Keeping Hydrated with an Ostomy (w/ video)

keeping hydrated with an ostomy
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Dehydration sucks, and anyone without a colon has likely been told by their nurse or doctor that maintaining adequate hydration is crucial. While it can be a challenge to keep up with fluid intake, there are many ways to do it. In this article, I’d like to share some practical tips that I’ve used myself, along with tips that have worked for others.

This information is focused on ileostomates, but many of these strategies can be used to help prevent dehydration in other circumstances, including diarrhea caused by IBD or for other types of ostomies.

Disclaimer: Dehydration is a very real, and serious complication. Please talk to your doctor or nurse if you have any health concerns.  This article doesn’t take into consideration any other health problems you might have

Video

https://youtu.be/khWTCIiuLgg

What Causes Dehydration in Ostomates?

While fluid loss can be caused my many things, including sweating and even breathing, ileostomates are at a greater risk of dehydration because their colon, which has a function of absorbing fluids and electrolytes, is either missing or bypassed.

If you’ve recently had surgery, you’ll likely be monitored to see how much fluid you’ve lost vs. how much you drank. When I had my ileostomy surgery, I was kept in hospital for a little longer than expected because of the risk for dehydration, but once my output slowed down, I was able to go home.

What can you do to prevent dehydration? There’s quite a bit, and I’ll start by listing several strategies that you can easily work into your lifestyle.

Hydration Strategies

  • Have a large pitcher of fluids available at all times, and set a goal to consume one or two pitchers per day depending on the amount of fluids you’ve been asked to consume by your doctor.
  • Carry a water bottle everywhere you go.  Don’t assume that you’ll be near a water source when you go out, so it’s best to always keep fluids with you when going out.
  • If you are going on hikes, long walks or other activities that you’ll be spending a lot of time doing, consider a hydration backpack.  I use the Teton Oasis 1100 and find it works extremely well as a day pack.
  • If it helps, get a bottle or pitcher that has measuring lines on the side; this will make tracking your intake easier.
  • A very novel way of keeping track is to mark your water bottle with times, as seen HERE.
  • Use an app to keep track of your intake or to give you reminders.  If an app isn’t your thing, try a simple kitchen timer instead.
  • Keep a glass of water by the bed so you can drink it when you first wake up.  This will also come in handy if you tend to wake up at night to empty your pouch, as you can take a few sips before returning to sleep.
  • Using small glasses (instead of large water bottles) might be preferred if you have a habit of chugging large amounts of fluid at a time.  Drinking small amounts throughout the day is ideal.

Getting the Right Fluids

Now that you’ve set up a strategy, you’re going to want to know what options are available, since water isn’t the best option to use exclusively in our case (it contains no electrolytes).

  • Sport drinks*, electrolyte drinks and electrolyte tablets tend to be the most popular options. I relied heavily on sports drinks for some time after surgery, then I only used them in situations where I needed a quick “pick me up”. I find this option to be the most expensive, and to be honest, I don’t like the overly sweet taste of these drinks (I’m not a fan of sugary drinks). They do offer convenience, so if they get you to drink, go for it. I have used one powdered sports drink in the past with great success (Vega Sport Electrolyte Hydrator), and I wrote about it HERE.
  • An alternative to sports drinks and store bought electrolyte solutions is a homemade rehydration solution.

Homemade Oral rehydration solution

  • V8/vegetable juices are one of my favourite ways to rehydrated. Not only do they contain sodium and potassium, but they also come with additional nutrients and don’t cause the same sugar spike you get with sports drinks. You can drink vegetable juice cold or heated like a soup. TIP: Most low-sodium vegetable drinks are higher in potassium than regular vegetable drinks, but they still contain a relevant amount of sodium for our purpose.
  • Water-rich foods are often overlooked as a source of fluids and electrolytes, but I find them to be very important in maintaining hydration. A few years back, when I was on a raw food diet, my meals often consisted of water-rich foods: fresh tomatoes, cucumbers, oranges, watermelon, celery, cucumber, mangoes, and so on. Eating large amounts of those water-rich foods meant that I almost never needed to drink liquids from a glass. How did I know it was keeping me hydrated? I was urinating many times throughout the day (and often at night), my urine was clear and in copious amounts! Even now, when I don’t drink enough during the day, I can rely on my large salads to help replace fluids easily. One benefit to getting your fluids via food is that it’ll slow down your output vs. straight liquids, which can be very helpful if you’ve got a high-output ostomy.

Water content of various fruits and vegetables:

Water content:

Apple 84%
Celery 95%
Cucumber 96%
Lettuce (iceberg) 96%
Orange 87%
Peach 88%
Tomato 94%
Watermelon 92%

A basic salad of:

4 cups of romaine
1 small tomato
1 small cucumber
1 medium celery
1 small carrot

Contains approx. 500ml of water plus nutrients!

