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

What starchy foods can I eat?

Breads and Cereals

Foods allowed ALWAYS CHECK IF THESE NEED TO BE PURÉED

  • Rice Krispies®, Cornflakes®, Cocopops®, Frosties®,Cheerios®
  • Ready Brek® (Stage 4 and above)
  • White flour, cornflour, rice flour, potato flour, chickpea flour, nut flour, lentil flour (to make sauces)
  • ‘Melt-in-the-mouth’ Melba toast, crackers and crispbreads (without seeds & grains)

Foods to avoid

  • Wholemeal, wholegrain and bran cereals e.g. All Bran®, Branflakes®, Weetabix®
  • Special K®
  • Cereals containing dried fruit, seeds or nuts e.g. Sultana Bran®, Fruit n Fibre®
  • Muesli, Crunchy Nut Cornflakes®
  • Oats, porridge
  • Granola
  • Wholemeal flour, wholegrain or granary flour, bran
  • Chickpea flour, cornmeal
  • ALL bread, wraps, pitta, rolls, baguettes, bagels
  • Crumpets, muffins, scones, pancakes
  • Croissants, brioche
  • Wholegrain or seeded crackers or crispbreads
  • Oat cakes, rice cakes, corn cakes

Rice, Pasta, Grains and Potato Products

Foods allowed ALWAYS CHECK IF THESE NEED TO BE PURÉED

  • White rice
  • White pasta
  • Rice pudding
  • White couscous, tapioca, sago

Foods to avoid

  • Brown & wild rice
  • Wholemeal pasta
  • Hash browns
  • Yorkshire pudding
  • Pastry
  • Waffles
  • Barley, pearl barley, spelt, quinoa, gnocchi, bulgur wheat

What dairy foods can I eat?

Foods allowed ALWAYS CHECK IF THESE NEED TO BE PURÉED

  • All types of milk e.g. cow’s, goat’s, sheep’s, soya, rice, oat
  • Cream, crème fraiche
  • Buttermilk
  • All types of melted cheese (without dried fruit and nuts)
  • Butter, margarine, spread
  • Smooth yoghurt
  • Smooth ice cream and sorbet
  • Custard

Foods to avoid

  • Cheese containing dried fruit or nuts
  • Yoghurt containing whole fruit, nuts or seeds or pips
  • Ice cream and sorbet containing nuts, seeds and whole fruits

What protein foods can I eat?

Foods allowed ALWAYS CHECK IF THESE NEED TO BE PURÉED

  • All types of fish, meat and meat products i.e. fresh, frozen, tinned (soft, tender, not charred with visible fat and skins removed)
  • Smooth paté and liver sausage
  • Eggs
  • Tofu
  • Quorn
  • Soya mince
  • Smooth peanut butter
  • Other smooth nut butters

Foods to avoid

  • Tough meat products like sausages and burgers
  • Crispy, fatty or charred meats
  • Skin and bones of fish
  • Convenience items which contain whole grains and fibrous  vegetables e.g. onions, peppers
  • Coarse paté made with onions
  • All varieties of pulses e.g. lentils, split or mushy peas, chickpeas, dried textured vegetable protein
  • All varieties of beans e.g. borlotti, cannellini, kidney, soya, baked beans
  • All nuts
  • All seeds e.g. sunflower,
  • pumpkin, sesame, poppy
  • Crunchy peanut butter
  • Chunky houmous (with bits)

What sweet treats can I eat?

Foods allowed ALWAYS CHECK IF THESE NEED TO BE PURÉED

  • Cakes made with white flour (without dried fruit or nuts) softened with cream or custard
  • Plain biscuits e.g. Rich tea, custard creams dunked in tea
  • Jelly (without fruit)
  • Boiled or jelly sweets, toffee
  • Smooth chocolate (without dried fruit and nuts)

Foods to avoid

  • Cakes made with wholemeal or wholegrain flour
  • Cakes made with dried fruit and nuts
  • Wholemeal and wholegrain biscuits e.g. Digestives, Hobnobs®
  • Biscuits containing dried fruit e.g. fig rolls, Garibaldi®
  • Hot cross buns, tea cakes, fruit scones
  • Crumpets, muffins
  • Cereal bars containing dried fruit and nuts
  • Flapjacks
  • Jelly made with fresh fruit
  • Chocolate with nuts and dried fruit
  • Nougat

What savoury treats can I eat?

Foods allowed ALWAYS CHECK IF THESE NEED TO BE PURÉED

  • ‘Melt-in-the-mouth’ crisps e.g. Quavers®, Wotsits®, Skips®
  • ‘Melt-in-the-mouth’ crackers
  • Mini cheddars® or TUC® sandwich biscuits
  • Smooth dips e.g. taramasalata, guacamole

Foods to avoid

  • Nuts
  • Popcorn
  • Bombay Mix
  • Dips that contain whole tomatoes, cucumbers, onions e.g. salsa, tzatziki
  • Crisps and bread sticks that do not melt in the mouth

What condiments can I eat?

  • Tomato ketchup
  • Smooth mustard
  • Smooth mango chutney
  • Brown sauce
  • Worcester sauce
  • Soy sauce
  • Mayonnaise, salad cream
  • Salt and pepper
  • Dried herbs
  • Powdered spices
  • Gravy
  • Onion or garlic powder
  • Seedless jam or marmalade
  • Lemon curd
  • Honey
  • Golden syrup, maple syrup
  • Marmite®, Vegemite®, Bovril®

Foods to avoid

  • Pickles & relishes
  • Chutneys
  • Wholegrain mustard
  • Fresh herbs
  • Jam with seeds
  • Marmalade with peel

If you have had no symptoms for 2 weeks ask your Doctor/Nurse/ Dietitian if you can add foods backinto your diet as you may be able to have a standard lower fibre diet.

Reference sources:

  • Cancer Research UK http://www.cancerresearchuk.org/about-cancer/coping-withcancer/coping-physically/bowel/types/blocked-bowel
  • British Dietetic Association http://www.bda.uk.com/foodfacts/MalnutritionFactSheet.

Contact details

If you have any questions about the information in this leaflet please contact the Dietetic Department on 01935 384250. Email: dietitians@ydh.nhs.uk

Acknowledgement:

Reproduced from The Royal Surrey County Hospital Dietitians information leaflet

Ref: 05-20-114
Review: 01/23