It can be a disservice when physicians tell a patient that they should have recovered sufficiently by x or y month post surgery to eat anything and everything. The fact is that the intestines do like to be manhandled during surgery. Surgery with resection is traumatic to the intestines. The months post surgery are not always a smooth transition with regards to food choices and digestion.
The symptoms you describe after eating lettuce and fibrous vegetables sound suggestive of a partial small bowel obstruction - either due to a congestion of partially digested food material (a difficult to pass food boulus) or a stricture/narrowing of a segment of small intestine or a tethering of scar tisssue/adhesion that is restricting the unfettered passing of food. Digestive pain and nausea and vomiting are symptoms of a partial bowel obstruction. You can think of it as a traffic congestion along the state highway at 5 pm . . . Traffic inching along, bumper to bumper, cars (digested food material) backed up . . . Until there is a widening in the roadway that allows the traffic to move along (clearing of the intestinal restriction).
It is not uncommon for some people to have to remain with a soft, low residue diet for several months. Adding in new food choices one at a time in small portions.
Lettuce and vegetables and fruits are often the more difficult foods for a healing intestine to tolerate. Salads can be particularly problematic. Chinese vegetables, fruits with membranes (oranges, grapefruit), fruits with outer skins (apples), fruits with dense fiber (pineapple, celery, coconut) most all be consumed with a degree of caution for those with a temperamental intestinal system.
1. Start small. Start with a small portion of a desired new food, 1/4 cup to 1/3 cup. You do not want to overwhelm the intestinal system with a large food portion that it is hen unable to process through the digestive tract.
2. Consider grazing as opposed to eating 3 square meals a day. The goal is to keep food intake at any one time to a small portion size that can be easily assimilated.
3. Cut, dice, slice, or pulverize with a food processor the new food item. The goal is to decrease the work of digestion by the stomach in having to break down the food item into smaller and more easiky digested particles. Think of cutting and dicing your food into small pieces as you would for a toddler as "pre-digestion" to reduce the work of your healing digestive tract.
4. Be cautious in introducing foods with insoluble fiber. Introduce these foods in small quantitis, one at a time, so that you can learn to identify which foods are problematic. Ex. Avoid a large Cobb salad at the restaurant when eating out with friends.
5. Chew, chew, chew. Chew food thoroughly before swallowing. Like the advice to cute and dice food into small nano particles, the goal of chewing is to mechanically break down food into smaller particles to lessen the work of the stomach and digestive enzymes.
6. Drink plenty of clear liquids. Water, tea, coffee, electrolyte drinks. Infuse your intestinal tract with adequate clear fluids to keep food material moving along.
7. Exercise and movement. The intestines are composed of smooth muscle and, like any muscle, need exercise and movement to function optimally. Walking and simple yoga postures both aide intestinal motility. Yoga postures that incorporate thoracic and abdominal rotation/twisting are especially helpful for intestinal propulsion. Think of gentle yoga as massage for the intestinal tract.
8. Use of an osmotic laxative. Miralax and milk of magnesia are both osmotic laxatives. They act to draw water into the intestinal tract with a mild kinetic muscle effect. Osmotic laxatives are not habit forming and are not stimulate in effect. Most can be taken safely for long periods of time. The benefit of an osmotic laxative is that you can add or subtract doses to reach the desire bowel consistency - soft bowel movements to watery/loose bowel consistency. Osmotic products can be very helpful when trying to ease a partial obstruction by liquifying fecal material and enabling it to pass. Consult with your doctor to determine if an osmotic laxative is right for you.
Problematic foods include:
A. Mushrooms (Whole and even half mushrooms can absorb water in the digestive tract and swell, causing pain).
B. Pineapple, celery, asparagus, artichokes, Chinese vegetables, brocolli spears - vegetables with stringy fibers.
C. Coconut flakes - can cause problems by coagulating in the digestive tract, forming a ball of coconut. Eat one macaroon cookie. Avoid eating two macaroon cookies.
D. Fruits with membranes: Oranges, grapefruit. Section fruits to remove the membrane covering.
E. Fruits with tough outer skins: Apples, potatoes. Peel the outer skin.
F. Seeds and nuts: Chop or grind nuts and seeds to avoid painful passing.
G. Dense oatmeal, granola, flax seed, legumes: These foods can be too harsh and rough when passing through an inflamed or healing intestinal tract. Proceed with caution.
I think you are likely dealing with an area of intestine that remains irritated and inflamed post surgery with the possibility of an offending area of structure or scar tissue that may be narrowing a segment of intestine. I would scale back in the foods that are know to give you digestive distress and reintroduce Foods one at a time using the guidelines above (small portion size of 1/4 cup to 1/3 cup; dice and slice food into small pieces; consume plenty of fluids to flush the digestive tract; chew and chew and chew some more; add in a small dose of Miralax in consultation with your MD.
Time and patience will be your best friend. I have a permanent ileostomy and still have to be cautious of my food choices.
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.