I was recently asked a question about cholesterol by an ostomate, and thought it a good opportunity to review it from the context of stomal surgery so that all ostomates...
When the summer months are upon us, it is a great time of year with lots of social engagements, fun and frivolity. And winter is a great time for staying indoors, keeping warm and enjoying some rest and relaxation. Both seasons bring their individual joys and pleasures. However, whether the weather is warm, cold or in-between, it is important for all ostomates to engage in one important activity – drinking!
I’m sure you’d like me to now start discussing the merits of an ice cold beer versus a good red wine, but unfortunately that is not what I am referring to (which I think you knew all along!) Instead, of course, I am referring to the health promoting activity of drinking more water to hydrate the body and facilitate a myriad of essential functions in the body.
Different parts of the gastrointestinal (GI) tract perform different functions, with the small intestine mainly digesting and absorbing nutrients from the foods that are eaten, and the large intestine (or colon) mainly absorbing water back into the body. In a person with full intestinal function who hasn’t had any stomal surgery, approximately 2.5 litres of fluid are lost from the body each day via the lungs (breathing), the skin (sweating), the kidneys (via urination) and the intestines. Of this 2.5 litres, only 100 mls is usually lost via the intestines.
However, for an ostomate who has had part of their intestinal tract removed, the amount of fluid lost from the intestine can be a lot more than 100mls depending on which part of the intestinal tract has been removed, and the consistency and quantity of the output. It is therefore imperative to replace this extra fluid on a daily basis.
For an ileostomate who has had all the large intestine removed and perhaps some of the small intestine too, the need for additional fluids is imperative. The tissue (colon) that normally performs the major function of absorbing water from the GI tract is no longer present, and output can be very loose as a result. If it is very liquid and resembles water, then it is critical to replenish this fluid frequently. However, if the output has a thicker consistency and is more like a paste, then less fluid is lost from the body and the need to replace it is not quite as great. Over time, the small intestine does begin to compensate for some of the functions of the large intestine by absorbing more water, but it takes time for this adaptation to occur.
In the case of colostomates, who may have had only a small part of the large intestine removed, the ability to absorb water may not have been affected very much and there may not be such a great need to compensate for reduced fluid absorption. However, if constipation and motility issues are a problem, then increased fluid intake can be an easy strategy to begin addressing this issue.
Hydration is very important for all ostomates, and this includes urostomates as well. A greater fluid intake is needed in this case to create a strong urinary flow that can flush out any harmful bacteria that may be lingering in the urinary tract and potentially cause infection. Extra fluid is also needed to flush out any mucous that is secreted by the intestinal tissue that was used to form the urinary conduit.
Fluid intake is usually via both moist foods (approx. 700ml) and ingested liquids (usually approximately 1600 ml per day), with around 200 ml of fluid being produced within the body itself via metabolic processes. Therefore fluid intake usually totals approximately 2.5 litres per day, which would normally equal fluid lost from the body when intestinal tissue is intact and maintain a positive fluid balance. However, as previously mentioned, if the output from the gastrointestinal tract is higher than 100 ml or a strong urinary flow is required, which is often the case for different types of ostomates, then the fluid intake needs to be much higher than this.
It is important for individuals to keep an eye on fluid intake compared to fluid losses to prevent dehydration. Some of the most common indications of negative fluid balance are dry mouth, headaches, irritability, fatigue, poor concentration, constipation and dry skin. Low blood pressure and fainting spells can also be indicative that fluid levels in the body are low.
An important fact to be aware of in order to maintain hydration is that the thirst mechanism becomes less reliable with advancing age. By this I mean that the sensation of thirst starts to weaken, and it isn’t triggered as often as it used to be. Therefore, as aging progresses, it is important not to rely on the sensation of thirst to indicate when it is necessary to consume fluid. A more useful tool can be to use a visual reminder to drink. This can take the form of a jug on the kitchen bench that is filled up each morning, and emptied by lunchtime and again in the late afternoon. That way you know you are regularly consuming an amount of fluid that will facilitate hydration. It also enables you to know how much fluid you are drinking every day. Setting a target of eight good sized glasses of water per day is also an option.
Using drink bottles can also help to provide a visual reminder to drink fluid, as well as providing a measuring tool for knowing how much fluid has been consumed. A note of caution, however – avoid consuming fluid from a drink bottle that has been left sitting in the sun or in the car on hot summer days. If the bottle heats up, there is a risk that chemicals from the plastic bottle may leach into the fluid in the bottle. These chemicals may be hazardous to health. During hot weather it can be safer to drink fluid from glass or metal containers if possible.
Another important consideration in maintaining fluid balance is that excessive amounts of fluids such as alcohol, tea and coffee may not be hydrating and fluid replenishing, but actually dehydrating and fluid depleting.
Alcohol is a potent diuretic and will increase fluid loss from the body. Caffeine is a more moderate diuretic. Approximately 1ml of fluid is lost for every 1mg of caffeine consumed. A 250 ml cup of instant coffee that contains approximately 80 mg of caffeine is therefore mainly hydrating; however a short black espresso in a tiny mug contains much more caffeine and much less water and is therefore more dehydrating. Tea contains less caffeine than coffee. The quantities of each of these fluids that are consumed on a daily basis can therefore have a considerable effect on fluid balance.
When it comes to replacing fluid in the body, water is best. For those who are not fond of the taste of water, adding some fresh lime or lemon juice, or a dash of apple, orange or pineapple juice can improve the taste a little. This can also help with absorption. Switching to herbal teas can also help to rehydrate the body. If having to get up to go to the toilet during the night is a problem, drink more fluid earlier in the day and less after 3 pm.
Fluid intake can also be boosted by eating watery foods such as watermelon, mango, juicy peaches and nectarines, and grapes. Just be aware that they may also loosen stools and therefore increase output, so keep the quantity moderate. Milk drinks and soups can also add to the total fluid intake for the day if tolerated.
I often get asked if sports drinks are appropriate for ostomates. My answer to this is yes, if you are replacing general fluid loss on a hot day, for example. However, if you are seriously dehydrated due to excessive diarrhoea for example, then oral rehydration solutions such as Hydralyte or Gastrolyte which can be purchased from the chemist might be more appropriate. But be mindful that with any of these beverages caution needs to be taken by those on a low sodium diet due to their sodium content.
In relation to hydration, an ileostomate made a very valid comment as we were talking on this subject. She said, “It’s not on the hot days over 30ºC when you are at greater risk of dehydration, because you are conscious of consuming more fluid on those days. It is when the temperature is between 25º and 30ºC that you are more likely to forget to drink extra fluid.” And she is right!
But the same can be said for the winter months. Cold weather certainly reduces the amount of fluid lost from the body via sweat, but overheated rooms can be generally drying on skin and mucous membranes, necessitating an increased fluid intake to re-hydrate them.
So my advice all year round is to drink up! Let’s toast to a positive fluid balance throughout all the seasons and better health for everyone!
Wishing you good health and happy days, – Margaret.