  • Vegetable broths with sodium are an easy way to replace fluids while providing additional electrolytes too. Don’t rely too much on broth, as it’s not as effective as electrolyte drinks or vegetable juices.
  • Flavored water can be a simple way to get you to drink more. For me, I don’t like water unless it’s got some flavor to it, so I’ll often squirt some lemon juice or Apple cider vinegar into my water to give it a flavor boost.
  • Coconut water can be a great source of electrolytes (although many are lower in sodium), but it can get expensive to rely on coconut water on a daily basis.
  • Drink less caffeinated beverages and alcohol. Things like coffee and cola don’t result in dehydration normally, however,  if you find that caffeinated beverages cause your output to loosen considerably, then you may want to cut back.  Alcohol acts as a diuretic for everyone, and can cause you to lose fluids because it causes increased urination.
  • Herbal teas can be a nice option, as they usually offer antioxidant benefits, but be aware that some may still contain caffeine and others may be high in tannins, which may reduce iron absorption.  If you are anemic, don’t drink teas at the same time you take your iron supplements or with meals.

* Sometimes high-sugar drinks can make hydration challenges even worse, as they sometimes cause diarrhea in some people.  If you are using an oral rehydration solution, get one that uses rice starch instead of glucose). 

Tips

  • Mix it up! Don’t rely on a single source of hydration, since they all have strengths and weaknesses.
  • Provided you don’t have high blood pressure, don’t limit your sodium intake if you have an ileostomy; that doesn’t mean to use only table salt, there are other ways to get sodium in your diet: high sodium vegetables (celery, tomatoes), baking soda and even MSG are better alternatives to table salt.
  • It may be helpful to measure your urine and/or ostomy output, especially if you’ve recently had surgery. Speak to your doctor or nurse to see if this is something they’d like you to do, and they’ll give you targets to watch out for.  It may be helpful to also track your food/fluid intake to see if the volume you are outputting corresponds with the amount you are consuming.
  • Don’t wait until you’re thirsty before you start drinking; thirst is a sign that you are already becoming dehydrated.
  • Fatigue may be a sign of dehydration.  I know that when I don’t drink enough, I feel heavy and sluggish, so keep and eye on your intake if you’re feeling extra tired or weak.
  • Headaches can also be a symptom of dehydration, so if you are prone to them, try upping your fluid intake.
  • You may notice that if you don’t drink enough, your output may slow down and you might get crampy; take that as a warning to drink more!
  • Be aware that many fruit juices can cause diarrhea (especially prune juice), so dilute or limit them if your goal is rehydration.
  • Experiment with drinking before, during or after meals. You may find that depending on when you drink, your output may loosen up or thicken up, and that’ll have an impact on the amount lost throughout the day.
  • If you have a high-output ostomy, that consists of liquid or loose output, you may want to use some of the strategies listed in THIS article.
  • Your urine frequency, amount, color and smell will give you a good idea at to how hydrated you are: aim to get your urine to be clear and as odourless as possible; dark and smelly urine is often a sign of dehydration.
  • Get regular urine and blood tests to measure your electrolyte balance.
  • Artificial sweeteners may cause diarrhea, so be mindful when using them.
  • Sip drinks, instead of chugging them.  I tend to chug, but it is recommended that you sip your drinks throughout the day, and not all at once for better absorption.

Further Reading

QUESTION: What are some of the strategies you use to keep hydrated?

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18 thoughts on “Keeping Hydrated with an Ostomy (w/ video)

  1. Someone in my support group told me that drinking to much water is bad for loose outputs. Is this true? If so, why???
    Marcie

    • Yes, they are correct.

      It’s possible to drink too much of anything (at a certain point, it just passes through you), but drinking too much water can cause an electrolyte imbalance. The quantity for “too much” really depends on the person.

      If your urine is clear and odorless, and you’re peeing often throughout the day, you’re probably getting enough. For ostomates, we also have to monitor our output so we aren’t losing more than we are taking in.

  2. I had a ileostomy 3 years ago. Very sick went un-consious w/pain-E.R. 4 months later in ICU/CCU with 2 month coma, death, strangulation 3 times of colon, colitis, bleeding internally for some time, then surgery of removal of colon. (didn’t know that I was even sick) Dr. Never checked if I was dehydrated. Sent to nursing home to learn how to walk etc. (2 months) Hard time and 50 pounds of weight loss. I am now with I.V. infusions of 12-14 pounds of fluid per week for the Past 3 years-sometimes E.R. for extra fluids. (4 pounds of fluids every other day) no weight gain- – why? With all the efforts of special drinks, fluids go to pouch within 5-8 minutes. No short small bowel indacations. Will this ever stop? Taking salt pills also.
    My life is totally gone!! I don’t mind the pouching system-but this? Can u help? No Dr. will or can help me. I am lost!! Been to many specliasits on this ….. Now have emphysema that was discovered 3 years ago and never told until last week by lung Dr. I am a mess… HELP!!

