Nutrition is an important part of any cancer treatment plan, especially for those individuals who are undergoing colorectal cancer treatment and have had surgery to remove part of the colon. Another important consideration for patients who have had surgery to remove part of the colon is avoiding a bowel obstruction. Knowing which foods you should and shouldn’t eat can be a helpful part of the treatment and the surgery recovery process. In this webinar, we will talk about how nutrition and avoiding bowel blockages can be helpful to you after a colorectal cancer treatment procedure and what foods to eat as we enter the holiday season. Margaret Martin, RD, MS, LDN, CDE is a Licensed Dietitian and Nutritionist in the State of Tennessee and James D. Waller, Jr., MD present this lively session.

1. Welcome to Fight Colorectal Cancer’s
Webinar:
Stomach Stuffers: How to eat well and avoid
a bowel obstruction this holiday season
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2. Today’s Webinar:
1. Today’s Speakers: Margaret Martin, RD, MS, LDN, CDE &
James D. Waller, Jr., MD
2. Archived Webinars: FightColorectalCancer.org/Webinars
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6. Speaker
Margaret Martin, RD, MS, LDN, CDE
is a Licensed Dietitian and Nutritionist in the
State of Tennessee as well as a Certified
Diabetes Educator. Margaret graduated from
the University of Alabama with a Bachelor of
Science in Dietetics and received her
Master’s Degree in Nutrition Science & Public Health from the
University of Tennessee. With more than 10 years of experience in
Clinical Nutrition, Margaret has also worked in the insurance
industry with WellPoint Inc. and Blue Cross Blue Shield providing
telephonic nutrition consultations, service assistance, and web-based
nutrition education. In her free time Margaret volunteers
with the American Lung Association’s annual “Lung Force Walk" in
Middle Tennessee.

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12/9/2014 7

8. Nutrition Tips for Colorectal Surgery
Objectives
• The Colon’s Job
• Nutrition Steps to Know
• Holiday Tips to Avoid obstruction
8

9. Nutrition & The Healthy Colon
The colon is your body’s food & nutrition
workhorse. What does the colon do?
• Finishes the final step of digestion
• Absorbs nutrients and fluids
• Balances nutrition for life and immunity
• Prepares waste for elimination
9

10. Nutrition and Colorectal Cancer
• Colorectal cancer & surgery may trigger
digestive issues.
• Digestive issues such as diarrhea,
constipation, gas, & bowel obstruction
can trigger malnutrition.
• Digestive issues are treatable!
– Start the conversation with your healthcare
team
– Share your “Side Effects Log”
10

11. Fortify Before Surgery
• Grab nutrient-rich foods
• Stir in extra protein sources
• Sip on supplemental liquids
• Follow your surgeon’s pre-op instructions
11

12. Fortify Before Surgery
• Choose nutrient-rich
foods with iron, protein,
vitamins, etc.
• Look on Nutrition Facts
labels for % Daily Values
5% or less=LOW
20% or more=HIGH
12

13. Fortify Before Surgery
• Stir extra nutrition into hot
cereals, gelatins, beverages,
soups, creamy items,
or casseroles.
• For example:
– egg whites powder
– dry milk powder
– commercial protein powders
– liquid daily multivitamin
13

14. Nutrition after Surgery
• Give your colon time to heal
• There is not just ONE post-op meal plan
• Surgeon or registered dietitian will prescribe your
nutrition plan
• Nutrition plan progresses over time from ice chips
to solid foods
14

15. Nutrition After Surgery
Tips to Avoid Obstruction:
• Ask for printed meal plan
• Meet with registered dietitian
• Drink fluids as prescribed
– Ice chips
– Clear liquids such as apple, cranberry, or cherry
juices
– Gelatins, decaf tea, soft drinks, coffee
– Full liquids such as milk, soup, ice cream, or yogurt
15

16. Nutrition After Surgery
Eat small, frequent mini-meals
• Go small
– Small meals give your colon an easier job
• Choose fuel
– Frequent nutrition fights fatigue & mood swings
• Drink up
– Aim for 10-12 ounces every 3-4hrs
16

17. Nutrition After Surgery
Types of Fiber
• Soluble Fiber thickens the stool
• Insoluble Fiber gives bulk
• Spread fiber intake throughout the day
17

18. Nutrition After Surgery
Watch Fiber Intake
• Know which foods and drinks contain fiber
• Low-fiber means less than 0.5 to 2 grams per
serving and less than 13 grams daily
• Low fiber = low-stress digestion which helps
speed healing
• High-fiber sources include nuts, seeds, pulp,
peels. Avoid these.
18

19. Nutrition After Surgery
Good Low-fiber foods
• Juices with no pulp or seeds
• Cooked veggies with no strings, peels, seeds
• White bread, plain bagels, crackers with < 2 grams fiber
• Cooked and cold cereals <3grams fiber
• Plain noodles, pasta, white rice
• Skinless potatoes
• Bananas
• Canned fruits, seedless in light syrup
• Cooked meat, fish, and eggs
• Broths and soups made with OK items
• Angel food cake, frozen yogurt, pudding, ices
19

