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Going Home: Part II

In this article, we will talk about dehydration, diarrhea, and infection and give you tips on how to handle these problems.

Symptoms of dehydration include:

  • Weakness
  • Dry skin, dry tongue
  • Fatigue
  • Blurred vision
  • Shortness of breath
  • Muscle cramping
  • Dizziness upon changes of position—i.e., standing from a sitting position
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What Should You Do?
Drink Gatorade, Pedialyte or sports drinks as they contain electrolytes and salts the body needs. However, be sure to read the labels of sports drinks and to check with your doctor before using them.

Measure urine and stool output with a measuring cup. Keep a record of the amounts for a 24-hour period. This information will help your doctor decide which treatment is best if your symptoms do not improve.

If symptoms continue for more than 24 hours, call your surgeon's office.

Diarrhea
Anyone can get diarrhea. For people with liquid waste output, diarrhea is an abnormal increase in the volume of waste.

  • Loop Ileostomy Output—The normal output of a loop ileostomy should not be more than emptying half a pouch-full five times a day, or half to one quart per day.
  • Number of bowel movements after Ileal J-pouch—Normally should not exceed five to six stools a day or half to one quart per day. More than this is considered diarrhea.

What You Should Do
If you feel you have a virus or generally upset stomach, use common sense remedies for 24 hours.

For instance, do not eat roughage such as salads or fresh fruits and vegetables. Avoid milk and milk products, as well as spicy, fried, or greasy foods, since these can all cause gas. Also, do not drink caffeinated beverages. Caffeine acts as a diuretic and makes you urinate more, which can contribute to dehydration.

Consume the BRAT diet: Bananas, Rice, Applesauce, and Toast.

Remember: Drink plenty of fluids—at least 8 eight ounce glasses a day. To help replace the salts the body loses from diarrhea, beverages high in sodium (i.e., bullion and added table salt) can help. To replace potassium, try drinking orange juice or eating bananas. Again, Gatorade and other sports drinks are excellent sources of salts and electrolytes.

Some over-the-counter antidiarrheals (i.e., Imodium) can often help control your diarrhea. You may take up to eight caplets a day or two to four teaspoons four times a day of the liquid Imodium.

Note: Since Imodium is an over-the-counter medicine, some insurance companies will not pay for it.

Most patients with ileal J-pouch anal anastomosis surgery will need to take two Lomotil or Imodium pills four times a day (before meals and at bedtime).

Following ileostomy closure—until the pouch stretches and the number of bowel movements decrease—most patients will need to continue taking these medicines for at least six months.

Sometimes bulking agents such as Citrucel can thicken the stool and slow the volume. In this case, mix Citrucel with 4 ounces of water. Be sure to wait 30 minutes before drinking anything else. Citrucel may be taken up to four times a day.

If you continue to have symptoms of dehydration, your stool output remains above one quart, or if your urine volume is less than a quart, call your physician.

Infection
Generally, for people who are otherwise healthy, infections are considered the most common potential risks. They may include:

  • Wound infections
  • Pneumonia
  • Intra-abdominal infections if the surgery doesn't heal properly

What Should You Do?
Call your doctor if you have a temperature above 101.5 F.

If you have pain on urination, foul smelling urine or blood in your urine, call your doctor, you may have a bladder infection.

Watch the incision for any excessive drainage, odor or redness. Be sure to have the home health nurse check your incision, if in doubt. He or she will notify your surgeon if something is wrong.

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