dehydration ostomies ileostomy jpouch ibd

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.

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

12 replies
  1. dpawson
    dpawson says:

    Misquote? Mistyped? “Your Daily intake of fluids should be 8-10 (8 oz.) glasses per day” How many Sam?
    [I note you don’t mention the beer you two are swigging! Isn’t that on the Ostomy Lifestyle quote? :-)]

  2. dpawson
    dpawson says:

    Misquote? Mistyped? “Your Daily intake of fluids should be 8-10 (8 oz.) glasses per day” How many Sam?
    [I note you don’t mention the beer you two are swigging! Isn’t that on the Ostomy Lifestyle quote? :-)]

  3. Pam
    Pam says:

    Such helpful information. I have both bags…..I come to hospital nearly every 2 weeks to get rehydrated, can only be done thru an introvenious line, drinking fluid alone at home won’t rehydrate me. It means getting an ambulance, getting admitted into emergency, waiting hours and hours for a bed, staying in hospital from 2 to 8 nights then being sent home!! Am so so over it, its only a bandaid cure.
    Someone please help……this will send me mad!!
    Appreciate any suggestions, thanks in advance.
    Cheers Pam

    • Victoria
      Victoria says:

      My heart goes out to you!
      Power Port Implant and IN home hydration therapy.
      Super Shortened Story:
      I totally understand what you are dealing with. When I had my 1st ostomy in ’02 from having my colon removed. I went from
      103 lbs in Nov.’02
      down to
      72 lbs. In Feb’03
      Do to the nausea cycle of dehydration. Very Long story of vain scar tissue to several picc lines causing a blood clot the size of a lemon = 9 months in a hospital. shortened. I was then blessed by a Dr that desided to put in a power port. Implant. Now can do hydration at home. OH Happy Days !!!
      You are in my prayers,

  4. Leslie
    Leslie says:

    Maybe try drinking organic coconut water. Long as your potassium isn’t to high. My mom has also been in and out of hospital. She was in hospital for two months ?. She is back in hospital now for electrolytes being out of balance and infection they cannot find, also a UTI. Hang in there your not alone.

  5. Helen
    Helen says:

    hi I have had an illeostomy bag for 18 years as i suffered with undiagnosed Crohns for years before. I regularly get blockage as i have adhesions and hernias. I take strong painkillers when this happens as it is very very painful. however my gp surgery has just taken on a pharmacist to advise about drugs…she seems determined to get me off codeine and pethedine (which i only take if bag blocks.)she says that my body is creating pain as i am addicted to painkillers. i am very upset about this as I have been taking the codeine for over 20 years and the pethedine only when bag blocks and i cant cope with pain. I have explained situation to her but she has taken the codeine off repeat now so i have to get in touch with her to get them? the consultant cant see anyway out of this and the surgeons wont operate unless blocks totally. I have seen pain nurse several times over last few years for advice and she has just said carry on if it works but I am worried that this pharmacist is going to stop me have the painkillers? any sugestions?

  6. Carmen
    Carmen says:

    I have 4 surgeries and have the same problems. I stay in hospital for 4 months. And be in the hospital on February, March, April, May. For low potassium,sodium,and magnesium too. I lost 60 pounds is been a roller coaster for me. And my family. I try everything first my pills just come out to my bags completely. So I put them on food to disuelve. Still have the problems. Nothing seen working. First surgery on October. Last December. Bils too the sky. And I’m tired to be tired ? if you know what I’m meant.


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