    • Hi Marcie, I’m so sorry that you’ve been going through that. I’m not a doctor, so I really can’t offer any suggestions for what you describe.

      That sounds like a lot of fluids per week. Are you also able to eat?

      • Yes, I eat more than my 2 sons do and they are in their 40’s.. I also “graze” eat. Cheerios I find to help keep things in longer—I tried every pill and shots..
        There is a shot that is new–But that costs-get this 3000.00 – 4,000.00 which equals to me is “sorry I cant help you” Who can afford that.. ?? Said I could get sponsors.
        Also this can cause cancer-lower your white blood cells.. etc. Like what sponsor would want to join in with that? Not interested in this. I am 5’8-112 pounds. Any milk products-sugar- goes right to my pouch.. It has been a long haul-every year something major–Last year I went to surgeon as I was having pain-said am fine.
        3 days later- I had a busted Gull Bladder-that took 4 surgeries.. Needless to say I went to a different hospital.. This year Emphysema, which that surgeon had my stomach -mri- as I had to feed myself through a stomach tube for a few months when I came home 3 years ago-That was written in this reading never told me!!!! And I was standing tall strong-feeling great and then boom!!! I had horrible pain and passed out and u know the rest. Before this I passed out, husband found me-911-Hartford Hospital and because I was not responding, they sent me to the psychiatric ward!! Didn’t have time for me at theE.R. has many people rather upset with their attitudes.!! Had fever and complained that I hurt-they told me that it was all in my head. and put me in a room away from others. I asked for a Dr. Nope- when my fever came down, I told them I have a lawyer and plan to sue.. I was out in 4 hours. didn’t sue. but filed many reports.. So because of this mistake of improper treatment at the e.r. I was delayed 4 weeks of proper treatment and I believe that this is why I became so sick-with bowel backing up in my system etc. The gull bladder took me a good year to get back on my feet again-if you can call this on my feet!! Do u have any samples to send me to try? Coupons? Marcie………… p.s. be happy to help others if I can just by writing to them to keep their chin up with dehydration of severity.. It helps.
        My best to you — and thank you for responding.. very nice.. Marcie..

      • HI, sending u some pictures of me and husband (sitting down) and the tall one is one of my sons. I am the blonde Swede. I am 68 yrs. old.
        before all this happened I looked like I was 30. U can understand the many difficulties I have had to adjust to. Ageing? doesn’t bother me.. It is the sick weight loss/and no fighting weight for future illness’s that I am afraid of. When I go down? I go down HARD !!!! And FAST!!
        But I keep very active, I clean the home rooms, gardening.. Maybe I should not do all of this? Is that a problem u think? House keepers are $30.00 per/hour. been there for a year after surgery 3 years ago. WOW huh? Ya, I live in Ct. expensive..
        Have a healthy week and a fun one!! I go to infusion 3 times a week-so not much time for fun.. But I try to slip a day in here and there.. Got to keep that smile!!
        Marcie………….

      • HI, Am I getting to much fluids? Think that these fluids (2 letters per visit-3 x wk) are flushing away to many important things?
        I have had 2 kidney shut downs the first year. But Dr. said that they healed them selves.

        • Hey Marcie,

          Your dr would be the one who could tell you whether you’re getting too much fluid, but I would hope that a stoma nurse and your doctor could share notes.

          You’ve gone through so much. I’m glad that you can still stay positive.

          • Been 12 times and talked until I was blue in the face with surgeon-just said “don’t know what to tell you- May go away.. Put me in the hospital for a few weeks to measure in/out puts a few times.. Like, I am so done with being their mascot!! Totally useless!! Just want to operate-take the money. They are more interested in stomas problems.. They should read your vegan ostomy– I will tell them-!! Anyone out there that has been through this?????? Thank You in advance.. Marcie…
            I will keep reading on.. . p.s. my support group in West Hartford, Ct. is wonderful !!!!!!!!!!

  3. I have an ileostomy and just recently tried the Vega hydration powder. I had diarrhea. I have a high output stoma. I think it was the beet derivative that caused it. I discontinued using it, although I really wanted to try it.

    • Yes, many people report those findings! Unfortunately, because traditional marshmallows contain gelatin (which I avoid), it’s hard to recommend them without easy access to a vegan version.

  4. Can you please explain how the sugar in fruit juice will cause a watery output. I use a Foly catheter and drink a couple of glasses of cranberry juice a day to help with the UTIs I sometimes get.  My colostomy output is watery and I need to firm it up but would like to keep drinking juice. Do you have any suggestions for dealing with this problem?

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