. It is important to be prepared for any potential side-effects which could develop after the operation and for you to know what to do if they occur.

Ideally, as many people as possible will have their bowel joined back up, but there could be reasons why your surgeon may be reluctant to do so. This will be discussed with you in person if this is the case.

The main considerations for the stoma reversal are:

• The doctors must be happy that you are fit enough for another operation.
• The bowel that your temporary stoma was created to protect has healed or improved since the first operation.
• The anal sphincters which control the flow from your bowels are working, so that loss of control of your bowels (faecal incontinence) will not develop afterwards.

Depending on what operation you have had, the surgeon may need to perform a rectal examination, and possibly arrange some further tests before making this decision.

What does the operation involve?

The closure of your stoma is ‘technically’ not as demanding as your previous surgery when the stoma was created.

This operation involves making a cut around the stoma, to free it from the abdominal wall and stitching the bowel back together to restore continuity, the stitching may be referred to as an anastomosis. The joined bowel is dropped back inside the abdominal cavity. This is followed by the stitching of the abdominal wall muscles and skin. It is still considered a significant operation.

Very occasionally it is necessary to reopen the original laparotomy wound scar to be able to reverse the stoma.

Alternatives to surgery

The alternative to this surgery is not having the stoma reversed and keeping the stoma. Around 1 in 12 patients who have had a planned temporary stoma for cancer of the rectum will keep a permanent stoma.

Preparation for your surgery

Before coming into hospital you will attend a pre-admission clinic. At this appointment you will be asked questions about your general health and you might have a chest x-ray, ECG (heart tracing) and blood samples if necessary. Most concerns can be addressed at this appointment but if you have further questions relating to your operation, you can contact your colorectal specialist nurse or one of the stoma team (contact numbers are at the bottom of the page).

You will be admitted on the day of your operation. You must not eat anything for 6 hours prior to your surgery, you can continue to drink water up to two hours before your operation. It is important that you drink plenty of fluids and eat well during the previous day.

The operation usually takes around 90 minutes. After your operation you will be taken to the recovery area for close observation before returning to your hospital ward.

What to expect after surgery

You may have a drip in your arm to give you fluids until you are drinking. Once you are awake you can eat and drink normally, you may find small, light, low fibre meals are better tolerated.

Most people are moderately sore at the reversal site afterwards, but this can be managed with pain killers. You may feel distended following the procedure, some patients describe this as a feeling of being “bruised and bloated” but as the swelling decreases this discomfort will ease.

On discharge from hospital you will be given some pain killers and a low fibre diet sheet to take home with you. You will also be provided with contact numbers for who to call if you encounter any problems.

Possible complications following surgery

As with any surgery, the operation to close your stoma has some risks which you need to be aware of. Your surgical team will take all possible steps to prevent them from happening.

General complications that can happen after surgery include:

• Deep vein thrombosis (DVT) is a blood clot in the leg which can occasionally move through the blood stream and into the lungs causing a pulmonary embolism (PE). Whilst you are in hospital you will have an anti-clotting injection daily and support socks to prevent this happening.
• Chest infection.
• Urinary tract infection (UTI).

These complications are avoided by early mobilisation and deep breathing. Getting up and walking around and out of hospital quickly can help prevent these problems.

• Wound Infection.
• Bleeding from the operation site.
• Formation of a fluid or blood collection under the scar (seroma or haematoma).

These complications are not serious but are the most common. Infection would be treated with antibiotics and a collection of fluid will either be reabsorbed by your body or discharged through the wound. Wound infection would usually occur after you have gone home so if the wound becomes hot, red and sore please see your GP or practice nurse for further advice.

Complications following reversal of stoma

Hernias

A hernia occurs when the bowel protrudes through the muscles of your abdomen causing a bulge beneath the skin. The hernia may reduce or increase in size when lying, sitting, or standing. Hernias occur at sites of potential weakness (the stoma reversal site or at the scar of the first operation). The risk of a hernia formation is small but is more likely in frail, older and overweight patients. Its also seen more frequently in those who have strained their bodies or have undertaken too much exercise in the first few weeks following surgery. Management includes supporting your hernia with a belt or binder. This helps with decreasing the protrusion and assists in maintaining a good posture.

Most hernias appear over subsequent months, generally developing within the first two postoperative years. Surgical repair may however be necessary in a proportion of patients.

