Controlling Dehydration After Ileostomy Surgery

I had an ileostomy almost one year ago. It's been difficult to stay hydrated. I've been to the emergency room no less than six times in the months after surgery with severe dehydration: nausea, vomiting, abdominal pain, headache. I do all the things to stay hydrated. Any tips? I'm depressed over this as there were complications. This has been difficult, as I'm sure all of you have experienced. The ER thinks I'm having panic attacks and not truly sick. It makes me sad. I'm on my own and I think I am doing pretty well supporting myself. Thanks in advance for hydration tips.

See a nutritionist, get a blood test, and in the meantime, search online for homemade hydration solutions. You may have an imbalance of some sort.

You may be having a reaction to other medications you're taking, so research those for any dehydration issues and talk to your doctor.

 

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Hello Jenny

Google St Marks Solution; it's a very well-known oral rehydration solution, but not the only one.

4 year Ileostomate here…I experience dehydration as well.  All I will say is….do not think drinking goo-gobs of water will help…yes water is good but too much plain water can flush out sodium and nutrients, etc…ask me how I know….us ileo’s with a lot of liquid output need hydrating with drinks that provide these things for hydration.  There are many of these on the market…find something you like or make your own as xnine and Axl have suggested.  

In addition, something I feel has really helped me in terms of excessive watery output is psyllium in powder form (not pills or gummies) - if you are not already doing psyllium you might want to give it a try.  It is Metamucil however, Costco or Amazon has it in powder form at a reduced price (picture for your viewing pleasure).  As we are all different you may want to check with your doc/stoma nurse - but for most it is okay.  It will solidify my output which has greatly helped with my dehydration issue. Before I started taking fiber I was experiencing “failure to thrive” that has greatly changed with the use of fiber.  I only started the fiber routine this last year or so….this is when my return to what I feel my “normal” returned.  Best wishes,  jb

 

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Words of Encouragement from Ostomy Advocates I Hollister

Good advice about the Metamucil. I started using it lightly, 1 teaspoon daily to see its effects.

Do you do the three times a day recommended on the bottle?

Nope - I use 2 teaspoons in a morning smoothie - it is so helpful in terms of output during the day… then at night, not so much… I am considering using 2 more teaspoons after dinner to help at nighttime but not sure if it would be okay. I am a freakazoid about any meds/drugs… jb

Cool. Thanks. Experiment.

That's the only way to find out really what works and what doesn't.

I've learned over the years to carefully experiment.  Rules and instructions are guidelines at best, and cannot account for a person's unique situation.

Water should be sipped, not chugged.  The body needs time to absorb it.  Too much, too soon will get flushed out... along with sodium and nutrients as JB described.

Proper hydration requires the addition of electrolytes.  Water by itself is not sufficient.  But the biggest challenge is absorption.  

How many times a day on average do you need to empty your bag? If you have a high-output stoma, advice is different from someone that has average output.

 

This information is only for ileostomy patients.

After surgery, you will need to drink one full oral rehydration solution (ORS) recipe every day until follow-up with your surgeon.

 

Remember to fill out an intake and output worksheet (PDF) daily after discharge to make sure you are getting enough fluids. Please bring these worksheets with you to your first follow-up appointment.

 

Orange juice base

¾ tsp salt

8 tsp sugar

1 cup unsweetened orange juice without pulp

4½ cups of water

 

Gatorade base

Choose any flavor, except red

2 cups Gatorade

2 cups water

½ tsp salt

 

Grape juice base

½ cup juice

3½ cups water

½ tsp salt

 

Apple juice base

1 cup of juice

3 cups of water

½ tsp salt

 

Randy's rehydration drink

1½ tsp salt

2 tbsp + 2 tsp sugar

4 cups Sprite Zero™

2 envelopes of orange or lemon sugar-free drink flavoring mix

Please be aware that carbonated (soda, seltzer) drinks will increase gas in your appliance.

