Ileostomy and Dehydration After Stopping Loperamide

If you were taking Loperamide and stopped, did you have problems with dehydration? We stopped due to resuming a diet of regular food after two years on a feeding tube. I thought maybe Loperamide was no longer needed, but we're having low blood pressure, kidney issues, and I'm thinking fluid loss might be part of it. If you've been through something similar, please let me know how you handled it. Thank you! It's my wife's ileostomy, by the way.

The short answer is... yes.

Why would you stop? You are correct—loss of fluids is doing it.

In my humble opinion, you need the loperamide. It builds bulk. And you need to figure out how much of a dosage you need by trial and error. You must always hydrate with a mix of fluids throughout the day. I do believe the tablets affect hydration in some mechanical way.

As an ileo myself, I have suffered dehydration. You lose nutrients too fast—output liquid. I use Imodium tablets. This requires water intake daily and slows down the rapid output.

Cause and effect going on here.

Some foods will help bulk you up. It doesn't seem to be helping in your wife's case. Supplementing with the tablets will help.

No, I didn't. I have loose output now but not high output. Has your surgeon given you any advice and told you not to take them? I would contact your doctor for professional advice urgently. I would start measuring your output in a jug. I know it sounds gross, but it's the best way to see if you have high output. You may need to take more than just Imodium if you do have it. I say measure in a jug as the first thing a doctor would say if you said you empty your bag, for instance, 20 times a day is that doesn't mean high output; you could be emptying your bag when it's only a quarter full.

Hi Walter, I would add some salt to the diet unless not recommended by a doctor.

For those with an ostomy, it's not just how much you drink or what medications you start or stop; it's also about what you drink. Do you drink electrolyte beverages? You can find some with pretty low sugar that still have things your body needs, like sodium and vitamins and stuff. GFit is a good one. Has stopping that medication caused you to have more liquid output and at higher volumes? If so, that is where you may be getting dehydrated. It's okay to take Imodium even if you are eating a regular diet now. I took it for a couple of years when I was eating a regular diet. It helped me manage output. But like I said, it's as much about what you are drinking as it is about how much.

Living with Your Ostomy | Hollister

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Here are some rehydration recipes that I received from the hospital where I got my ileostomy.

Hmmm, funny they want you to add more salt to Gatorade 🤣 ...nice tips, though. Thanks for sharing.

The additional salt increases the water retention, which you need if you are really dehydrated. You don't need to do this on a regular basis - i.e., just trying to stay hydrated.

Stopping loperamide was probably not a good idea. You should restart it since it can slow motility. Glad to see no more feeding tube. Learning what you can eat takes time. Certain foods increase flow while there are other foods that slow down flow.

Foods that help reduce flow:
    • cheese, cheesecake
    • smooth nut butters
    • pretzels
    • white rice
    • tapioca
    • matzo
    • water crackers
    • marshmallows and Jell-O
    • bananas
    • applesauce
    • oatmeal.

Foods that may increase flow:
    • apple juice
    • fried foods
    • fructose-sweetened drinks
    • sugar-free candies, often sweetened with sugar alcohols such as sorbitol and mannitol

These are just suggestions; you will have to experiment to see what works for you. Until you better understand how certain foods affect your output, you should keep a diary of the foods you eat and their effects on your output. There are mobile apps you can use. Two I have used are "mySymptoms" and "My Ostomy Journey".

To thicken stool and consistency, slowly increase the amount of soluble fiber in your diet. Soluble fiber decreases the movement of food through the GI tract. This leads to more substantial water reabsorption by the intestine, resulting in a thicker, more formed stool. On the other hand, insoluble fiber increases the passage of food through the intestinal tract, decreasing the opportunity for absorption.

Soluble fiber:
Adding soluble fiber to meals can increase its effectiveness.
    • oat products (oatmeal, oat bran)
    • barley
    • tapioca
    • pectin
    • banana flakes
    • legumes (cooked/canned chickpeas, kidney beans, and lentils with skins peeled off)

An ORS is better than water for treating dehydration. Some of the preferred commercial ORS (Oral Rehydration Solution) products on the market include:
    • CeraLyte 70 or CeraLyte 90.
    • Drip Drop.
    • EquaLyte.
    • Hydralyte Electrolyte Oral Solution.
    • Liquid IV Hydration.
    • Parent's Choice Pediatric Electrolyte.
    • Fluid Tactical ORS
    • Pedialyte.
    • Rehydralyte.
    • Trioral (Reduced Osmolarity ORS).
    • WHO packets — Jianas Brother.

The following are the ones I am more familiar with:
    • Fluid Tactical ORS
    • DripDrop
    • Liquid IV
    • Trioral ORS

Fluid Tactical is specifically formulated for intense physical activity and boasts a higher electrolyte content, including magnesium and zinc.
    ■ Each packet contains 816 mg of sodium, 370 mg potassium, 100 mg magnesium, and contains 25% daily value of Vitamin C and zinc.
    ■ The formulation aligns with World Health Organization (WHO) guidelines for effective rehydration.
    ■ Uses sodium citrate instead of sodium chloride — sodium citrate is used for better taste and reduced stomach irritation.
    ■ Available in many different flavors

DripDrop is a medically formulated oral rehydration solution (ORS) designed to treat mild to moderate dehydration effectively.
    ■ Each packet contains 700 mg of sodium, 410 mg potassium, 90 mg magnesium, 3 mg zinc, 7 g glucose, and 70 mg Vitamin C
    ■ B vitamins (in DripDrop Zero): includes B3 (Niacin), B5 (Pantothenic Acid), B6 (Pyridoxine), and B12 (Cobalamin)
    ■ Available in different flavors and a sugar-free version

Liquid I.V. is a consumer product designed for everyday hydration. Liquid I.V. is effective for mild dehydration.
    ■ Each packet contains 500 mg of sodium, 370 mg potassium, 500 mg Vitamin C, 20 mg Vitamin B3 (Niacin), 10 mg Vitamin B5 (Pantothenic Acid), 2 mg Vitamin B6, and 6 mcg Vitamin B12
    ■ The exact amounts can vary slightly between different Liquid I.V. flavors and product lines (like their "Hydration Multiplier" vs. "Sugar-Free" versions).

Trioral ORS follows the WHO's recommended formulation for ORS. This is significant because the WHO formula is based on extensive research and is considered the gold standard for treating dehydration due to diarrhea.
    ■ Each packet contains 13.5 g of glucose anhydrous, 2.9 g trisodium citrate dehydrate, 2.6 g sodium chloride, and 1.5 g potassium chloride
    ■ Trioral is primarily focused on rehydration, especially in cases of dehydration due to diarrhea, vomiting, or excessive sweating.
    ■ Because it doesn't contain any artificial flavors or sweeteners, Trioral has a more neutral or slightly salty taste.

    ■ Compared to commercial ORS (e.g., Liquid I.V., DripDrop): Trioral is generally more focused on basic rehydration using the WHO formula, while some commercial ORS may include additional ingredients like vitamins, minerals (magnesium, zinc), or flavorings.