Less common complications

Anastomotic leak

A leak from the stitching where the bowel is joined back together. This happens in 1 in 250 cases of stoma reversals. This is a more serious complication which usually requires further surgery. If this happens your stoma might need to be reformed. This does not mean that it will be permanent as depending on your general health, it is still possible for another attempt at reversal in the future.

If there is a leak, you will probably experience a dull pain in your pelvis (the area below your belly button and above your hips), have a fever, and feel lethargic.

This complication usually presents within a few days after the operation and can make you feel generally unwell.

Abdominal collection

This refers to a collection of infected fluid inside the abdomen and presents as worsening pain and bloating. You may also have a high temperature and either frequent loose stools or the bowels stop working. The management of this condition involves antibiotics and drainage of the collection using either an ultrasound or CT scan.

Ileus and bowel obstruction

Initially after the surgery there is the risk of the bowel not working properly. This is because of a delay in the bowel movement or contractions known as peristalsis. The cause of this condition is generally due to the handling of the bowel during the surgery and the bruising which creates swelling. It can take a few days before the bowel movements occur normally again and you start to pass both wind and stool from your back passage.

If an ileus or bowel obstruction occurs and your bowels temporarily stop working you may experience increased bloating, abdominal pain, nausea and vomiting. This can be managed by stopping dietary intake and allowing your bowel to rest. It may also be necessary to pass a small tube through your nose into your stomach to relieve the symptoms. Keeping mobile and chewing gum will help prevent an ileus. You can return to normal diet once your bowels start working again. We will not expect you to necessarily have opened your bowels before you go home, but we would expect you to be eating and drinking without significant abdominal bloating, nausea or vomiting.

Similar symptoms may occur in patients who develop a blockage in their bowel (bowel obstruction). An obstruction after surgery is generally caused by adhesions (sticking of bowel tissue) or kinking of the bowel. In most cases the initial management is the same as described above for an ileus. In the majority of cases the bowel obstruction will also settle down on its own. A small percentage of patients will require a further operation or intervention.

If you are at home and are worried about any of the symptoms or complications described please contact us on the numbers provided in this leaflet for further advice. Readmission to hospital may be necessary if your symptoms are causing you to feel unwell and there is a suspected deterioration in your health, such as you can no longer tolerate fluids.

Fistula formation

A fistula is an abnormal connection between two parts of the body, in this case it is often from the bowel to the surface of the skin. In rare cases problems from the join made during the first operation can occur once the stoma is reversed and continuity of the bowel is restored. The most common problem is caused from an infection around the rectal anastomosis (join) which can present as a fistula. Some fistulas can heal on their own but surgery may be considered if the fistula does not close within a few months.

Possible side effects after stoma reversal

Diarrhoea

After the reversal it is common to experience liquid bowel motions for the first few days up to a few weeks before it settles down. In a small percentage of patients it can take up to 6 months before the bowel motions become more firm. It is fairly common to pass looser and more frequent stools than you may have been used to previously. Adjusting the food you eat and taking bowel slowing medication can help with this.

Frequency and urgency

It is normal to have erratic bowel movements for several weeks after this operation. You may find that you need to go to the toilet more urgently and also more often. This can be more of a problem for those who have had a low join or anastomosis in the bowel and for those who have had pelvic radiotherapy and/ or were already suffering from a weak sphincter muscle. The patients who have weak pelvic floor and anal sphincter muscles may leak gas, liquid or solid stools.

Performing pelvic floor exercises may help to regain continence but need to be practiced at least five times a day and over a few months to be of benefit. (Separate leaflets on how to exercise the pelvic floor are available). When done correctly, these exercises can build up and strengthen the muscles to help you to hold both gas and stool in the back passage.

Good hygiene and a light barrier cream may be useful to prevent the skin becoming sore if you are experiencing loose and frequent stools.

How long will you stay in hospital?

Our aim is that most patients who have an ileostomy reversal would go home after staying one night in hospital. You will be seen by your team of doctors the morning after your operation and a decision will be made to send you home if you are ready for discharge. This would usually be in the afternoon or early evening, but this may be earlier if you are well.

As long as you are tolerating fluids and a light diet, are mobile, have passed urine and are reasonably comfortable on pain killing tablets then you can go home.

Symptoms to look for once discharged home

Occasionally patients need to be re-admitted to hospital following discharge home due to complications such as an anastomotic leak, abdominal collection or obstruction.

Acute and persistent symptoms will require further observation and investigation.

