How To Manage Dehydration When You Have IBD

Do you find that you have trouble staying hydrated because of the signs and symptoms of inflammatory bowel disease (IBD)? Diarrhea can lead to dehydration even in healthy adults and can be a special problem when IBD causes chronic diarrhea. People with Crohn's disease and ulcerative colitis sometimes also have surgery to treat their disease, which can include the removal of some or all of the large intestine. The large intestine is where most water is absorbed, and when part or all of it is missing, less water might be absorbed by the body. This is why hydration is a special area of concern for people who have an ileostomy or have had j-pouch surgery (ileal pouch-anal anastomosis or IPAA). Dehydration is a major cause of readmission to the hospital after ileostomy surgery.

Many people turn to sports drinks as a source of hydration. There are a few different groups that developed drinks that were meant to provide hydration and energy before, during, and after exercise. The most famous of them was originally developed for use by athletes who may lose a lot of water by sweating, especially during hot weather. Dr. Robert Cade of the University of Florida, at the request of the university's assistant football coach, led a team that originally developed a drink containing electrolytes and carbohydrates. The football team went on to have a successful season while using the drink, and other colleges started asking for it. This, of course, was the start of the sports drink Gatorade.

In time, manufacturers began adding other ingredients to their drinks, including stimulants like caffeine, to create energy drinks. Most energy and sports drinks also contain artificial colors and sweeteners.

There are a few things about sports and energy drinks that make them a less than perfect choice for people with IBD who need to replenish fluids and electrolytes. The first is that they don't actually offer the right mix of nutrients: most don't contain enough electrolytes. The second is that some brands contain things that aren't needed that make them taste better (sugar or artificial sweeteners), look colorful (artificial colors), and provide a burst of energy (caffeine).

The World Health Organization has developed an oral rehydration salts (ORS) solution that is used across the world, especially in areas where severe dehydration is a cause of illness and death. Using a special combination of salts and water to rehydrate is called oral rehydration therapy (ORT), and it saves lives in areas of the world where diarrheal disease is a leading cause of death in children. ORS are available in Western countries at pharmacies, hospital supply stores, and sometimes in sporting goods stores with the first aid kits. There are also recipes for ORS that can be made at home. ORS is usually fairly inexpensive, but check with a doctor before resorting to buying it or making it at home for rehydration.

Short of keeping a supply of ORS on hand (although it's not a bad idea to keep some with your emergency supplies), how can people with a j-pouch, an ileostomy, or IBD, rehydrate at home? According to the University of Michigan IBD Team, rehydration is probably best done with a mix of a few things most people with IBD probably already have at home. The experts at U of M recommend that the sports drink is just a start.

To bring hydration up, they suggest eating and drinking the items in this "recipe" designed to mimic ORT:

• 1 liter of sports drink
• 1/2 cup of chicken soup
• One of the following:
  • 1.6 bananas
  • 1.6 sweet potatoes
  • 1.6 medium avocados
  • 1.5 cups of yogurt
  • 1 cup of spinach
• 3 1/2 tablets of 650 mg of sodium bicarbonate (or 7 325 mg tablets)

The United Ostomy Association of America also has recipes available for replacing electrolytes and fluids. This is the suggested homemade electrolyte drink:

• 1 teaspoon salt
• 1 teaspoon baking soda
• 1 teaspoon white Karo syrup
• 1 6-ounce can frozen orange juice
• Add water to make one quart, mix well

Mild cases of dehydration can usually be dealt with at home. Severe cases of dehydration may need to be treated by a physician or in a hospital. For severe dehydration, with symptoms of confusion, dizziness, or fainting, call 911. If you have more questions about how to avoid becoming dehydrated, or what you should eat or drink if you are dehydrated, ask your physician.