 

World Health Organization ORS Recipe

3/8 tsp salt (sodium chloride)

¼ tsp Morton Salt Substitute® (potassium chloride)

½ tsp baking soda (sodium bicarbonate)

2 tbsp + 2 tsp sugar

Add tap water to make 1 liter

Optional: NutraSweet or Splenda-based flavoring of choice to taste

 

Drip Drop

In the hospital, you were provided pre-mixed Oral Rehydration Solution in the form of “Drip Drop”. This is a brand name electrolyte solution. This is available at stores or online (Walgreens, Walmart, Amazon, etc.). If you prefer this solution, please mix per packet instructions and drink 4 cups per day.

[b]Signs of a clogged stoma.

[/b]

No output or only watery output under pressure for a few hours after eating could be caused by a covered stoma due to improper application of an appliance, typically when the hole is cut too small or too much paste is used. It could also be caused by eating hard food. Seek treatment in an emergency room, remove the appliance if necessary, and wait. If clogged, severe pain will eventually appear, which will hopefully clear itself. If not, a trip to surgery would be necessary. Unfortunately, very high and frequent output will ensue after clearing for quite some time, which will likely make putting on a replacement appliance difficult. Use stool-thickening tactics (below). If going to an ER, bring your own ostomy gear and a change of clothes, as the hospital likely doesn't carry or doesn't know how.

 

[b]What is "pancaking?"[/b]

 

Pancaking occurs when a vacuum in the bag (likely due to a clogged filter) or super thick stool blocks stool from depositing to the bottom of the bag. This can force the bag off and cause leaks. Control what one eats and by mixing and consuming stool-thickening and stool-softening foods at the same time to get a balance.

 

 

[b]What is "ballooning?"

[/b]

Ballooning occurs when foods eaten produce too much gas and the filter gets clogged (likely due to lying down), thus forcing the bag off and causing leaks.

 

These two conditions can cause premature bag replacement and leaks, which burn the skin. It's better to replace the appliance if there is any continuous stinging pain; don't just live with it. Keep an eye on your ostomy supply and have ample reserves.

 

I've found that caffeine, in coffee, tea, and even chocolate, causes diarrhea and can assist in controlling flow so stool is more liquid. However, coffee makes output very acidic, making burns worse. Dried Chinese Crispy Noodles, Cheerios, or applesauce (peeled apples) are the exact opposite, a stool-thickening food. By mixing these with other foods, one can manipulate their stool output and counter the issues above. Also, the severe thickening helps in cases where one has severe diarrhea and is unable to reattach a new bag due to high flow.

 

 

[b]Eating Guide

[/b]

 

Partially copied from my nutritionist's guide. Ileostomy Nutrition Therapy from the Academy of Nutrition and Dietetics. (This handout may be duplicated for client education.)

 

My recommendation is to see a nutritionist for the full guide as not all can be pasted here.

 

I've added my own observations to further clarify.

 

Chew all foods well to the consistency of paste.

 

[b]Foods That May Cause Blockage (very bad, avoid!)

[/b]

Apples, unpeeled (unpeeled and applesauce are excellent thickeners; don't eat the core, chew well)

Bean sprouts

Cabbage, raw

Casing on sausage (inside fine if no tough parts, avoid swallowing if a chunk is felt)

Celery (avoid)

Chinese vegetables (stir-fried crunchy, too hard, need soft veggies with no skins)

Coconut

Coleslaw

Corn (grits also, corn anything doesn't seem to dissolve in the stomach)

Cucumbers (skins bad, inside chewed up good seems okay, no seeds)

Dried fruit, raisins

Grapes

Green peppers (red, yellow also) pureed or very very small seems okay in small amounts

Mushrooms (doesn't dissolve in the stomach) pureed or very very small seems okay in small amounts

Nuts (totally avoid)

Peas (mushy interior okay, like pea soup, skins a problem)

Pickles (skins a problem, inside if chewed up good seems okay, seeds not)

Pineapple (liquid okay, mushy parts fine, hard parts not, tricky)

Popcorn (totally avoid)

Relishes and olives

Salad greens (diarrhea nightmare too)

