Dehydration is a common challenge for ostomates. Those with an ileostomy are most at risk of becoming dehydrated than those with a colostomy or urostomy and it can happen quickly. Don’t be one of the many ostomates re-admitted to hospital due to dehydration, take control and monitor your input and output, to prevent from becoming unwell. Once you are home after stoma surgery make sure you follow the few lifestyle adjustments you need to stay properly hydrated following your surgery. Your surgeon will advise you of how much fluids you should be drinking each day now you have an ileostomy. If you are unsure, make contact with your Stoma Care Nurse for advice.
Why do people with ileostomies become dehydrated?
Having an ileostomy makes it more difficult to stay well hydrated. An average person looses about 2.5litres of fluid a day through sweating, breathing, urine and faeces. Those with an ileostomy can lose an additional 800-1000mls per day in addition! The reason for this is the large bowel (colon) is responsible for absorbing most of the body fluids you need but following ileostomy surgery your large bowel will have been ‘taken out of circuit’ and will either be no longer connected, or it may have even been removed completely.
What happens to your body when you become dehydrated?
Dehydration can cause problems with your electrolyte balance and your kidney functions. If not treated quickly and effectively it can lead to re-admission to hospital. Some people with ileostomies have no issues with keeping hydrated but for others it can be tricky, and they can have issues with dehydration and staying well.
What to watch out for with an ileostomy:
Signs of dehydration:
Signs of becoming dehydrated are easy to spot if you know what to look for, and you can prevent becoming dehydrated if you act on them swiftly. The number one best way of confirming your hydration status is checking your urine colour. Try to aim for a pale straw like coloured urine – this means you are probably drinking enough. If your urine is darker in colour you need to drink more water. If you are experiencing any of the below symptoms contact you Stoma Care Nurse or GP for advice and support:
- Headache or feeling lightheaded
- Feeling thirsty
- Tiredness and fatigue
- Increased stoma output or diarrhoea
- Dry mouth
- Muscle and stomach cramps
- Poor concentration
- Dark urine
- Decreased urine output (peeing less than normal)
Monitoring a high output ileostomy:
It is important to check and monitor the output from your ileostomy. If you notice the output consistency becoming looser than normal (which should be a porridgy consistency) and you are emptying your pouch more often than normal, then you may be experiencing symptoms of a high output stoma. When you have a high output stoma most of the fluid that is taken by mouth is not absorbed and will be passed straight out of the body, into your stoma bag.
A high output stoma is when you have more than 1.5 – 2 litres (6-8 cups) of fluid from your ostomy in a 24hour period. The output is usually very watery, and your pouch needs to be emptied 8 to 10 times or more per day. Due to the very loose consistency of your stool, it may lead to issues with leaks and move quickly on to sore skin. If this occurs, contact your Stoma Care Nurse for advice with stoma products which will help prevent any sore skin around your stoma.
If your output is not controlled with diet and medications, then you can become very unwell with severe dehydration and need admitting to hospital for intravenous fluids and monitoring.
Why does this happen?
This maybe due to your stoma being too high in the small bowel for normal absorption to occur ie: not enough small bowel is available to absorb water and salts. Or your bowel is a having a temporary functional disorder causing the increase output ie: the bowel is present but not absorbing salts and water correctly.
What are the risks of a high output stoma?
- Dehydration (long and short term)
- Electrolyte imbalance
- Kidney injury
- Medication may not be absorbed properly (avoid enteric coated capsules/tablets if possible)
- Weight loss and maintaining a healthy weight
Ways to slow down a high output and prevent dehydration:
- Make sure you eat starchy carbohydrate foods with each meal:
such as white bread, potatoes without skins, rice, pasta
- Avoid high fibre foods:
such as raw fruits & fresh fruit juices, raw vegetables & leafy green vegetables
- Snack between meals:
try a biscuit, rice cake or banana with your mid-morning coffee, or graze on foods which contain gelatine eg: marshmallows, jelly babies, jelly (be careful of the sugars if you are diabetic)
- Avoid sweeteners such as sorbitol as these can have a laxative effect
- Take any prescribed anti-diarrhoeal medication 30-60minutes before you eat and before you go to bed
- Add extra salt to your meals to help replace the salt you are losing from your stoma
- You may be prescribed an electrolyte replacement drink (Dioralyte or Electrolyte mix). You must take this daily as prescribed.
Tip: Try to avoid fluids whilst you are eating as this increases the rate that passes through the digestive tract. Sip rather than gulp fluids and eat slowly, chewing food properly.
What to drink to keep hydrated with an ileostomy?
- When you have a high output ostomy, your ability to absorb fluids is reduced. Drinking too much fluid can increase the output from your ostomy and cause you to become dehydrated. To help you absorb fluids: limit the amount you drink and change the types of fluids you are drinking.
- There are special drinks available called rehydration solutions – such as Dioralyte or St Marks Solution. These contain electrolytes such as sodium and potassium. These should be made up and sipped regularly throughout the day.
- Many ostomates prefer sport drinks…. dilute these down with water.
- Caffeine can increase the speed at which foods and fluids pass through your bowel, so try and change to decaffeinated versions or herbal teas. Avoid sweeteners such as sorbitol, xylitol or mannitol, or foods which contain, them as they can also increase your stoma output and can also cause wind and bloating.
- Avoids other drinks high in sugar such as squashes, fruit juices, fizzy drinks as they make symptoms of diarrhoea worse.
- It is a good idea to separate fluids and solids. It may even be better to wait 30mins before or after a meal before drinking fluids. Try to limit fluids with meals to sips and have no more than 125mls (1/2 cup) in total. This will help the solid food pass more slowly through your intestines which helps your body absorb the nutrients.
- Try to avoid alcohol until you have the high output under control. Bear in mind other factors such as what medications you are taking and how these will react together.