The symptoms which should alert you include:

• Progressive and worsening abdominal pain.
• Increased bloating and abdominal discomfort.
• Persistent nausea and vomiting.
• High temperature.
• Breathing difficulties.
• Feeling generally unwell.
• Unable to eat and drink sufficiently.
• Persistent loose stools and diarrhoea.
• New difficulty with passing urine

Early detection of a serious complication leads to a better recovery, so if you feel unwell please contact The Enhanced Recovery Team for advice (contact numbers are at the bottom of the page). Out of office hours, please contact the surgical admissions unit.

We would prefer that you talk to us in the first week after discharge rather than your GP so we can identify problems early and bring you back to hospital if needed. Where possible, we will ask your GP to help to save you a trip to hospital.

Eating and drinking

Once you are home you should gradually build up to a normal diet. In general, you are advised that for the first couple of weeks after your operation you should reduce the amount of fruit, salad and vegetables that you eat. These types of food contain fibre and will be hard for your bowel to digest initially. Meal snacks like crisps and biscuits are good to nibble on when you start eating. The main advice is to eat little and often until your appetite returns to normal and you feel able to return to a healthy balanced diet.

You may find your sense of taste and smell is altered following the surgery. This can be because of the antibiotics, anaesthetics and painkillers. Be reassured that your taste and appetite will return to normal within approximately six weeks.

A good fluid intake of eight cups a day (some of which should be water) is advised. However if you experience constipation, you may need to drink more.

If any particular food does seem to cause problems (such as frequency) just stop eating it for a while, then try again at a later date.

Caring for your wound

It is good idea to inspect your wound daily once you are home. Keeping the wound dry and clean will help prevent infection. You may apply a dry dressing for the first week, which is usually changed after showering. The nursing staff will be able to provide you with a small supply if required.

If you are worried about possible infection, please call the ward for advice.

Signs of infection could be:

• Increased pain, swelling or inflammation.
• Redness around the wound.
• Discharge of fluid or pus from wound.

Exercise

It is very important that you start to walk around as soon as you can after the surgery, as this helps your breathing and circulation, as well as helping you to regain your strength. It is normal to feel tired after surgery so consider what help or support you may need when you go home.

When you first get home after your operation, initially plan your day to have a rest in the afternoon. It takes time to regain your normal strength, so try to build up to the amount of exercise you do slowly. Some people find it helpful to set goals to reach each week, for instance start by going for a short walk each day and increase this distance once you feel able. The level of exercise you will be able to do will vary dependent on your level of fitness before surgery. If you participate in strenuous sports or exercise, you should generally wait six weeks and then introduce this back into your lifestyle gradually.

Having had surgery on your abdomen, you are advised not to lift for the first six weeks. It is important that you do not do any heavy lifting (no heavier than a half-filled kettle) for at least two weeks following the operation, and build up gradually. The concern is that if you put too much stress on your abdominal muscles, you may cause a permanent weakness, which may lead to a hernia in the old stoma site.

Driving

You can drive as soon as you are able to concentrate fully and can make an emergency stop without discomfort in your abdomen. A minimum of two weeks is suggested however it is advisable to check with your own insurance policy as some insurance companies state that you will not be covered for six weeks after any abdominal surgery.

Returning to work

You can return to work when you feel ready to. However you may be surprised at how tired you feel after this operation, so it is advisable to consider returning to work on a part-time basis for a few weeks. If you have a physically demanding job or involves heavy lifting, it is preferable not to consider going back to work for six weeks, and to request lighter duties if possible. This will initially allow you to build up to your stamina and strength for normal duties.

Resuming sexual intimacy

The anxiety and all the stress your body has been through with this operation often reduces your sex drive. This is quite normal and in time it should return. It is important that you and your partner share time talking about your feelings, being close and enjoy being intimate without necessarily having penetrative sex. Once your body feels fitter and more relaxed, you may feel more confident resuming your usual sexual activity again. If you do experience any problems in having sex with your partner, please do discuss this with your doctor.

Follow up care

When you are initially discharged home, some people find it helpful to have family member or friend to stay. Extra help for this first week at home will allow you to rest when you will feel tired and may help you recover sooner. After this, you may still need help with the shopping, cooking and cleaning for a couple more weeks. But remember it is important for you to stay as active as possible.

If you have any queries or questions, do not hesitate to contact your surgical team or GP.

