Why It’s Important to Stay Hydrated if You Have Crohn’s

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.

Not only can dehydration worsen your Crohn’s symptoms, but Crohn’s can also increase the risk of dehydration, which can cause headaches, constipation, muscle cramps, and dizziness. In severe cases, dehydration can even have life-threatening health effects.

The good news: It’s usually possible to avoid dehydration, as long as you’re aware of what can cause it and are drinking enough of the right fluids. The not-so-great news: If you have Crohn’s, you may need to work harder to stay hydrated than most 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.

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 physician at University of Colorado Hospital’s Digestive Health Center and an assistant professor at CU School of Medicine.

Even if you aren’t experiencing diarrhea, you can still be at risk for dehydration. “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 with Crohn’s who’ve had a portion of their gastrointestinal (GI) tract removed are also at increased risk for dehydration. Both your small intestine and colon “absorb some of the fluid that you drink,” explains Ashwin Ananthakrishnan, MBBS, a gastroenterologist at Massachusetts General Hospital in Boston. If your GI tract isn’t absorbing as much fluid, more liquid is lost in your stool, which 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 or diuretic drugs
• High alcohol intake

Dehydration is also an immediate risk for people with Crohn’s who have an ileostomy. 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, a 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 and, in my opinion, GI symptoms as well.”

The most widely recognized early signs of dehydration include:

• Thirst or dry mouth If you experience “constant thirst, feeling like you’re not satisfying that thirst no matter how much you drink,” Click says, then you’re probably dehydrated.
• Headache or light-headedness “If you feel dizzy, light-headed, like you’re going to pass out” or have a headache in combination with a potential cause of fluid loss, 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 you’re passing less urine than usual, this points to dehydration.

Signs of more serious dehydration that require prompt medical attention may include:

• Muscle cramps
• Pale, dry skin
• Sunken eyes

Severe, life-threatening dehydration that requires emergency treatment may include:

• 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…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. For older people, dehydration can cause additional problems: A 2020 study published in the Journal of Gerontological Nursing found that dehydration was linked to an increase in falls and adverse medication effects.

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 the 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, chances are you’re well hydrated. A 2020 study published in Frontiers in Nutrition found that the longer the body is deprived of water, the darker the urine, with the greatest levels of dehydration causing a green hue.

Carry a beverage with you. It’s important to drink about two liters (eight cups) 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,” says Click. “Even if they think they’re just going 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 problems staying hydrated, beverages need to contain electrolytes for optimal hydration, Ananthakrishnan notes. You can buy oral rehydration solutions that are electrolyte balanced; some sports drinks 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 potassium and sodium, which often means consuming more potassium-rich fruits and vegetables. Sources of potassium include bananas, raisins, spinach, salmon, tomatoes, and more.

Avoid excess sugar. Soft drinks, juices, and sports drinks with too much sugar can actually worsen GI fluid loss, according to Click. Check product labels, and reach for beverages with as little sugar as possible.

Avoid alcohol. Alcoholic beverages can lead to a 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 makes you urinate more, so they won’t be as effective as noncaffeinated drinks.

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 beverages that contain electrolytes if you’re losing moisture through sweating, 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.”