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.