How to contact us

• Enhanced Recovery Nurses: 0117 414 3610 / 0117 414 3611 or 07808 201713
• Stoma Office: 0117 414 0270
• The Surgical Admissions Unit, Gate 32B: 0117 414 3233
• Switchboard: 0117 950 5050

© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT002926

Your estimated discharge date

The Enhanced Recovery Nurses will discuss your estimated discharge date with you.

Introduction

This information aims to increase your level of understanding of how you can play an active part in your recovery, after your emergency surgery. If there is anything that you are unsure about, please ask. It is important that you understand how you can help yourself recover, so that you, your family and friends can be involved.

Enhanced Recovery is a programme offered by North Bristol NHS Trust for patients undergoing emergency bowel surgery. Having surgery as an emergency can be stressful, and this information will help your recovery.

What is Enhanced Recovery?

The aim of Enhanced Recovery is to get you back to full health as quickly as possible after your operation.

Research indicates that after surgery, the earlier we get you out of bed, exercising, eating and drinking, your recovery will be quicker and it will be less likely that complications will develop.

Some of the benefits include:

• A quicker return of normal bowel function.
• Reduced chest infections.
• A quicker return to usual mobility.
• Decreased fatigue.
• Reduced risk of developing blood clots after surgery.

In order to achieve this we need you to be partners with us, so that we can work together to speed up your recovery.

Before your surgery

There is evidence to suggest that keeping warm, before surgery, helps prevent infection. Please ensure you have a warm dressing gown or similar item of clothing to wear immediately before your operation.

If possible, please ask a relative or friend to also bring you a supply of comfortable ‘day clothes’ for after your operation. You will be encouraged to return to normality as quickly as possible, and this includes getting dressed.

Eating and drinking

In preparation for your operation, if you are allowed to eat and drink normally, you should aim to take 3 of the Fortisip or Fortijuce supplement drinks per day. The drinks will be supplied by the ward for two days before your surgery.

The supplement drinks are important to help with wound healing, to reduce the risk of infection and aid with your overall recovery. It is important that you also continue to have a variety of other non-fizzy drinks during your hospital stay.

As well as the supplement drinks mentioned, you will also be required to take special carbohydrate drinks called ‘Pre Op’. You will require two drinks the night before and 2 drinks on the day of your operation, three hours before surgery. If your operation is very urgent, you may only be given two ‘Pre Op’ drinks before surgery.

You may continue to eat for up to six hours before your operation and drink fluids for up to three hours before, unless otherwise directed by your doctor.

A few hours after your operation you will start to drink and eat if you wish. It is important that you eat and drink early after your surgery, however if your operation was for a blockage in the bowel, early eating may not be appropriate. The ward staff will help and advise you. You will be expected to recommence the supplement drinks to help build up your strength. The drinks will either be given to you by the ward staff or you can help yourself to the drinks from the patients fridge.

Studies show that chewing gum after an operation can be helpful towards improving your recovery by assisting the bowel to return to its normal function.

Please ask a relative or friend to bring some chewing gum in for you. After your operation chew gum for 15 minutes, three times a day, until your bowel function returns to normal.

Preparing for theatre

On the day of your operation you may be given an enema to empty your bowel contents.

In order to help prevent blood clots you will be required to wear special support stockings (TEDS). The nurse will need to measure your legs to obtain the correct size.

You will also be given a small injection called ‘clexane’ at approximately 6pm each day you are in hospital. This helps reduce the risk of blood clots by thinning the blood.

Some patients who are at higher risk of experiencing blood clots may have to continue with the injection once home. This would only be for a few weeks after surgery and will be fully discussed with you when you are in hospital. Most patients are able to administer the injection themselves or with the help of a relative or carer. The nurses on the ward will show you how to use the injection during your hospital stay. If you have any problems with administering the injection an appointment can be made with your practice nurse to carry this out each day, or we will arrange for a District Nurse to visit you if you are unable to leave the house.

It is important that you keep yourself warm before your operation and you are advised to dress accordingly, (warm dressing gown, socks, slippers, blankets). You will be asked to remove the warm clothing when it is time for your operation as you will be required to wear a hospital gown.

After your operation

Mobilising and exercising

Following your operation when you wake up, it is important that you do deep breathing exercises (as prevention against chest infection). You will need to do 5 deep breathing exercises every hour. To do these you will need to:

• Be in an upright position.
• Take a deep slow breath in (feel your stomach gently rise).
• Hold the breath for 3 seconds.
• Breathe out slowly.
• Repeat 5 times.

