Why hydration with Crohn's disease isn't just about drinking water
It's hot. Very hot. Sweltering, in fact. And when the weather is like it as at the moment, all we hear is: make sure you drink plenty of water.
However, if you have Crohn's disease, staying hydrated is far more complicated than just drinking a liter or two of water a day. In fact, for some people, purely drinking lots of water could make their dehydration risk increase. Before we begin, I am not a doctor: I'm just sharing useful resources from trusted sites.
Why are those of us with Crohn's or UC at risk of dehydration?
The reason most of us are at risk of dehydration with IBD is because of diarrhea. We lose fluid through all sorts of different ways; from sweating to going to the toilet. Since diarrhea is both more watery and more frequent than normal bowel movements, we lose more water through that too and thus are at risk of dehydration.
IBD Patients who have an ileostomy (a procedure where the patient's small bowel is diverted through an opening in the stomach) lose more fluids. It's estimated they lose loses an additional 800-1000ml per day along with the usual fluid losses the rest of us have.1
With an ileostomy, the large intestine can be removed or rested but this organ plays a really important role in helping us absorb water from our food waste so without it, it can be hard to stay dehydrated.2
The problem with just drinking water
When we're flaring, we not only flush out water through using the loo but also essential electrolytes like salt. We can replace our water through drinking it but if we're also low in these electrolytes, needlessly glugging down on lots of plain water can actually flush these electrolytes out further meaning we need to replace the electrolytes and not just water.
This is why it's sometimes recommended, especially for those with a short bowel or an ileostomy that has a high output, that you try to replace these electrolytes also. Some people aim to make sure their salt intake is higher through food or use special oral rehydration sachets; essentially a mix of water, salt, and sugar. I use Dioralyte but there are other brands.
Finding simple recipes with a balance of electrolytes
It's important to speak to your IBD team about this as they can give you a simple recipe to make up by your own solution to the right balance of electrolytes (this is really important to do). You can find a few recipes online such as the United Ostomy Association of America who suggest mixing: 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.3
The St Mark's Solution recipe usually recommended by the NHS is 20g/six-level 5ml spoonfuls glucose; 3.5g/one level 5ml spoonful salt; 2.5g/one heaped 2.5ml spoonful sodium bicarbonate. Dissolve in 1,000ml water. Keep chilled in the fridge. Flavor with a small amount of squash or cordial.4
Planning water and fluid intake
However, always seek advice from a doctor before trying them as they'll be able to tell you what your dehydration risk is and what rehydration you need.
Finally, a reminder that drinking alcohol and even a cup of tea or coffee can act as diuretics, meaning we need ever more water and fluids to replace what we lose. Bear this in mind when planning your water and fluid intake to stay as healthy as possible. If you want to know more about the signs of dehydration, then this is also a really great guide by Crohn's and Colitis UK.
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