20. Holiday Tips To Avoid Obstruction
• Choose low fiber
• Hydrate thru the day with 64 ounces +
• Eat every 3-4 hours
• Enjoy what you eat
• Review your food intake log for any issues
• Seek help for meal plan, cooking & shopping
20

21. Holiday Tips to Avoid Obstruction
• Take good posture
• Off the high risk foods—nuts, strings,
peels, seeds, stalks, whole grains, etc.
• Avoid spicy foods, gassy foods, gum, & straws
• Set goals to get active-start 5 minute walk
• Trim alcoholic and caffeinated beverages
21

22. For more resources to help you navigate your
cancer journey, sign up for a free dashboard on
My PearlPoint at mypearlpoint.org.
22

23. For more tips managing
nutrition side effects,
download our free Cancer
Side Effects Helper mobile
app from Google Play or
iTunes.
23

24. Additional Resources
• www.MyPearlPoint.org
• www.FightColorectalCancer.org
• www.cancer.gov
• www.cancer.org/Low-FiberFoods
• www.OncologyNutrition.org
• www.AICR.org
24

25. Speaker
James D. Waller, Jr., MD is a
native of Evansville, Indiana. He
attended medical school at Indiana
University and completed his internship
at Methodist Hospital in Indianapolis.
His residencies in general surgery and
colorectal surgery were in Michigan at Butterworth Hospital
and Ferguson Hospital respectively. Dr. Waller is board-certified
by the American Board of Surgery and the American
Board of Colon and Rectal Surgery. In 1986, Dr. Waller
joined Dr. Krystosek in practice at Ohio Valley Colon and
Rectal Surgeons. Outside the office, he enjoys playing ice
hockey and softball.

26. Ohio Valley
Colon &
Rectal
Surgeons
801 St. Mary’s Drive, 200 West
Evansville, IN 47714
(812) 477-6103 ● (800) 371-1169
www.colonsurgeons.com
James D. Waller, M.D.
12/9/2014 26

28. DIGESTIVE CARE CENTER
12/9/2014 28

29. Bowel Obstruction
 Small bowel
 Colon

30. Obstruction
 Small bowel obstruction more common
 Colon cancer most common cause of colonoic
obstruction
 Colon cancer obstructing in only 2-3% of cases

31. Small Bowel Obstruction
 Complete or partial occlusion of the intestinal
lumen
 Adhesions in 60%
 Cancer in 20%
 Hernia in 10%
 Inflammation 5%, Crohn’s, diverticulitis, abcess

32. Adhesions
 Can occur after any surgery
 More common with extensive or multiple
surgeries
 Worse with pelvic or colon surgeries
 Obstruction occurs with torsion/twisting of
bowel (garden hose)
 This reults in kinking of the bowel and possible
compromise of the blood supply

33. Tumors
 Metastatic cancers are most common
 Small bowel cancers are rare
 Intra-abdominal:
ovaries/pancreatic/stomach/colon
 Extra abdominal: lung/breast/melanoma
 Obstruction caused by direct
compression/invasion or twisting

34. Hernia
 Entrapment of bowel within the hernia
 Compression/twisting and possible restriction
of blood flow

35. Inflammation
 Crohn’s disease
 Ulcerative colitis
 Diverticulitis

36. Majority of Obstructions
 Adhesions with twisting or entrapment of the
bowel
 Involving the small bowel
 Even in patients with a history of colon cancer!!

37. Clinical presentation
 Crampy abdominal pain
 Abdominal distension
 Nausea and vomitting
 Obstipation (no stool or gas )
 Loose frequent stool/diarrhea with partial
obstruction!

38. Evaluation
 Exam
 -abdominal distension
 -pain
 -hyperactive bowel sounds
 -scars
 -herniae

39. Evaluation
 Plain abdominal Xray- Upright KUB
 CT scan
 Barium study when intermittent or partial
 CBC, CMP, EKG, UA

40. Treatment
 IV fluid support
 Tube ( NG ) decompression
 Surgery when indicated

41. Medical Tx
 Monitor closely… vitals, urine output, exam
 Over 50% will resolve with medical treatment

42. Surgery
 If no improvement in 24-48 hours
 Deterioration
 Any sign of acute abdomen
 Negative exploration is sometimes better than
waiting!

43. Surgery
 Laparoscopic approach sometimes possible
 Simple lysis of adhesion in most cases
 Reduction repair of herniae
 Bowel resection if not viable
 Bypass or resection if cancer or radiation
 Resection or stricturoplasty in Crohn’s
 Resection of sigmoid if diverticular

44. Special cases
 Early post op
 History of multiple surgeries for obstruction
 Metastatic disease
 Radiation

45. Colon Cancer Patients
 15% or greater lifetime risk of obstruction
 ? Less risk with laparoscopic resection
 Partial obstruction can occur with anastomotic
strictures
 Radiation induced strictures
 Ostomy can represent an area of partial
obstruction

46. Prevention
 No proven method of prevention
 Minimize ‘injury’ of surgery
 Not caused by diet or activities

47. Summary
 Most obstructions caused by adhesions
 At least a 15% risk after colon resection
 Most respond to conservative treatment
 Surgery for those who do not improve or
present with incarcerated hernia or acute
abdomen

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