Drinking against the bag: what a 2026 scoping review says about oral rehydration solutions and the ileostomy hydration problem
Staying hydrated with an ileostomy is harder than it looks, and plain water isn't always the answer. A 2026 scoping review surveys what the evidence actually shows on using oral rehydration solutions to manage the fluid and electrolyte side of ileostomy life — and where the gaps still are.
Hydration sounds like the simplest piece of life with an ileostomy — drink water, drink more water — and it is one of the trickiest. The reason isn't a mystery, it's anatomy. With an ileostomy, the lower end of the small intestine has been brought out through the abdominal wall to release stool into a pouch, which means the colon — the part of the bowel that normally spends most of its time reclaiming water and salts — is no longer in the last stretch of the road [1]. So fluids leave faster, and they take electrolytes with them. Plain water alone doesn't always close that gap, and in some situations it can make it worse.
That is why authority guidance treats fluid and electrolyte balance — and, in certain situations, oral rehydration solutions (ORS) — as a normal part of ileostomy care, especially when output runs high. It is also why this is usually a conversation guided by the stoma team or gastroenterology service rather than a do-it-yourself project: ORS recipes vary, the timing matters, and what works for one person doesn't automatically work for another [2].
A 2026 scoping review in the Journal of Parenteral and Enteral Nutrition (JPEN) takes that practical landscape and surveys it. It looks specifically at oral rehydration solutions used for the management of fluid and electrolyte disturbances in patients with an ileostomy, and asks what the literature actually contains on how ORS is being used and studied in this exact group [3].
It is worth slowing down on what kind of review this is. A scoping review is, by design, an evidence map. It is not a meta-analysis that will tell you "ORS X reduces stoma output by Y percent." It is the kind of review that sweeps through the field and reports what evidence exists, what questions are being asked, and — usefully for honesty — where the gaps still are. The headline value here isn't a number to copy into a recipe; it is that ORS for ileostomy hydration is enough of a real clinical question for a 2026 scoping review to be worth doing, and that the review now sits as a shared reference for the clinicians and dietitians working in this space [4].
So the patient-relevant takeaway is the calm version, not the headline one. If you live with an ileostomy and dehydration shows up in your life — through high output days, light-headedness, dark urine, repeat trips to A&E for fluids — ORS is on the clinical menu. It is not new, it is not a wellness trend, and it does not require a guru. What it does require is a conversation with your stoma nurse, dietitian, or gastroenterologist about whether and when ORS belongs in your routine, in what form, and how to use it without doing harm. The 2026 scoping review is more reason for that conversation to happen, not a substitute for it.
Your clinician knows your case best — ask them first.