Exercising and hydrating occurs differently for ostomy patients. The interruption of the colon restricts water absorption only to the small intestine (duodenum, jejunum and ileum), which partially absorbs water to maintains the ostomate hydrated. Thus, finding balance between hydration and exercise is delicate, especially for patients with colostomies or ileostomies who practice sports or exercise to cope their condition.
“A number of studies have demonstrated that lifestyle may be an important target to improve outcomes for people with a stoma. Lifestyle factors, such as diet, physical activity (PA) and smoking, have been associated with stoma-related complications, and are considered important for overall health, well-being, and mortality. However, studies with colorectal cancer survivors suggest that the presence of a stoma is associated with a decrease in PA after diagnosis, and with less favorable lifestyle behaviors. Similarly, a recent survey of 2631 people with a stoma found reductions in PA following stoma formation but did not explore whether other health behaviors also deteriorate. A stoma has also been identified as a barrier to improving health behaviors, highlighting a need for targeted interventions that address stoma-related concerns associated with health behaviors. In particular, previous research has found that patients report a fear of exercise after stoma surgery, with fears of developing a parastomal hernia representing a major barrier for this group.”1
Using an Ostomy for Intake Purposes
“An ostomy is a surgical creation of an abdominal opening that enables a connection from an internal organ (such as the intestine) to the skin surface. In many cases, the purpose is to allow the elimination of bodily waste products, such as feces. However, if higher up in the gastrointestinal (GI) tract, an ostomy can be used for intake purposes as well (i.e., feeding). The opening of the ostomy on the skin is called a stoma, a term of Greek origin, meaning “mouth.” For gastrostomies and jejunostomies, the stoma, indeed, often functions as a mouth so that a person can receive nutrients that they wouldn’t otherwise be able to eat or drink. For other ostomies, usually, in the lower parts of the GI tract, such as ileostomies and colostomies, the stoma effectively functions as an anus, requiring many people with these types of ostomies to wear special types of pouches to hold waste.”2
Ostomy and Dehydration
As ostomates, patients are susceptible to excessive liquid loss. Physical activity heightens this fact, hydration during sports is critical. Hydration is key for both physical health and overall performance. “You should also be drinking 10 to 12 glasses of fluid every day unless your doctor tells you otherwise. Since you no longer have a large intestine to absorb water and fluids are lost through your stoma, you need to help your body hydrate. More fluids are essential so that you don’t become dehydrated. However, sugary beverages such as fruit juice and soda should be limited because they cause intake to pass rapidly through the intestine and may lead to dehydration.”3
Dehydration makes your blood thicker and less efficient to transport oxygen. Muscles wear out faster and your performance decreases. Dehydration diminishes the capacity to sweat, inducing overheating and poor performance. Exercising while dehydrated may cause heat exhaustion (fall in blood pressure accompanied by dizziness and nausea). These circumstances may induce heat strokes, seizures, coma, or death.
“The large intestine does not play a major part in absorbing nutrition; although it absorbs some minerals, notably salt. Its main job is to extract water from waste coming from the small intestine. If all or much of the large intestine is removed, the patient loses this natural ‘rehydrator’ and can be at risk for dehydration. Therefore, dehydration affects ileostomies more than any other type of ostomy. Thirst is not always an accurate measure of your body’s needs; those with ileostomies should develop the habit of drinking water throughout the day. (8 to 10 glasses per day is recommended.)
- Mild Dehydration: (increase fluid intake — and for babies, call a medical professional): Thirst, dry lips, dry mouth, flushed skin, fatigue, irritability, headache, urine begins to darken in color, urine output decreases.
- Moderate Dehydration: (call a medical professional): All of the signs of mild dehydration, plus: skin doesn’t bounce back quickly when pressed, very dry mouth, sunken eyes, (in infant – sunken fontanel, the soft spot on the head), output of urine will be limited and colour of urine will be dark yellow, cramps, stiff and/or painful joints, severe irritability, fatigue, severe headache, and increased heart rate.
- Severe Dehydration: (call emergency number): All of the signs of mild and moderate dehydration, plus: blue lips, blotchy skin, confusion, lethargy, cold hands and feet, rapid breathing, rapid and weak pulse, low blood pressure, dizziness, fainting, high fever, inability to pee or cry tears, disinterest in drinking fluid”4
“Dehydration happens when your body loses too much fluid. This might happen when you do not drink enough water or you lose large amounts of fluids from your ostomy. Dehydration is one of the most common reasons to return to the hospital after surgery and can be life-threatening. After discharge from your operation, it is a good idea to record your liquid intake and urine output each day until your first clinic appointment after surgery.
How should I measure intake?
All liquids should be recorded in “cc” or “ml”, which are the same amount (1cc is equal to 1 ml).
- To convert an ounce (oz.) to a “cc” or “ml”, multiply the number of ounces by 30 (1 ounce is equal 30 cc/ml). You can also google: “convert xx oz to ml” to help with the calculation.
- Look for the number of cc, ml, or ounces on the containers of drinks you buy at the store.
- Drink 1500 ml more than ostomy output every day.
- Best drink choices are: Gatorade or sports drinks, Juices, Tea (non-caffeine drinks only), Protein drinks such as: Boost, Ensure or Carnation instant shakes.
What are the signs of dehydration?
- Feeling light-headed
- Dark yellow or amber-colored urine
- Less than 500ml of urine in 12 hours
- Ostomy output greater than 1500 ml in 24 hours
If you feel any signs of dehydration, you need to drink more fluid and call the surgery clinic immediately.”5
You need to know your body and understand what your specific situation entails. It’s a good approach to discuss your exercise program with an ostomy health professional to determine the fluid intake recommended before, during, and after your routine.
