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.

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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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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?

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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.

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

Did you give yourself an IV or did someone come in?

My wife was in emergency last week for dehydration, so we hired a nurse to give us IV at home, but it cost us a ton of money. Trying to arrange home care.

Rehydration products are great; they don't have the best taste, but they can work to keep you out of the hospital. Be very careful if you are drinking large amounts of water and are still dehydrated. I found out the hard way that for those of us who have very little or no large intestine left, water is not necessarily our friend. I am confused, though, in that if you have had that many problems with hospital visits for dehydration, have you not checked back in with your stoma nurse or surgeon?

I'm trying to slow and thicken output with Imodium because I'm worried about blockage with Metamucil. I had a blockage using it while still in the hospital, and fortunately, they irrigated it right away. After 3 months, I want to try, but I am very scared.

I would be scared too - given your experience, I doubt I would try it. Some things work for some people, and some folks have had bad experiences…lessons learned…I hope you can find a resolution for your issues. Jb

I've experimented with making my own electrolyte mix to add some variety. I mix juice from half a lemon, a few tablespoons of honey, and 1/8 teaspoon of salt with 24 ounces of water. I read somewhere that citrus has a fair amount of potassium. I've also tried this with lime but might do orange next time. Sugar increases output, so it's important to keep that in mind when looking for options; at least that's what my doctor told me.

I have a PICC line for TPN and saline on days I don't have TPN. But that will end when I am weaned off the TPN and the PICC line gets removed. Insurance covers until then. A nurse visits once a week to take labs and change the dressing.

And V8 juice