You should cough regularly to make sure your lungs are clear of secretions. To do this, place a towel or pillow over your abdomen and wound. Support it with your hands and cough.

When you are sitting in the chair or lying in bed, you should also do frequent leg exercises, (as prevention against blood clots) pointing your feet up and down and moving your ankles as if making circles can achieve this.

Depending on what time you come back to the ward, the staff will help you out of bed about six hours after your operation. You may sit out of bed for up to two hours on the day of surgery and then up to six-eight hours out of bed on each subsequent day after surgery if you can manage this.

You will be encouraged to walk at least 60 metres four to six times per day after your surgery if you can manage this. By being out of bed in a more upright position and by walking regularly, lung function is improved and there is less chance of a chest infection after surgery. Circulation is also improved, reducing the risk of a blood clots and helping bowel function return to normal.

Try wearing your day clothes as soon as you feel able after your operation as this can help you feel positive about your recovery.

Pain control

It is important that your pain is controlled so that you can walk about, breathe deeply, eat and drink, feel relaxed and sleep well. Please let us know if your pain is not manageable so that we can help you.

It is also important for us to know if you are either allergic or sensitive to certain pain killers.

You may be given one of, or a combination of the following methods of pain relief, to keep you comfortable after surgery:

• Patient controlled analgesia (PCA). This is an intravenous pain killing medication, delivered by a machine, which is set up so that you can control it yourself. You will be given instructions on how to do this.
• Tap block. This is an injection given at the time of your operation to temporarily numb the abdomen and keep you comfortable immediately afterwards.
• Spinal block. This is an injection given at the time of your operation that will temporarily numb you from the waist down and will keep you comfortable afterwards.
• Ketamine infusion. This is a continuous intravenous pain killing medication which will run up to 24 hours after surgery.

The anaesthetist may discuss these options with you and explain more about it whilst you are in hospital, before your operation.

Alongside this, the doctors will prescribe other types of pain relieving medicines, which work in different ways. You will be given these regularly (three or four times per day) and you should feel more comfortable.

If the pain worsens at any time, please tell the nursing staff immediately and they will be able to help you.

Sickness

Sometimes after an operation it is not uncommon to feel nauseated and occasionally vomit. You will be given medication during surgery to reduce this, but if you feel sick following surgery please tell a member of staff who will be able to help.

Tubes and drips

During your operation a tube (catheter) will be placed into your bladder so that we can check that your kidneys are working well and your urine output can be measured. This tube will be removed as soon as possible.

You will have an intravenous drip put into your arm to ensure you do not become dehydrated. The drip will normally be removed the day after surgery, but you may still have the intravenous port (venflon) in place for a couple of days in case we have to give other drugs through it.

It is possible you may return from your surgery with a tube in your nose. The tube may stay in a few days which will help drain your stomach if your surgery was due to a blockage or an emergency. We aim to remove the tube as soon as possible. Please wait until the tube is removed before trying to eat. Staff can advise.

You may also be required to breathe extra oxygen for a short while after your operation.

Monitoring

Many different things will be monitored during your treatment including:

• Observations (blood pressure, pulse, temperature).
• Fluid in.
• Fluid out.
• Food eaten.
• When your bowel first starts working or you pass wind.
• Pain assessment.
• Number of walks achieved.
• Time spent out of bed.

You may be asked to tell us about what you eat and drink and what you pass so that we can record it.

Whilst you are in hospital you will be asked to participate in maintaining a daily diary / log (provided by the ward), so that you can keep a record of how well you are managing. This will help us monitor your progress.

Please remember playing an active part in your recovery will help you get better sooner. If you have any questions regarding your recovery please do not be afraid to ask a member of staff.

References and further information

For further information on the Enhanced Recovery Programme you may access the following websites:

www.nbt.nhs.uk/erp
www.gov.uk/government/organisations/department-of-health-and-social-care

How to contact us

Brunel building
Southmead Hospital
Bristol BS10 5NB

Surgical Admissions Unit
Gate 32B
Telephone: 0117 414 3233

Enhanced Recovery Nurses
Telephone: 0117 414 3610
Telephone: 0117 414 3611

Colorectal nurses
Telephone: 0117 414 0514

Stoma Care Nurses
Telephone: 0117 414 0270

© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT002721