“Unless your favorite hobby is a contact sport with lots of potential for injury, you’ll be free to go back to the activities you enjoy after you heal from ostomy surgery. The main danger is an injury to the opening where waste or urine leaves your body (stoma), which means rough sports may be out.
If you want to continue these pursuits, ask your doctor or ostomy nurse about special products you can use and precautions you can take to protect your stoma during these activities.
Check with your doctor before you begin lifting weights after your surgery. You may need to wait for your surgical incision to heal before lifting weights, to reduce your risk of complications. Once you’re fully healed, your doctor or an ostomy nurse might recommend a device to support your abdomen when lifting weights.
If you’re nervous that running, swimming or other athletic activity will loosen your ostomy bag and cause a leak, use a special belt or binder to hold your ostomy bag in place. Check with your local medical supply store or look online for specialty products for active people with ostomies.”6
Recommendations for Ostomate Athletes
- As a baseline, ostomy patients may take the recommendations for non-ostomate amateur athletes. Depending on your type of ostomy you should ingest at least that much fluid.
- Normally, specialists recommend to drink either water or a sports drink (16 oz.) one hour ahead and right before your workout (one glass). Depending on exercise intensity, weather, and humidity, drink water every 10 minutes. If you are exercising vividly for less than 30 minutes, drink approximately 6 oz. of fluids every 15-20 minutes. For longer durations where there is a risk of glycogen depletion (30 minutes of vigorous exercise or more), have a sports drink containing glucose and electrolytes.
Ostomy patients must pay special attention to electrolytes, particularly those with an ileostomy. “Electrolytes refer to the normal chemicals dissolved in body fluids needed to maintain body activity. If electrolytes are out of balance, a person may become weak or ill and may need to take medications by mouth or intravenously. Electrolyte balance (especially potassium and sodium) is important. When the colon (large intestine) is removed, a greater risk for electrolyte imbalance can occur. Diarrhea, excessive perspiration and vomiting can increase this risk. A person with short bowel syndrome is at high risk. Their electrolytes should be monitored closely. Your diet should include fluids and foods rich in electrolytes.”7
- For long-lasting activities, consider eating energy bars. Once finished, have at least half a glass of water and at least two servings of juice fruit like watermelons, oranges, or grapes.
- On a hot day, after an intense session, avoid alcohol or caffeinated drinks . Instead, have water and fruit.
- Another tip is to include protein full foods to repair muscles, which helps maintain an acidic urine in urostomy patients. Beware of sugary drinks. Adding more calories than needed will just make you gain weight.
“Water is essential for every cell in the body. Water controls body temperature, serves as building material and solvent and transports nutrients. Thirst is a signal that the body needs fluids and may already be dehydrated. Daily losses must be replaced. Any liquid containing water (milk, juice, etc.) helps to meet your daily requirements. You can also get water from the food you eat. (e.g., tomatoes have a 94 percent water content). Drinking coffee or tea will decrease hydration because they increase urine and salt output. Be sure when drinking coffee or tea to increase your water consumption to counterbalance the increased loss of water.”8
“Your best plan is to stay as active as you can both before and after surgery. We suggest a simple walking program – one that focuses more on minutes rather than miles.
Week 6 and beyond: Slowly increase your minutes of walking each time and your number of times each week until you reach 30 minutes, 5–7 days of the week.”9
Fluid intake is related to the amount of fluid lost during exercise. Although each body is different, and the amount varies among individuals. To determine how much water needs to replenishment, you may compare your weight before and after exercise. Alternatively, check your urine. When it gets clear like water, the likelihood is that you are well hydrated. Remember that our thirsty alarm wears out with age. Therefore, hydrate before being thirsty. Consult a physician for any special requirements if you decide to exercise with an ostomy.
(1, 3) New Ostomy Patient Guide. Kalibjian, C. United Ostomy Association of America. 2017. https://www.ostomy.org/wp-content/uploads/2018/05/All-In-One-New-Patient-Guide_2018.pdf
(2) Smoking, alcohol consumption, diet and physical activity following stoma formation surgery, stoma-related concerns, and desire for lifestyle advice: a United Kingdom survey. Beeken, R., Haviland, J., Taylor, C., Campbell, A., Fisher, A., Grimmett, C., Ozakinci, G., Slater, S., Wilson, I. & Hubbard, G. BMC Public Health. 2019. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6913-z
(4) A Handbook for New Ostomy Patients. Vancouver Chapter of the United Ostomy Association of Canada. United Ostomy Association of Canada. 2012. http://www.ostomytoronto.ca/pdf/handbook.pdf
(5) Preventing Dehydration after Ileostomy Surgery. Reames, C. Health System, University Of Michigan. 2015. http://www.med.umich.edu/1libr/WoundAndOstomy/DehydrationPreventionAfterIleostomy.pdf
(6) Ostomy: Adapting to life after colostomy, ileostomy or urostomy. Mayo Clinic. 2018. https://www.mayoclinic.org/diseases-conditions/colon-cancer/in-depth/ostomy/art-20045825
(7, 8) Ostomy Nutrition Guide. United Ostomy Associations of America. 2017. https://www.ostomy.org/wp-content/uploads/2018/01/OstomyNutritionGuide.pdf
(9) Urostomy Patient Handbook. Theriault, J. & Walker, T. University of Michigan Comprehensive Cancer Center. 2016. http://www.med.umich.edu/cancer/files/urostomy-handbook-web.pdf