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Dehydration and your stoma

As we are having a bit of an Easter heat wave, it’s more important than ever to talk about dehydration with a stoma.

What the NHS say

The NHS says:

Dehydration means your body loses more fluids than you take in. If it isn’t treated it can get worse and become a serious problem.
Symptoms of dehydration in adults and children include:

  • feeling thirsty
  • dark yellow and strong smelling pee
  • feeling dizzy or lightheaded
  • feeling tired
  • dry mouth, lips and eyes
  • peeing little, and fewer than 4 times a day

Its bad news for anyone but if you have an ostomy, it’s far easier to get dehydrated than someone with all their intestines because the large intestine plays an important role in helping absorb water from food waste.

Severe dehydration can be life threatening, and any dehydration with a stoma can make you feel poorly causing tiredness, a feeling of sluggishness and more.  If your output loosens and you find you are emptying your bag more frequently then it’s worth upping your fluid intake.

Dehydration and your stoma

The NHS also say:

With an ileostomy, you will be losing more salt and fluid. This happens because your colon is not being used and therefore is not absorbing extra fluid. You will need to include a teaspoon of salt a day into your diet. Salt is an essential requirement for your body and low levels of sodium (the main ingredient in salt) can affect how well your heart works. Signs of salt depletion are tingling in the fingers.

If you are also a renal patient, you will need to discuss your salt intake in more detail with your Renal Nurse Specialist, as your salt and fluid requirements may be different.

Drink plenty

You will need to drink plenty of fluids to avoid becoming dehydrated. The recommended amount is 2-2.5 litres per day (a minimum of 8 cups per day). If you are becoming dehydrated it can generally make you feel very unwell.

We recommend that you have isotonic drinks, which are higher in salt and sugar. Isotonic fluids are better for you because of the higher sodium (salt) and glucose content. They encourage fluid to be absorbed into your gut, rather than passing straight through into your stoma bag.

These types of drinks include Dioralyte (which you can buy from supermarkets and chemists) and Lucozade Sport or Powerade, or you can make up your own rehydration drink using:
• glucose – 6 flat teaspoons
• salt (sodium chloride) – 1 flat teaspoon
• sodium bicarbonate/citrate – 1⁄2 teaspoon • make up to 1 litre with tap water.
You can flavour this with small amounts of fruit juice.

Tips to avoid dehydration with a stoma

Its so important to keep on top of hydration with a stoma, I would say it’s one of the most important things. The make up of your body has changed and you need to readjust how you look after it. I remember after my first surgery the shock of just how thirsty I was.

My tips would be to have a bottle and sip through the day. I always drink sugar free squash and water as I find water alone goes straight through me. I also take a jug to bed with me as I know I get so thirsty in the night.

Rehydration sachets are not just for when you’re ill! I have them in all the time, I have one in my handbag for emergencies and they’re part of my ostomy kit.

Theyre my go to solution if I feel more tired than usual or if I have loose output, if I have any alcohol, I have one before bed and one in the morning and I highly recommend getting some in! I like the ORS tablets available from chemists and supermarkets.

When the temperature rises either at home or if you’re off on your holidays, then be very mindful of dehydration.

And as always, I can’t give medical advice so if I’m doubt, speak to a medical professional.

✌🏽& ❤️

Sam xx

Stomach bugs and ileostomies

DON’T WAIT!! That’s my general advice on the subject of stomach bugs and ileostomies, don’t wait to see a doctor. If you’ve been ill for more than a day or so with vomiting/diarrhoea/stomach pain, call the doctor!!!

Obviously I don’t follow my own advice and so I’m kind of writing this to my future self as a reminder to not be a dick. I think I’m superwoman when I get ill, I think I’ll just power through it.  I tend to think that 5 surgeries haven’t toppled me so I’ll be damned if a belly ache will!

Which is stupid.

If you don’t have a colon, it’s best to not fuck about with these things.  We can get very quickly dehydrated which is not something to mess with. What is a bit of a nasty bug for a person with a functioning gastrointestinal tract can be quite devastating for those of us missing parts of the bowel.

On Wednesday I was working in town and feeling a little queasy but ok, then I quite quickly got very hot, very tired and my stomach hurt.  I was in a coffee shop and felt wetness on my legs, I thought I’d knocked my coffee over but looked down and realised that my bag had leaked. It had filled to bursting in minutes and had leaked down the back of the seal.  Not good.

Woman with ostomy bag

Post lunch, Pre bag blow out

So I came home and felt grotty for a couple of days, I had terrible diarrhoea and tummy pain and felt really run down. But still I powered through and managed to work from home.

On Saturday my symptoms seemed to ease a little and so Timm and I went to the cinema, by the end of the day I felt really queasy. I knew it must be bad as I couldn’t even finish my wine!

By Sunday night I was crying in pain, my bag was filling with water around once an hour, anything I drank seemed to go straight through me. I had gotten myself dehydrated and I felt sick as a dog.  I was shaking, hot and felt like I was going to pass out. I thought I was going to need to go to A&E and I was pissed off. I felt stupid for letting it get to this point, my feelings of not wanting to overreact were ending up in more trouble.

Thankfully my stomach calmed enough for me to get some sleep but this morning I knew I needed to see a doctor. I called in sick to work (which I HATE doing) and got an appointment at the GP. One good thing of having an ostomy is that it terrifies the doctor receptionist! One mention of the bag tends to get me straight in!

I saw the doctor this morning who got me straight in for blood tests and a stool sample (another positive of an ostomy bag! Easy access to poop!) and has got me straight onto Cipro antibiotics with strict orders to rehydrate and rest.

