H2O: Hydration

You’ve probably heard those narrators on the National Geographic specials say things like "Water gives life" or "Without water there could be no life." They’re overly dramatic, but they’re right.

It’s easier than you think to get dehydrated
We humans are more than 70% water. We begin to get dehydrated and our performance drops off with just so much as a 2% water loss. What can cause a 2% water loss? It doesn’t take much. It can happen to an athlete who’s competing, to someone who’s in bed with the flu or diarrhea, in the very hot weather, or even to someone who just doesn’t drink enough.

No water, no go....
What happens to your body when you’re dehydrated?

Your brain won’t work properly – you’ll be groggy, slow, and feel out of it
You’ll lose muscle tone
Your kidneys won’t be able to function; toxins and wastes will back up in your body, making you feel generally crummy
You’ll have trouble regulating your body temperature; you make feel overheated, or you may feel chronically cold and unable to get warm.
You’ll get constipated
Fats stored in your body won’t get used up or metabolized
You’ll think you’re hungry all the time, and so you’ll be likely to eat more
Your skin will get dry, itchy, and saggy

It’s even worse if you have a spinal cord injury
All of the things we just listed on the last page can happen to anyone who gets dehydrated. However, at least half of these problems are also things that doctors and researchers tend to worry about happening in people with spinal cord injuries – regardless of whether they’re dehydrated!

Think about it: body temperature? You’ve already heard about how hard it can be to regulate, especially if you have quadriplegia. Constipation? You’ve heard about it and probably even experienced it. Doctors and SCI survivors alike also worry about skin condition, metabolism, and kidney function. So, since all these things are worsened by dehydration it doesn’t take a rocket scientist to see that water and keeping hydrated is especially important for people who have spinal cord injuries.

Most articles you read recommend between 8 and 12 eight-ounce glasses of water a day for nondisabled people. If you’re thinking, "That’s A LOT of water," you’re right! But that’s only part of the story. Because of the benefits of constantly flushing out your kidneys and bladder, many physicians recommend EVEN MORE water for many people with spinal cord injuries. And, they also recommend greatly increasing the amount of water you drink when:

You’re exercising
The weather is warm
You’re on a high fiber diet or taking a fiber supplement. (Fiber uses up lots of water.)
You’re trying to lose weight. Some people worry that if they drink too much water they’ll get bloated. This really isn’t true – your body only stores as much water as it needs; the rest it dumps out.
You’re in a high altitude area, where the air tends to be drier and evaporation occurs faster
You’re traveling, especially in airplanes where the same air is re-circulated over and over again, which also may make the air drier.
You spend most of your time indoors, where there’s little fresh air.
You have an acute illness – like a cold or a bladder infection. Fevers, vomiting, diarrhea all cause you to lose or use up large amounts of water, which needs to be replaced.

You should have noticed that a few paragraphs back we said that physicians recommend large amounts of water for many people with spinal cord injuries. We didn’t say all people with spinal cord injuries. If you use a bladder program that involves intermittent catheterization, you may have been told to restrict your fluid intake. For sure, you should follow that advice. If you’re on one of these programs, your health care professional should have developed a plan that balances what goes in – what you drink – with what comes out – how often you catheterize yourself. It’s not a good idea to reduce how much you drink simply for the convenience of catheterizing yourself less often; this could leave you not only thirsty, but dangerously dehydrated as well. Check with your doctor first. And, if you’re on an intermittent catheterization problem and you don’t think you’re getting to take in as much fluid as you want or need, you should also check with your urologist or spinal cord injury doctor. He or she might be able to help you adjust the balance between how much you drink and how frequently you need to empty your bladder.

And, regardless of what kind of bladder management program you use, keep these points in mind:

Drinks with caffeine do not help meet your water requirements. In fact, they cause you to lose water by increasing your urine output. So, if you use caffeinated drinks, increase your water intake as well. If you drink four cups of coffee, you may need more than eight cups of water per day to make up for what the caffeine causes you to lose. If your fluid intake is restricted to begin with, you may want to avoid entirely, or at least greatly limit, caffeinated beverages. Caffeine is found in coffee, tea, colas, and some other soft drinks.
Sports drinks and juices do help you replace water, but they contain lots of calories. They’re also expensive. If you’re not a heavy-duty exerciser, sports drinks really aren’t necessary; they’re no better than plain water. And, if you’re watching your weight, they may have far more calories than you want!
Finally, know that your thirst sensation runs quite a bit slower than your body’s need for water. By the time you realize that you’re feeling thirsty, your body will already be suffering from drought. Most experts suggest that you drink before you get thirsty. If you’re exercising – even if you’re just pushing a long distance – drink water before, during, and after.

It’s no easy feat...
As one of the SCI survivors commented after reading this brochure, "It’ not going to be easy to get in 12 glasses of water a day!" That’s especially true if you need help to do it. Here are some suggestions:

Keep a water bottle with you. If you have limited hand function, maybe a large tube can be rigged connecting the bottle and your mouth.
Some people have used "Camelback" or similar water systems that they wear like a backpack.
Make it a point to drink a glass or two of water every time you empty your leg bag.
Drink before meals, when you’re hungry, rather than afterwards, when you’re already full.
Try to do most of your drinking in the morning and early afternoon so there’s time for all that water to be eliminated before bedtime.
Don’t waste your drinking efforts on things that won’t help – coffee, many teas, colas, etc. A smaller amount of water will do you more good than a larger amount of many other beverages.

Questions to ask yourself:
How do you know if you’re not getting enough water? Check off the questions that you can answer "yes" to:

Drinking enough?

____Is your skin dry? If you wrinkle it or pinch it, does it take awhile to "bounce "back"

____Is your urine dark? (It should be a light yellow in color)

____Do you get an unusually high number of bladder stones or bladder infections?

____Are you frequently constipated?

____Do you get groggy or headachy part way through the day?

____Do you have a lot of trouble staying cool – or keeping warm?

A "yes" to any one of these questions can mean you’re not getting enough water. Any of them could be lessened by taking in more fluids, especially if you think your intake hasn’t been up to snuff anyway. However, don’t kid yourself – every one of these problems or complaints can also be caused by something other than dehydration – sometimes by something very serious. While you can feel safe prescribing "extra water" for yourself, if drinking more doesn’t solve the problem – or if it’s a problem that you have pretty much all the time, regardless of how much you drink — check it out with your physician.

This is part of a library of educational brochures developed by Craig Hospital with a federal grant titled, "Marketing Health Promotion, Wellness, and Risk Information for Spinal Cord Injury Survivors in the Community. The opinions expressed here are not necessarily those of the funding agency, the National Institute on Disability and Rehabilitation Research of the US Department of Education.

For a hard copy of this brochure, click on your selection above and hit the "print" button on your browser. If you'd like to ask for one directly from Craig Hospital, you can contact us by telephone at 303-789-8202, or you can e-mail us at HealthResources@craighospital.org.