Why Hydration Matters (SO MUCH) when you have an Ileostomy

By Sarah Russell

On average, a person loses around 2.5 litres of fluid per day through sweat, urine, breath and faeces. Stoma bag wearers lose an additional 800ml – 1000ml of fluid through their ostomy. That’s a whole litre of extra fluid loss every day.

Research estimates that 80% of British people don’t drink enough fluid to maintain good health, leaving themselves chronically dehydrated. There’s a good chance, therefore, that when somebody undergoes stoma surgery, they are already dehydrated. The additional fluid loss of a stoma must surely exacerbate the problem. I suspect that most people with ileostomies are dehydrated without knowing it.

Hydration with a Stoma

Having a stoma myself, I know how hard it can be to stay hydrated. I have a high output, losing around 1200ml – 1500ml per day through my ileostomy, although I’ve never properly measured it! Sometimes, I feel that I am constantly monitoring my hydration. It’s become a running joke that I always have a bottle with me, even for a 10 minute car journey or short walk. Nowadays, I’m an expert on which bottles won’t leak in my bag and will fit into the cup holder in my car. I am also a runner, so I have an extensive collection of hydration backpacks. Some women are obsessed with shoes – I’m obsessed with hydration backpacks.

I’ve learnt from experience that I can’t take shortcuts to hydration. My vigilant approach allows me to live the active lifestyle that I enjoy. Maintaining my hydration is a daily task, and a small lapse can cause me serious problems. If I spend a day in an air-conditioned office, I’ll be dehydrated the following day. I was once hospitalised when a bout of flu left me requiring fluids through an IV, whereas somebody without a stoma could probably have shrugged it off.

Even a small amount of alcohol can dehydrate me, so I don’t drink. It’s a choice that I make for my own wellbeing and I don’t find that it causes any problem. Sometimes my husband fills a wine glass with my electrolyte fluid as a joke.

After my ileostomy, my surgeon advised me to drink Lucozade Sport. This is the case for many stoma patients and is based on the idea that sports drinks will replace lost electrolytes and help the body absorb sodium. I used to be a running coach, so I had done some sport science training in the past. I knew from my training that those drinks were usually full of sugar. I didn’t want a drink that would make me fat and rot my teeth! My concerns were confirmed when I took a closer look at the label. The high levels of sugar and relatively low levels of electrolytes made me think that there must be a better solution.

My Personal Solution

When I coached marathon runners, I always recommended that they drink 400ml of Dioralyte, an oral rehydration solution, the night before their race. Often, people consider Dioralyte as a medicine for the sick, but I think it can have a place in every day hydration strategies. The runners were better hydrated and usually performed better as a result. My husband uses Dioralyte if he’s a bit hungover, and my running buddies use it to help rehydrate after a long race. Admittedly, the taste takes some getting used to, but it is useful.

In 2013, I ran a 100 mile stage race in the Himalayas. The altitude, high temperatures and extreme running created tough conditions to stay hydrated. I was the first ever participant with an ileostomy. The race doctor was a gastroenterologist from Delhi hospital, and he told me he never thought he’d see someone with a stoma complete the race. I know that it wouldn’t have been possible without such a robust hydration strategy, including the use of oral rehydration solutions (which happen to be sold extensively in India!).

So, I admit, I might be a little obsessive about hydration, but it keeps me healthy, out of hospital and able to take part in my crazy running events.

If you have a stoma, it’s very likely that you’re not hydrated enough. That headache, and those feelings of fatigue and grogginess, may well be linked to not drinking enough. It does take some experimenting and you’ll need some dedication, but if you can get on top of your hydration, you’ll likely feel healthier and more energised.