I usually use Diaralyte but I’m trying the chemist own brand today along with a strawberry flavoured one called ORS which actually taste really nice so these may be my rehydration go to from now on!

Ciprofloxacin antibiotics

 

I wish I’d gone to see the doctor last week when things weren’t so dire. I’m waiting back on the results he says he’ll rush through now to see if I’ll need any further treatment.  If I end up back in hospital I’m going to be fuming with myself.

Often we are scared to seek medical advice because we don’t want to cause a fuss, we worry that it’s not that big a deal but please if you’re struggling with a stomach bug/stomach flu/gastroenteritis or general vomiting and diarrhoea and you have an ostomy, jpouch, missing bowel, please don’t wait.  Get medical advice as soon as you can.

I’m on bed rest today and hope I’ll feel better soon, till then I’ll snuggle back down with my ridiculously cute Lemmy.  Timm caught us this morning in full on chronic illness cuddle mode…

 

Stomach bug and ostomy

 

Sam xxx

Dehydration and ileostomies

I was warned when I was in hospital that dehydration is a massive problem for folk with ostomies and pouches, this is because your large intestine absorbs water from your food and a lot of the salt your body needs so if you don’t have a large intestine, you are in for a bit of trouble.

This means that I am always thirsty and drink litres and litres of fruit squash a day, I find water goes through my system too quickly and was advised by a doctor to try adding dilute squash to it as the body has to digest it and so hangs on to the fluids for that little bit longer.  I keep a store of squash in my ensuite bathroom as I drink two or three pints just through the night and so it stops me having to go downstairs at 2am.

Ostomy Lifestyle recommend this…

“People with ileostomies, particularly if the stoma is formed higher up in the bowel, can have more difficulties with their fluid intake. This is because it is the role of the large bowel to absorb water (and salt) and for people with ileostomies this is no longer being used. The small bowel will, with time, adapt to absorb more water and more salt, however careful attention should be paid to ensure that you are drinking an adequate, varied fluid intake (e.g. water, juice, cordial, herbal/fruit teas, etc) to maintain kidney health. Remember, you are aiming for light straw coloured urine.

For those who are more active it is even more important to pay attention to your fluid intake. Fluids lost through sweating contain electrolytes, so it is important to replace those with specialist sports drinks. 

Everyone should bear in mind that alcohol is a dehydrating fluid in the most part and caffeinated drinks such as tea and coffee cause you to lose more fluid in your urine. The majority of your fluid intake should therefore be from fluids such as water and fruit cordials.”

The other issue is salt.  As you don’t absorb salt well it is recommended to increase your salt intake at least for a while after surgery.  I find I crave salt and add it to pretty much everything since having my bowel removed.  I am a big believer that if you are craving something, it tends to be because your body needs it.

“Salt is important for nerve and muscle function and is found naturally in most food and drink. There are risks associated with both having too much and too little salt in our diets. Too much salt can lead to high blood pressure, which can make you more likely to develop heart disease, or have a stroke, while too little salt can cause headaches, cramps and fatigue. While there is some evidence that people with ileostomies can lose between 35-90mmol of sodium per day (equivalent to up to a teaspoon of table salt) because this would normally be absorbed in the large intestine, each person with an ileostomy will differ in terms of the amount they lose. There is also evidence that the small bowel of someone who has an ileostomy adapts over time to compensate for absorption issues. But, in the first few weeks after surgery you may need to add salt to your food and have additional salty snacks. There is conflicting information about long-term addition of salt to diet but evidence shows that most people have adequate salt in their diet to make up for what is lost through their ileostomy and there is no need to add more.”

Stomawise says…

“It is important to know the signs and symptoms of dehydration as well as preventative measures.  These symptoms can include thirst, dry tenting skin, abdominal cramps, rapid heart rate, confusion and low blood pressure.

Dehydration can occur after ileostomy surgery as the purpose of the large intestine is to absorb water from the indigestible waste and then expel the waste material from the body through bowel movements.

During ileostomy surgery, a part or all of the large intestines is removed, which prevents the body from absorbing water from the waste before it is excreted from the body. Dehydration can occur when the person does not drink enough fluids to replace the fluids lost as the waste moves through the stoma and into the attached bag.

Your Daily intake of fluids should be 8-10 (8 oz.) glasses per day and can be of any liquid containing water (soda, milk, juice, etc.) to help meet your daily requirement.

Dehydration can also upset your electrolyte balance (especially potassium and sodium) When the colon (large intestine) is removed, there is a  greater risk for electrolyte imbalance, Diarrhoea, excessive perspiration and vomiting can also increase this risk.

You should be aware of the signs and symptoms of dehydration and electrolyte imbalance. Dehydration and electrolyte imbalance is more common with an ileostomy as opposed to a colostomy.

Dehydration
Increased thirst, dry mouth, dry skin, decreased urine output, fatigue, shortness of breath, stomach cramps.

Sodium Loss
Loss of appetite, drowsiness and leg cramping may indicate sodium depletion.

Potassium Loss
Fatigue, muscle weakness, shortness of breath, decreased sensation in arms and legs, and a gassy bloated feeling may indicate potassium depletion.”

I am researching Himalayan Pink Salt at the minute for a future blog post, I’m not sure what I think yet but will write about it asap!

These are issues that most people don’t even think about, I thought I would bring it up as I recently spoke to two different people who highlighted to me that there are so many other issues and side effects to having Inflammatory Bowel Disease, a stoma or a pouch that people just do not know about and so thought I would share.

So next time you see an IBDer downing a pint in one or having an extra shake of the salt, you may just understand a little more.  And if you have a stoma or jpouch, take note and keep an eye on your hydration as the effects can be grim and we don’t need any other reason to feel crap!

 

Love Sam xx