Ask the Doctor (Hydration & Blockages)
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Dr. Joga Ivatury Podcast Interview Transcription For 2/2/2022
Intro (0:00)
This week’s guest is Dr. Joga Ivatury.
“Ask The Doctor”
He is my Colorectal Surgeon who helped remove cancer from my pelvis and gave me my Ostomy.
Chief of Colorectal Surgery at Dell Medical School at University Of Texas Austin
I am here today because of him!
Hydration & Why Is It So Important (2:08)
Dehydration is a different problem for an Ileostomy than it is for a Colostomy.
The small intestine (Ilium) doesn’t do a lot of water absorption when you don’t have an ostomy.
Ilium does not of nutrition absorption and some water absorption but a lot of that water absorption happens within your colon.
Typically find that people with new Ileostomies end up having a 1-3 month period where they have a higher output.
Looking for 1.5 liters of output or less in a 24 hour period with an ileostomy.
6.5 cups or 50 ounces.
The small intestine is not absorbing the water until it realizes that the colon is not involved.
Depends on how much intestine you have.
Most people with just an ileostomy with no or very little small intestine removed, can live fine with normal levels of hydration a couple of months after having it
A colostomy is still similar, but you have some of that colon especially the right side that does a lot of water absorption.
May notice you have good solid stool out of that Colostomy.
Same as a system standpoint.
People with colostomy that have the majority of their colon have the same things we tell people. 8-10 glasses of water a day, good fiber.
Important to continue to just have an eye on how much comes out.
When you drink liquids and do not eat food you will find the liquids come out much quicker in the ileostomy.
Small meals and drink liquid with those meals.
Slows the time that it goes in the small intestine and has time to absorb liquids.
Drink more and stay hydrated when it’s warm.
Oral rehydration solutions.
All the same applies as people without Ostomy’s a good balance of liquids and solid foods.
How Long Does It Take For An Ileostomy to Understand That It Is Taking On More? (8:21)
Typically it’s somewhere from 6 weeks to 3 months after having a new ileostomy when that small intestine starts absorbing liquid better.
The output will be a lot less liquid and thicker.
It all depends on how much they have of their small intestines you have and surface area to absorb things.
Some people need to have more routine infusions of fluids depending on how much small intestine and the health of small intestines.
Smaller meals with Ilesomty, drink your fluids with it. Look for the consistency of thick applesauce.
Colostomy; our bodies can do a lot more but still 8-10 glasses of water minimum.
This will all depend on what your diet is like as well.
Things that can help thicken things quickly may be helpful. Banana, cheese, pasta, bread, creamy mashed potatoes, marshmallows, are helpful from a thickening standpoint if you notice you are having too much liquid output.
Supplement or Medication Tips (11:46)
People sometimes have to use things like Imodium to slow things down.
½ a tablet 30 minutes before meals and bedtime.
It helps but not enough can do 1 tablet.
Usually a short-term thing.
The best way to control it is with how you eat.
Sometimes you may find you will have high output and medication like Imodium will help.
Metamucil we use sometimes with Ilesotomys in a small amount of water helps slow things down and has fiber.
Blockages (14:20)
What are some of the things that can cause a blockage and what are some things people can do to prevent them?
Can have blockages from the inside.
Could be adhesions or scar tissue on the outside.
Could be 1 or could be both.
A hernia can push up against the Ostomy and be a reason why you get a blockage.
Some people with ileostomies that have inflammatory bowel disease are possible things within the lining that are not food that is like inflammation or scar tissue that is narrowing the channel.
A tumor or polyp.
Could be 1 or many things.
Either something on the inside, or someone kinking or pinching the bowel on the outside.
When you have symptoms of a blockage; nausea, vomiting, bloat, not enough output from ileostomy or colostomy. These kinds of symptoms are very suggestive of a blockage.
Internal blockage; can use warm fluids and time and the body can get the food debris out.
If you are passing gas but not putting out stool, you are probably just constipated. So you may be dehydrated, or your stool is hard. So you may want to take something for constipation.
If nausea, vomiting, not putting out from the Ostomy, then that’s a time you should really consider going to your primary care doctor, your colorectal surgeon, gastroenteritis, or emergency room.
Most blockages related to scar tissue, actually get better without surgery.
Cramps; Can You Use Heating Compress Around Ostomy Bag If Have Blockage (21:29)
Not directly on the tissue, but a cloth or heating pad around it.
Just no extreme temperatures right on it. But Heat will still go through the towel.
The heating pad relaxes abdominal muscles and then also heat helps break up things in your intestines as it’s trying to push out things.
May hear louder noises as a first symptom.
Coca Cola (23:29)
Carbonation and bubbles help break things up and move things along.
If you feel something starting, warm liquids, fizzy liquids are helpful.
Wrap Up (24:43)
The major thing that we see is the people that manage it the best pay attention to their bodies.
If you have an ostomy, you have a physical way to see how much is coming out of your ostomy.
Just monitor how you feel, how your body feels.
Be conscious of what your body is feeling.
A lot of things like dehydration you can prevent if you are figuring it out early.
You all know your bodies, that is the major advice I would give.
So excited to have him here on the regular for MORE questions that we will ask and get answered from Dr. Ivatury