Staying hydrated is essential for all of us, especially for those living with a stoma. Having an ileostomy, colostomy, or urostomy, can alter the body’s digestive or urinary system which may lead to changes, significantly impacting our fluid balance. Dehydration is a common concern for ostomates and those with an ileostomy (where the large intestine which normally absorbs water and electrolytes is bypassed or removed) can be more at risk. Now the summer is upon us and the days are warmer, it is even more important understand how to keep hydrated and recognise the signs of dehydration, knowing what to do if it happens to you.
Why is staying hydrated so important?
The colon’s (large bowel) main role is to absorb water and salts from the waste material passing through it. When this section of the digestive system is altered or removed, as it is with stoma formation surgery, the body loses its main site of fluid reabsorption. As a result, individuals with an ileostomy are at greater risk of losing large volumes of fluid through their stoma output. This increased fluid loss can lead to dehydration, which may present as dizziness, dry mouth, fatigue, decreased urine output, or dark-coloured urine.
For those with a urostomy, fluid intake is equally important. The urinary system is rerouted to an external pouch, and maintaining a steady flow of diluted urine helps reduce the risk of urinary tract infections, kidney stones, and mucus buildup. In these cases, hydration supports kidney health and prevents complications associated with concentrated urine.
Signs of dehydration to watch out for:
People with a stoma need to be especially vigilant about the signs of dehydration. These include:
- Dry lips, or mouth
- Increase in thirst
- Dark, strong-smelling urine
- Headache
- Fatigue
- Dry skin,
- Decreased urination
- Muscle cramps,
- Feeling confused or irritable
- A drop in blood pressure, which can cause fainting.
- More serious effects can involve electrolyte imbalances, such as low sodium or potassium levels, which can lead to heart rhythm problems, confusion, and muscle weakness.
What dehydration feels like with a stoma:
Dehydration with a stoma can feel intense and come on quickly. You may experience dizziness, light-headedness, fatigue, and a dry mouth. Your stoma output may become thicker or slow down, and your urine may appear dark and concentrated. Muscle cramps, headaches, and a general feeling of weakness or confusion are also common. However, for people with an ileostomy, these symptoms can be more severe due to greater fluid loss. If not addressed, dehydration can lead to serious complications. It’s important to act quickly by increasing fluid and electrolyte intake and seeking medical advice if symptoms persist or worsen.
It is also important to check and monitor the output from your ileostomy. If you notice the output consistency (which should be a porridge consistency) becoming looser than normal 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.
What type of stoma puts you most at risk?
An ileostomy puts you most at risk of dehydration. This is because the ileostomy (small bowel) diverts waste from the small intestine, bypassing the colon, which normally absorbs most of the body’s water and electrolytes. As a result, ileostomy output is usually more liquid and frequent. Without the colon’s absorption function, it’s easier to become dehydrated, especially in hot weather, during illness, or after increased stoma output. People with an ileostomy need to be especially mindful of their fluid and electrolyte intake to prevent dehydration and maintain overall health and energy levels.
Hydration tips for daily life – apps/trackers, carrying a water bottle etc.
Staying hydrated with a stoma requires consistent habits. Carry a reusable water bottle and sip regularly throughout the day, don’t wait until you feel thirsty. Use hydration tracking apps like Ostobuddy, My Ostomy Journey (on the App Store and Google Play), Waterlogged or Hydro Coach to monitor your fluid intake and set reminders. Consider electrolyte drinks or rehydration powders, especially in hot weather or after increased stoma output. Include water-rich foods like cucumbers, melons, and soups in your meals. Keep a hydration journal if apps aren’t your style. Having fluids readily available at work, bedside, and in your bag helps make hydration a seamless part of daily stoma care.
When plain water isn’t enough – electrolyte balance
With a stoma, especially an ileostomy, plain water alone may not be enough to maintain proper hydration. Because the colon is bypassed, the body loses not just water but also vital electrolytes like sodium, potassium, and magnesium through stoma output. This can lead to symptoms like fatigue, muscle cramps, or dizziness. To maintain balance, include oral rehydration solutions, electrolyte tablets, or sports drinks low in sugar. Homemade solutions with water, a pinch of salt, and a little sugar can also help. Balancing fluids with electrolytes is key to preventing dehydration and supporting overall health with a stoma. You may also find that Imodium can help slow your output down so that it is more manageable and prevents dehydration.
How seasons and illness impact hydration:
Seasonal changes and illness can significantly affect hydration for people with a stoma. In the summer months and hot weather, the body loses more fluids through sweat, increasing the risk of dehydration. This risk increases especially for those with an ileostomy, where water absorption is already reduced.
Cold weather can also be deceptive, as thirst may decrease. Warm drinks can still be hydrating, try to switch to decaffeinated tea/coffee or try clear soups to aid rehydration. Illnesses like diarrhoea, vomiting, or infections can further increase fluid and electrolyte loss through the stoma. During these times, it’s crucial to increase fluid intake and consider electrolyte-rich drinks. Monitoring stoma output and staying ahead of fluid loss helps prevent complications and maintain well-being.
When to seek medical help:
Knowing when to reach out for help is important for all ostomates. If you are feeling any of the above symptoms, try to recognise these early and speak to your stoma nurse or make an appointment to see your GP. Don’t leave it until you are feeling weak and unwell. Dehydration can be life threatening with a stoma.