Seeds and nuts (avoid)

Spinach (doesn't digest, pureed perhaps)

Tough, fibrous meats (for example, steak on grill, well done, tough parts especially)

Vegetable and fruit skins (any avoid)

Whole grains (no grits, oatmeal seems to be okay, Cheerios is an excellent thickener)

 

 

 

 

[b]Foods That May Cause Gas or Odor

[/b]

Alcohol

Apples

Asparagus (stink)

Bananas

Beer

Broccoli (clog hazard)

Brussels sprouts (clog hazard)

Cabbage (clog hazard)

Carbonated beverages

Cauliflower

Cheese, some types

Corn (clog hazard)

Cucumber

Dairy products

Dried beans and peas (clog hazard)

Eggs (don't digest in the stomach)

Fatty foods

Fish (cooked salmon in small portions may not, nor stink)

Grapes

Green pepper (red and yellow also, clog hazard)

Melons

Onions (clog hazard)

Peanuts (clog hazard)

Prunes

Radishes

Turnips

Soda and sipping using straws (drink from glass instead)

Seafood (oh God, does it stink!)

 

If you're having pancaking issues, a small amount of something above (like having a soda during a meal) could introduce some air into your diet and thus into the bag. Also, by avoiding too many thickening foods by themselves, which often contribute to pancaking.

 

 

[b]Foods That May Help Relieve Gas and Odor[/b]

 

Buttermilk

Cranberry juice

Parsley

Yogurt with active cultures (Greek yogurt)

 

 

[b]Foods That May Cause Diarrhea (looser or more frequent stool)

[/b]

Alcohol (including beer)

Apricots (and stone fruits)

Beans, baked or legumes

Bran

Broccoli

Brussels sprouts

Cabbage

Caffeinated drinks (especially hot)

Chocolate

Corn (in my experience, corn anything doesn't digest in the stomach, just passed through and out, kernels/popcorn will clog)

Fried meats, fish, poultry (KFC, supermarket rotisserie chicken very bad, anything soaked in brine)

Fruit juice: apple, grape, orange (small amount okay)

Fruit: fresh, canned, or dried (small amount okay)

Glucose-free foods containing mannitol or sorbitol

Gum, sugar-free

High-fat foods

High-sugar foods

High-salt foods (KFC, supermarket rotisserie chicken)

Highly seasoned foods (blackened)

Licorice

Milk and dairy foods (small amounts okay)

Nuts or seeds (bad, clog hazard)

Peaches (stone fruit, one rarely okay)

Peas

Plums (stone fruit)

Prune juice or prunes

Soup

Spicy foods

Sugar-free substitutes

Tomatoes

Turnip greens/green leafy vegetables, raw

Wheat/whole grains

Wine

Rice (1/4 cup mixed in food okay), refried beans (1/4 cup okay), pasta (one cup max).

Any foods soaked in brine or fried (rotisserie chicken, Kentucky Fried Chicken, etc.)

 

 

 

[b]Foods That May Help Thicken Stool

[/b]

Applesauce (unpeeled apples, no cores)

Bananas

Barley (when OK to have fiber)

Cheese (cheese food may be a clog problem, use real cheese)

Dried Chinese Crispy Noodles (severe thickening, mix with other food that causes diarrhea)

Marshmallows

Oatmeal (when OK to have fiber)

Pasta (sauces may increase symptoms) (in my experience, more than a cup of pasta causes diarrhea)

Peanut butter, creamy only, nuts clog (makes skin oily)

Potatoes, no skin (skin clogs, more than a cup causes diarrhea)

Pretzels (salty may cause more flow water consumption)

Metamucil, mix or crackers (mix in a cup of water and drink before it gels up)

 

I'm adding to this list based on experience.

