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

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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 powedered 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?