It’s hard to live in this day and age without frequently being reminded of the importance of hydration. But as important as this message may be for the general population, it’s absolutely critical when you have Crohn’s disease.
While it’s possible for dehydration to worsen your Crohn’s symptoms, the bigger concern is that your Crohn’s can lead to dehydration — with harmful effects on your overall health, including headaches, constipation, muscle cramps, and dizziness. Over time or in severe cases, dehydration can have even life-threatening health effects.
The good news is that it’s usually possible to avoid dehydration, as long as you’re aware of what can cause it and pay attention to getting enough of the right fluids. This means that people with Crohn’s may need to work harder to stay hydrated than most other people — especially if disease-related factors put you at high risk for dehydration.
Here’s how Crohn’s disease can lead to dehydration, and what you can do to make sure you’re keeping this risk as low as possible.
What is Crohn’s Disease?
Crohn’s disease is a chronic digestive disorder that causes inflammation and damage in the digestive tract.
The disease belongs to a group of conditions called inflammatory bowel diseases (IBD).
Crohn’s disease most commonly affects the end of the small intestine and the beginning of the large intestine (colon), but inflammation can occur anywhere in the digestive tract, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
How Crohn’s Disease Leads to Dehydration
Crohn’s disease contributes to dehydration in a number of ways.
“Probably the most recognized mechanism is gastrointestinal losses related to diarrhea,” says Benjamin Click, MD, a gastroenterologist at the Cleveland Clinic in Ohio. But people who experience diarrhea aren’t the only ones who have to worry about hydration.
“Sometimes oral intake can cause or worsen abdominal symptoms, so people may avoid eating or drinking accordingly, and that can lead to dehydration,” says Dr. Click. When you aren’t eating as much as you usually do, it’s easy to end up drinking less as well.
Finally, people who have had a portion of their gastrointestinal (GI) tract removed because of Crohn’s disease are at increased risk for dehydration. Both your small intestine and your colon “are important to absorb some of the fluid that you drink,” explains Ashwin Ananthakrishnan, MBBS, a gastroenterologist at Massachusetts General Hospital in Boston. “And so you lose more of it in your stool, and that contributes to dehydration.”
People with Crohn’s who fall into any of these three categories should be especially vigilant about staying hydrated, says Dr. Ananthakrishnan, but anyone can develop dehydration if the conditions are right. Other factors that can contribute to dehydration include:
- Sweating excessively during hot weather, exercise, or fever
- High urine output due to diabetes, caffeine intake, or diuretic drugs
- High alcohol intake
- Diarrhea due to stomach or bowel infection (gastroenteritis)
Dehydration is also an immediate risk for people with Crohn’s who have ileostomy formation surgery. A study published in December 2018 in the journal Diseases of the Colon & Rectum found that 2.9 percent of people who had this surgery were readmitted to the hospital within 30 days because of dehydration. Factors that increased this risk included high blood pressure, more severe disease status, older age, shorter original hospital stay, and being female.
Symptoms and Effects of Dehydration in People With Crohn’s
Most of the telltale signs of dehydration aren’t likely to be in your digestive tract, says Click. “There’s not much data directly correlating preexisting dehydration with worsening of Crohn’s symptoms,” he explains. “But it seems that dehydration probably amplifies all symptoms, from headaches to muscle pain. In my opinion, it could potentially amplify gastrointestinal symptoms as well.”
The most widely recognized early signs of dehydration include the following:
- Thirst or dry mouth
If you experience “constant thirst, feeling like you’re not satisfying that thirst no matter how much you drink,” then you’re probably dehydrated, according to Click.
- Headache or light-headedness
“If you feel dizzy, light-headed, like you’re going to pass out,” or you have a headache in combination with a potential cause of fluid loss, then this may also point to dehydration, says Ananthakrishnan.
- Feeling fatigued or faint
Dehydration commonly causes a general lack of energy, and may make you feel especially weak or unbalanced when you stand up from a seated or lying position.
- Dark urine
If your urine is a deep yellow color or if you’re passing less urine than usual, this also points to dehydration.
Signs of more serious dehydration that requires prompt medical attention may include:
- Muscle cramps
- Pale, dry skin
- Sunken eyes
Severe, life-threatening dehydration that requires emergency treatment may also cause the following symptoms:
- Confusion or disorientation
- Difficulty waking up from rest
- Bluish lips
- Rapid, shallow breathing
- Rapid pulse
Dehydration can also potentially impact your kidney function because of reduced blood volume. “If dehydration is unchecked and severe, it can affect your kidney function and cause kidney failure,” says Ananthakrishnan.
But the long-term damage of dehydration isn’t limited to your kidneys. “Every organ system needs hydration,” Click notes.
Tips to Stay Hydrated When You’re Living With Crohn’s
Even though you might not always be able to prevent dehydration, there are several steps you can take to reduce this risk.
- Monitor your fluid intake and loss.
“I think it’s important for individuals to recognize and observe their own [fluid] volume status, and make sure they’re watching how much loss from the gastrointestinal tract they’re having,” says Click. This means paying attention to both diarrhea and excessive urination, in addition to your fluid intake.
- Check your urine.
The color of your urine is usually a good way to gauge your hydration. If it’s pale yellow or clear in color, chances are you’re well hydrated.
- Carry a beverage with you.
It’s important to drink about two liters of fluids throughout the day, says Ananthakrishnan. It’s easiest to do this if you always have a beverage on hand. “I always instruct my patients to carry fluids with them wherever they go,” says Click. “Even if they think it’s just to the grocery store, that could turn into several different errands and hours later.”
- Get enough electrolytes.
While water isn’t a bad choice if you’re not having any problems staying hydrated, beverages need to contain electrolytes (a mix of certain minerals) for optimal hydration, Ananthakrishnan notes. You can buy oral rehydration solutions that are electrolyte-balanced, and some sports drinks also come close. Or you can look for a recipe to create your own electrolyte-balanced beverage.
You can also get electrolytes in a balanced diet with the right amounts of both potassium and sodium, which often means consuming more potassium-rich fruits and vegetables.
- Avoid excess sugar.
Soft drinks or sports drinks with too much sugar can actually worsen gastrointestinal fluid loss, according to Click. Check product labels, and go for beverages with as little sugar as possible.
- Avoid alcohol.
Alcoholic beverages can lead to greater loss of fluids than they supply, so avoid alcohol if you’re prone to dehydration.
- Keep caffeine under control.
While caffeinated beverages can still be hydrating, caffeine does make you urinate more, so they won’t be as hydrating as beverages without caffeine.
- Sip, don’t gulp.
“I tell this to people who are prone to dehydration,” says Click. “Gulping can lead to worsening of gastrointestinal losses,” since it can mean you’re consuming more fluids than your body can handle.
- Drink more fluids if you’re sweating a lot.
If you’re outdoors in hot weather or doing strenuous exercise, don’t wait until you feel thirsty to up your fluid intake. It may be even more important to drink electrolyte-containing beverages if you’re losing moisture through sweating than in other situations, since you lose salt and other minerals when you sweat.
Ultimately, every person with Crohn’s is different, and you’ll need to figure out what steps you do or don’t need to take to stay hydrated. What’s important is that you go through this process and make hydration a priority.
“Dehydration is very serious,” Click says. “Trying to recognize, treat, and certainly prevent it is a critical step in managing Crohn’s disease.”
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