You might need a potassium or magnesium supplement. Have your GP do a blood test to test your sodium, potassium, and magnesium levels. You want to be careful about getting dehydrated because you can wind up with acute kidney injury, and that can turn into chronic kidney disease. That is what happened to me. Now I have stage 3 CKD. It is scary to have that. If you feel you are dehydrated, they can tell in the ER with a simple blood test. They can check your levels and your kidneys that way and tell you if you are dehydrated. Then they can give you fluids intravenously if need be. I have had to have that done before, for 4 days once. I was very sick. When I had acute kidney injury, I was in the hospital for about a week and a half. They pumped me full of fluids and kept telling me to drink things as well as the IV fluids. It was scary. You don't want to mess with dehydration. Try some of the solutions mentioned above. Also, you can try Gfit. It's a low-sugar, low-carb electrolyte drink. It also provides some vitamins. There are several electrolyte drinks out there. Pedialyte is a good one. You can get it in powder you add to water, you can get it already mixed up in a bottle, and you can get it in freezable ice pops. The ice pops are good because you are not guzzling liquid that will just come out your ostomy. Sipping throughout the day is better than guzzling a whole bottle of water all at once. Sip often, but don't guzzle. Carry a bottle of drink with you wherever you go. Don't drink caffeinated beverages; they will dehydrate you more. So, decaf coffee and tea if you must drink coffee. Herbal tea. Electrolyte drinks. And don't hesitate to go to the ER if you need to, no matter what they say. Have them do a blood test. Check your levels. Have your GP check your sodium, potassium, and magnesium levels. Find out what is going on in your body. Then you will know where to go from there.

Less water, more:

V-8 Juice, Powerade Zero, Gatorade Zero, Liquid IV, or any of the many other good powdered water additives that provide electrolytes, milk, coconut water. Snack on Fritos, pretzels, potato chips, or other salty items. Add one teaspoon of bicarbonate of soda to a teaspoon of water daily and drink.

Suggest you check out a product called H2ORS.  It’s my go to especially living in Florida.

Suggest you check out a product called H2ORS. It's my go-to, especially living in Florida.

Have a read all about Coconut Water. IGGIE

I have had my ileostomy for 15 months, and that was one of the many complications post-op. March 30, 2024, was my last hospital discharge. I opted for a line to give myself 1 liter of IV fluids 3 times a week. Some of my medications have been changed to lower doses. I have learned to add half a banana and possibly oatmeal later in the day.

 

 

We actually found pretzels with extra salt for my husband because his sodium levels would drop. Food with sodium is absorbed better than sodium tablets. 

Plain ol' water is the best hydrating juice. Plenty of it. Drink a gallon a day. You can add flavoring if you don't like plain water. Some say Gatorade, but it would add to your waistline, so drink that on occasion only.

What does your MD advise? If not a medical issue, you need a hydration plan. I used to dehydrate while hiking, before surgery. Finally got kidney stones. You need a hydration mix and drink 64 oz a day. Small sips, as gulping just fills your pouch. Pedialyte is popular. My dietician has me mix 25-30% Gatorade to water. Quick and easy to do.

Like Fierce Grape but will use Orange (Caitlin Clarks's fav).

Beware of excess salt; it raises BP. Potassium is safer than sodium. Salt in liquid is the easiest to absorb. The villi in your small bowel use it to absorb nutrients; the rest goes into the pouch.

Actually, orange juice and milk, according to Google, are the best hydration fluids.

I started drinking coconut water, especially after playing pickleball and getting hot and sweaty, and it helps a lot!

G-Day Supreme, I agreed with you the other day on your opening information and I said I agree with you 100%. But I do not agree with you this time. Drinking plain water only will wash out your electrolytes and you will be in trouble. Ileostomies more so need electrolytes. Not with every drink but a couple of times a day. Regards, IGGIE

Totally agree! As they say…been there, done that…overwatered (per doc's suggestion) then was told to “stop drinking so much water; it has flushed your sodium levels.” Per the Google-god…The general rule is to drink one ounce of water for every 2 pounds of body weight…Conclusion: everyone is different…this site has been so helpful to me in terms of information, but as with all decisions we must make…gather information, then use your own good judgment in ALL decision-making…just sayin'…jb