On July 9th, I’ll be getting scoped as a follow up to my ostomy surgery and to also make sure that my Crohn’s hasn’t spread to my small intestine. When we lose our colon, we don’t expect that we’ll ever need to be scoped again, but the reality is that those of us with IBD (especially Crohn’s) need to get monitored to make sure that our illness is kept in check. Before getting my stoma, I was told that my chances of Crohn’s spreading to other parts of my bowel were very low – still, it’s always a possibility. While researching for my post on the Environmental Risk Factors for IBD, I came to realize that even though I can make lifestyle decisions which can reduce my chance of flaring or a reoccurrence, nothing is guaranteed. I was feeling pretty great after my last two surgeries, but after receiving a tetanus booster in February, my joints started hurting and haven’t felt right ever since. This reminded me that my body is still primed for IBD, losing a colon didn’t cure it and there will always be a chance that Crohn’s will one day rear its ugly head again.
For my ileoscopy prep, I’ve been told to take Pico-Salax, which is the same stuff I used for several colonoscopy preps. To be honest, it tastes pretty good (the Cranberry one is free of animal-ingredients), and I’d recommend it to anyone doing bowel prep. Now, some ileostomates don’t do prep and others do. I think it depends on the GI and/or hospital doing the scope, but I’ll go ahead with the prep using some extra precautions.
One of the first concerns with doing a prep with an ileostomy is the risk of dehydration. Anyone who’s done a traditional bowel prep can tell you that they lose a LOT of fluid, and since ileostomates can’t absorb as much fluid through their gut (which is what the colon does), we have to be extra-careful not to fall behind on fluid intake. I’ve traditionally had sports drinks for the colon prep, but I feel that there are better options out there. So I’ve narrowed down a few that would work well. Each option has their own pros and cons, so I’ll go through each one separately. Keep in mind that my goal is hydration and electrolytes using a clear fluid free of animal ingredients.
Coconut water, various brands (cost approx. $6 / L):
- Offers some calories (approx. 130 calories per liter), which may help if you’ve fasted the day before
- One liter offers approx. 2000mg of potassium
- The most natural drink of the bunch and contains the least number of ingredients (usually just coconut water!)
- Vegan product
- Unsweetened coconut water may not taste good to many people
- Lacks many electrolytes found in other products
- Some brands preserve with chemicals. Get organic, 100% coconut water if you can
- Low on sodium at approx. 100mg / L
- You may need to visit a health food store to find it locally
Vega Sport Electrolyte Hydrator Powder (cost approx. $1.50 / L using two scoops or two packets):
- Sold in 168g tubs (Approx. 40 servings per tub) and individual packets
- Nice flavor (see note below)
- No sugar
- Can be made anytime by adding it to water.
- For two servings ( which is what I would use in a liter of water),itcontains approx:
- 800mg of potassium (20% of RDA)
- 200 mg of sodium (8% of RDA)
- 120mg of Vitamin C (200% RDA)
- 400mg of calcium (40% of RDA)
- 178mg of phosphorus (16% of RDA)
- 2mg of zinc (12% of RDA)
- 2.50mcg of selenium (4% of RDA)
- 0.4mg of copper (20% of RDA)
- 40mcg of chromium (30% of RDA)
- 308mg of chloride (8% of RDA)
- Somewhat cloudy, but clear enough
- Vegan product
- Ingredients (lemon lime):
- Potassium, natural lemon and lime flavours, magnesium, citric acid, malic acid, stevia extract, calcium, chloride, phosphorus, sodium, vitamin c, silicone dioxide, zinc, copper, selenium, chromium.
- May be hard to find in your area. Health food stores generally carry it, but I’ve seen it at our local grocery store too
- May be too low in sodium for ileostomates losing a lot of fluid
- Some concerns over the high calcium and vitamin C when consumed in high amounts
- While the flavor is nice, some may find the stevia slightly bitter
- Zero calories
Pedialyte (unflavored) cost approx. $5 / L:
- Widely available. Every pharmacy or store with a baby section will carry this.
- Contains 100 calories, which will help with some fatigue due to fasting
- One liter provides the following:
- 770mg of potassium (16% of RDA)
- 1010mg of sodium (67% of RDA)
- 100mg of calcium (10% of RDA)
- 0.1mg of copper (5% of RDA)
- 10ml of magnesium (4% of RDA)
- 100mg of phosphorus (7% of RDA)
- 0.2mg of zinc (2% of RDA)
- Ingredients are free from animal product:
- Water, Dextrose. Less than 2% of the Following: Potassium Citrate, Salt, Sodium Citrate, Citric Acid, and Zinc Gluconate
- Ready to drink, no dilution is needed
- Since it’s from Abbott, the pharmaceutical company, I suspect that this product may be tested on animals. I have not confirmed this, but if you have, please let me know
- While there is a powder available, the ingredients are as bad as most sports drinks, so I’d avoid it
- Calories come from dextrose
- The high sodium content might be a problem if consuming this product every day
After seeing the list, you can see that there are several options available to replace sports drinks (there are more than what I listed), but I’ll be going with the Vega Sport Electrolyte Hydrator for several reasons:
- COST: It’s the least expensive of the bunch, and it’s something that won’t break the bank if used daily.
- WIDE-SPECTRUM: Unlike the coconut water, this one covers more than just a few electrolytes and even has the edge over Pedialyte.
- FLAVOR: I don’t like really sweet things, and Gatorade actually hurts my teeth, but I don’t mind the stevia-sweetened Lemon Lime flavor that Vega uses.
- CONVENIENCE: Because it’s a powder, I can control the amount used per serving. When I drink this throughout the day, I tend to use double the water suggested (or half the powder). The packets are something I can take with me anywhere and if I need a quick pick-me-up, I just add it to some bottled water.
- LESS WASTE: When using the tub, you generate far less waste (even if recycling) compared to bottles of Pedialyte or coconut water.
- IN SYNC WITH MY VALUES: Vega was founded by Brendan Brazier, a Canadian, vegan athlete. The company only carries vegan products and operates with sustainability in mind.
I used the Vega Sport Electrolyte Hydrator during the Gutsy Walk and I found that it worked better for me than any sports drink has. I drink it daily and will likely continue to use it as my first choice for hydration when I’m active or for future ileoscopies. If I had any concerns with the Vega, it would be that there may not be enough sodium to adequately replace a very-high output ileostomy, but that can easily be compensated for by making a high-sodium broth that’s clear and strained of any bits.
Other than hydration, my second concern with the ileoscopy prep is what to do with all the output from my stoma! Ileostomates are use to emptying their pouch 5-7 times a day and I tend to empty about 7 times a day if I’m eating a lot. I suspect that I won’t be emptying my pouch very often the day before and the scope, since I will be fasting, but from about 5am (when I take the Pico-Salax) until I get to the hospital at 8:30am, I expect a lot of fluid to pass through me. Most “large” pouches hold about 600ml of fluid – that’s the TOTAL CAPACITY and it would be unrealistic to make my pouch fill to that level, so I’ve requested samples of the Coloplast Sensura Click Magnum, which is designed for high-output and has a total capacity of 1160ml (almost double that of the Maxi Sensura pouch). It has a spout on the bottom, rather than a roll-up closure. I used this pouch during my last hospital stay and I think it’s the best option. Also, because it’s a two-piece, I may be able to have the ileoscopy done without removing my wafer. I’m hoping that it will be enough for the drive to the hospital that morning!
I’ll write about my experience of having the ileoscopy after it’s done, but hopefully this information will help anyone who’s looking for ideas on keeping hydrated, especially for any kind of bowel prep.
For more information on the products mentioned above, please visit the links below: