How to cope with dehydration and IBD?

Our body is made up of 66% water.  By this level dropping by just a couple of percent our body can become dehydrated.  The lack of water with the dehydration can eventually lead to different problems such as kidney stones, muscle or joint damage.

By having Crohn's disease or Ulcerative Colitis it can sometimes increase our risk of dehydration.

Dehydration and what is it?

·         It is when our bodies do not get enough water or fluids.  This can happen by not drinking enough or when our bodies lose too much fluid e.g. through sickness or diarrhoea.

·         Dehydration can be described as mild, moderate or severe depending on how much body weight has been lost due to the loss of fluid.

·         Mild dehydration is the loss of no more than 5% of your body weight.  It carries a few risks and can be dealt with replacing lost salts and fluids.

·         Moderate dehydration is the loss of 5-9% of body weight and is more serious.  If the dehydration is ongoing (chronic) it can affect the kidney function and can lead to the development of kidney stones.  It can also be dealt with replacing salts and fluids.

·         Severe dehydration is the loss of 10%+ of body weight.  It is very serious and needs immediate treatment as it can be fatal.  You may need to go to the hospital to be put on a drip to restore the lost fluids.

·         Dehydration is very serious in children and babies as the have a low body weight and can make them more susceptible to loss of fluids.

What are the causes?

Dehydration can happen when we lose too much fluid than what we take.  We lose body fluid and salt throughout the day in sweat, tears, urine and our stools.  Usually, the water and salt content of what we eat and drink make up the loss, however we become dehydrated if the loss exceeds the intake.

The kidneys and intestine work together to try and control the level of fluid in the body.  The intestines absorb the salt and water while our kidneys try to regulate how much fluid needs to be lost through urine.  If you have a lot of diarrhoea then the kidneys cannot regulate the water/sale proportions correctly within our body.  This means when restoring the water content you may need to restore your salt at the same time.

Will I become dehydrated?

Dehydration may not be a problem for everyone with IBD. However, you may be more likely to become dehydrated if:

·         You suffer from frequent or watery diarrhoea

·         You are not drinking enough water, because, for example, you are feeling nauseous or have lost your appetite through illness

·         You are losing more than usual amounts of water and salt through your skin because you are sweating excessively e.g. hot weather, exercise, fever

·         Your urine output is too high from uncontrolled diabetes, taking diuretics e.g. caffeine

·         You have drunk too much alcohol. Alcohol is a diuretic, which increases the amount of urine you pass

·         You are suffering from gastroenteritis (a stomach or bowel infection), which can be caused by a virus or bacterial infection, or by food poisoning

·         You have had your colon removed

·         You have an ileostomy (or stoma), because output from an ileostomy contains more water than normal stool

·         You have a very short bowel as a result of extensive surgery

·         You have bile salt malabsorption. This can happen if you have Crohn’s in the ileum (the lower part of the small intestine), or you have had a resection in that area.

How will I know if I am dehydrated? 

·         Thirst is the first sign

·         Dry mouth

·         Headaches

·         Tiredness

·         Lack of energy

·         Feeling faint

·         Pass urine less than 3 or 4 times in a day

·         Dark urine

·         Constipation

Seek medical advice with any of the following symptoms:

·         Dizziness

·         Muscle cramps

·         Pale/dry skin

·         Sunken eyes

·         Confused/disorientated

·         Difficult to rouse

·         Lips turn blue

·         Breathing/pulse becomes rapid

What should I do if I become dehydrated?

To treat dehydration you will need to rehydrate your body.  Drinking plain water may not be enough as you will need to replace any essential sugars and salts as well as the water lost.

For mild and moderate dehydration you will need to increase your fluid intake and the level of the salt in your body.  You can buy over the counter rehydration salts such as, Dioralyte.  However, you can also drink water or flat coke and eat a salty snack e.g. crisps.  If this does not help and you still feel dehydrated speak to your doctor.  They might suggest making a homemade Oral Rehydration Solution (ORS).  The usual recommendation is to drink the full litre in one day, sipping it slowly to maximise the rehydrating effect.  It was developed for people with a short bowel, and may not be as useful for people with diarrhoea caused by other forms of IBD.

A similar rehydration solution can be made by dissolving eight sachets of Dioralyte in one litre of water (instead of one per 200ml). This solution then also contains potassium (an essential mineral), unlike the ORS above.

It is particularly important to check with your doctor before taking an ORS if you are diabetic. This is because both of these solutions have a high sugar content and can increase blood sugar levels if drunk very rapidly or in large amounts (more than one litre a day). Your doctor may suggest you see a dietician. You should also talk to your doctor before taking an ORS if:

·         Your ankles are swollen

·         You are taking diuretic tablets (encouraging urine production)

·         You are known to have kidney problems

·         You are taking tablets for heart or blood pressure problems.

Please seek medical help immediately if you think you have become severely dehydrated.

Oral Rehydration Solution (ORS)

3.5g (approx. one level 5ml teaspoon) table salt

2.5g (one heaped 2.5ml teaspoon) sodium bicarbonate (baking soda)

20g (6 level 5ml teaspoons) glucose or sugar

Make up to 1 litre with water. If preferred, use carbonated water and/or flavour with low sugar fruit squash. Refrigerate and drink chilled.

How can I avoid becoming dehydrated?

·      The easiest way to avoid dehydration is to make sure that you drink enough water. In the UK, to keep well hydrated, most people need to drink about two litres (about eight to ten average size glasses) of water a day. You will need more in hot weather or hotter climates, or when exercising or playing sports, when you lose more salt and water through your skin.

·         Drinks such as tea, coffee and cola will also help, but because these contain caffeine they are mild diuretics and will make you urinate more. So, such drinks are slightly less effective at rehydration.
·         Be aware of situations when you may be more likely to be susceptible to dehydration - for example when it is very hot, or you are active. Don’t wait until you feel thirsty before you start drinking extra water.
·         Sip your drinks rather than gulping them down. This will help you to avoid getting too much air into your system, which can cause discomfort.
·         A balanced diet that includes foods rich in essential body salts (potassium and sodium), such as avocado, bananas and marmite, can also help to maintain the electrolyte balance in your body.
·         Avoid drinking alcohol.

Will increasing my fluid intake make my diarrhoea worse?

If you have IBD but a normal or near normal bowel length, increasing the amount of water you drink should not worsen your diarrhoea. This is because the diarrhoea is more likely to be caused by your IBD rather than as a direct result of a failure to absorb fluid from the bowel. For the same reason, restricting how much you drink will probably not help to lessen the diarrhoea. However, it could still increase the likelihood of you becoming dehydrated.

If your diarrhoea does seem to be getting worse, and is very troublesome, anti-diarrhoeals such as loperamide (Imodium) or codeine phosphate may help. However, it is a good idea to check with your doctor or IBD team before taking these.

If you have a stoma, it is particularly important to drink enough water to keep yourself well hydrated. You may also need to add extra salt to your diet, and perhaps take an ORS. Check with your doctor first.

ORS drinks can be useful if you have a short bowel, or a high output ileostomy, but with these conditions you may also need to restrict your fluid intake to avoid dehydration. Your IBD team will tell you if this is the case, and can also help you manage your general diet and fluid intake.

Causes of Crohn's Disease

While the causes of Crohn's disease are unknown, researchers have several ideas as to what the culprit may be. One of the aspects the researchers are looking into are the fungus and bacteria which live within our digestive tract.

Causes of Crohn’s Disease

The causes of Crohn's disease are not known as of yet. Diet and stress were believed to be responsible. However, we now know that these can aggravate the disease, but they do not cause it. Researcher have suggested that a malfunctioning immune system, genetics, and environment may be factors in the development of the disease.

Immune System

A main characteristic of Crohn’s disease is chronic inflammation within the body. Inflammation is a normal immune system response to outside invaders such as viruses, bacteria, and parasites. Some researchers believe that Crohn’s disease may start as a normal response to an outside invader. Then the immune system fails to shut off the attack, resulting in chronic inflammation mainly within the digestive tract.

Another theory is that the immune system mistakes the normal bacteria of the intestinal tract for invading microorganisms and responds by attacking them instead. When your immune system attacks normal parts of your body, it is called an autoimmune disorder.  It has also been theorised that the immune system may be mistaking food for an invading organism and attacking what you eat.

Genetics and Heredity

Evidence suggests that genetics plays a large role in the development of Crohn’s disease.

According to studies, 5-20% of people with Crohn’s disease have a first-degree relative (parent, child, or sibling) with the disease. A specific gene mutation that increases the risk of Crohn’s has also been identified.

Crohn’s disease is more common in people of Northern European and Anglo-Saxon descent and is many times more common in Jewish people of European descent than it is the rest of the population. Crohn’s occurs much less in central and southern Europe and less still in South America, Asia, and Africa. It is now beginning to occur more frequently in blacks and Latin Americans living in North America. This and other evidence strongly suggests that genetics alone is not always responsible for the cause of the illness.

Environment

Crohn’s is more common in industrialised nations and in urban areas. People who live in northern climates seem to have a greater risk of developing the disease. This suggests that environmental factors such as pollution, stress, diet, and lifestyle may play a role.

Other Risk Factors

The following factors may increase your risk of developing Crohn’s disease.

Smoking

Smoking seems to contribute to the development of Crohn’s. If you have Crohn’s and smoke, your symptoms are likely to be more severe, and you are more likely to require surgery.

Age

Crohn’s can occur at any age, but most people who develop the disease are diagnosed before age 30.

Until the researchers and scientists come up with a known conclusion of what exactly causes or starts the development of the illness we cannot find a known cure.  There are many people out there that say they have found a cure for themselves which is actually not the case as they have found a method of putting themselves into remission.  Some have found an illegal way and others found a legal way.  For myself it is a combination of drugs from my gastroenterologist doctor at the hospital which had been a trial as very few doctors are known to use the combination of allopurinol and 6-mercercaptopurine due to the risks and not finding the correct dose of both medicines.

What is Crohn's Disease?

Crohn’s disease is a chronic illness which causes severe inflammation of the digestive tract.  It is known for abdominal pain, diarrhoea and affecting the persons quality of life.  It is characterised by alternating between flare ups and remissions.  It was named after the person who first described the disease back in 1932, Dr Burrill B Crohn.

Crohn’s disease is included within a larger group of illnesses known as inflammatory bowel diseases (IBD).  It can appear anywhere along the gastrointestinal tract from the lips to the anus.  However, it is mainly found in the distal small bowel and colon.  Due to it developing anywhere within the intestinal tract it can make diagnose and treatment slightly difficult.

Over time, ulcerations can develop and extend through the layers of the intestinal tract. This can cause severe complications such as:

·         Strictures (intestinal narrowing)

·         Fistulas (abnormal tunnelling)

·         Anal fissures (painful tears in the skin around the anal area)

·         Ulcers of the gastrointestinal tract

·         Malabsorption

What Causes Crohn’s Disease?

The cause of Crohn’s disease is unknown. It’s an autoimmune disorder. That means that a combination of genetics and environment cause your immune system to attack your own intestinal cells.  At the moment there is research into the different fungus and bacteria which live within our bodies in our digestive track to see if there are any differences in how they work within our body to a person who has not got Crohn’s disease.

• What about age?
Crohn’s disease most affects people between the ages of 15 and 35.  But with all the new technologies within the hospitals there are children as young as 6months old being diagnosed with Crohn’s disease and Ulcerative Colitis.

• Family History?
Those with a family history of Crohn’s disease unfortunately are at a higher risk of having the illness.  Unlike myself I happened to be the first of many generations who had been diagnosed with Crohn’s Disease.  With me having it, there is a chance of 10-15% of my children having but if they are not diagnosed with it they can be a carrier just like all the other genetic illnesses out there.

• History of Autoimmune Disorders?
If other autoimmune disorders are present within the family or within yourself (such as rheumatoid arthritis and fibromyalgia) you have a higher risk for developing Crohn’s disease.

• Race/Ethnicity?
Although people of all races have the disease, Crohn’s is found more often among people from Eastern Europe and American Jews of European descent.

Symptoms

What Are the Symptoms of Crohn’s Disease?

Symptoms of Crohn’s vary depending on the severity of the disease and the location of the inflammation. The most common symptoms, however, are severe abdominal pain, bloating and cramping during a severe episode. Other symptoms can include weight loss, diarrhoea that may or may not contain blood or mucus, fever, and fatigue.

Because it involves the immune system, symptoms of Crohn’s disease can also be found outside of the gastrointestinal tract. The disease can also include arthritis, skin rashes such as; erythema nodosum, sores inside of the mouth such as; mouth ulcers or canker sores, osteoporosis, and kidney or gallstones.

How Is Crohn’s Disease Diagnosed?

Crohn’s disease is difficult to diagnose because the symptoms can mimic many other diseases, such as a parasitic infection, diverticulitis, a common disease found in the large intestine, Coeliac disease and colon cancer. Another reason that Crohn’s is difficult to diagnose is that there is no specific blood test to identify the disease.

A doctor will consider a variety of factors in diagnosing Crohn’s disease. These include:

· History and Physical Exam

Your doctor will begin with a detailed history of your symptoms and any ask about a family history of autoimmune disorders.

· Abdominal X-ray

This is done to check for any intestinal narrowing or obstruction, which can be a medical emergency.

· Ultrasound

An ultrasound will rule out diseases of other abdominal organs such as the liver, gall bladder, or pancreas.

· CT Scan or MRI

These imaging methods are used to determine any complications of the disease such as fistulas or abscesses.

· Colonoscopy

This is the gold standard for diagnosis of Crohn’s disease. A colonoscopy enables a doctor to see the inside of the intestinal wall and remove a tissue sample for further examination.

How Is Crohn’s Disease Treated?

Due to no known cure as yet for Crohn’s disease doctors can only try to prevent complications and control inflammation. Since the disease alternates between periods of remission and flare-ups, treatment focuses on helping you avoid any flare ups. Treatment varies based on the site and severity of disease as well.

Some treatment options include:

Medications

Many different medications are used to manage Crohn’s disease. They may be used alone, or in combinations.

· Corticosteroids can be used to control inflammation and quiet the immune system. Because of the side effects of chronic use, steroids are often prescribed for a short-term during a flare-up.

· Aminosalicylates are anti-inflammatory drugs that treat mild to moderate symptoms and help keep you in remission.

· Immunosuppressive agents are prescribed to help you maintain remission by calming an over-active immune system.

· Antibiotics are prescribed to prevent and treat infection or decrease the overgrowth of bacteria in the gastrointestinal tract.

· Biologic agents are similar to drugs used in chemotherapy and are given for more severe cases. These medications may be given orally, intravenously, or by self-injection.

Surgery

Depending on the location and severity of the condition, it may be necessary to remove a diseased portion of the intestine. Unfortunately, this doesn’t cure the disease. Crohn’s is a chronic illness that often will reoccur later in life. There are also times when it is necessary to remove an ulceration or blockage in the digestive tract.

Surgery is done cautiously and every attempt is made to preserve as much intestine length as possible to avoid further complications.

Nutrition

People with Crohn’s disease are often underweight because intestinal inflammation interferes with the absorption of food. Nutritional counselling and dietary supplements may be used to try and prevent malabsorption.

Stress Management

Stress can increase the frequency and severity of flare-ups. Stress management and emotional support are important to a successful treatment plan.

Can a Crohn’s Flare-up Be Prevented?

Crohn’s flare-ups cannot be prevented. Certain lifestyle changes, however, can decrease the severity of a flare-up:

· Dietary Changes

A low fibre diet can decrease bowel frequency and help reduce diarrhoea. Many Crohn’s patients find that diarrhoea and flatulence improves by limiting gas-producing foods such as beans, cabbage, broccoli, raw fruits, and juices. Limiting dairy has also been helpful in managing the condition. A dietitian may also recommend six small, frequent meals per day instead of three large ones.

· Stress

Limiting stress and learning to manage it with exercise and relaxation techniques can help decrease symptoms.

· Smoking

Recent studies have shown that even light or occasional smoking can increase the intensity of flare-ups.

· Compliance

Patients who have Crohn’s must take their medications exactly as prescribed and follow their treatment plan in order to prevent complications and hospitalisations.

Crohn’s disease can be a lifelong challenge. Following your doctor’s advice and sticking with your diet and treatment plan can greatly improve your quality of life.