Hydration and Wound Healing
If you have recently had surgery or have a wound that is healing, this blog is for you. Be that orthopaedic or trauma surgery, a caesarean section, breast surgery, or anything else.
It is estimated that approximately two thirds of the human body is water. If we don’t drink enough fluids, or if we are losing fluid and not replacing it, then it is easy to become dehydrated.
Possible signs of dehydration can include:
- Feeling thirsty, dry mouth or lips.
- Headaches or dizziness.
- Feeling tired or lacking concentration.
- Pain when going for a wee.
- Smelly or dark coloured wee.
- Constipation
A good starting point is to monitor the colour of your wee, as per the chart below.
(https://www.open.edu/openlearn/mod/oucontent/view.php?id=72178§ion=2)
Other than this, being dehydrated can affect your mood, your energy and how your skin looks and feels.
How can I stay hydrated?
You should try to drink fluids throughout the day, for example water, diluted squash or fruit juice. A rough guide is you should aim to drink around 2 litres of fluid, or 6-8 mugs of fluid each day, (requirements vary depending on age, sex and any other medical conditions), however, if you use thirst as a guide and drink when you’re thirsty then you will likely remain well hydrated.
If you are breastfeeding, you may find that you feel even thirstier than normal, and it is important to try to add some extra to your daily fluid intake goal, aiming for around 2.5 – 3 litres a day (lllc.ca).
If you are less mobile following surgery or if you are spending a lot of time nursing a newborn baby, then have a friend or relative place drinks around the house next to your chairs / bed or wherever you tend to settle to rest or nurse your baby. Try to make a habit of having a drink whenever you sit down.
We can also get around 20% of our fluid intakes from the food we eat. Generally, a diet including a variety of fruit and vegetables is a good starting point. These foods all have a high water content so can be a good idea to include in your diet.
What does water do?
Water helps our body maintain lots of vital functions and is vital for survival. Water helps to:
- Regulate your body temperature.
- Keep the inside of your nose, mouth and eyes well lubricated.
- Protect your internal organs.
- Lubricate your joints.
- Bring oxygen and nutrients to your cells.
- Remove waste products.
- Dissolve nutrients so your body can use them.
(https://www.webmd.com/diet/foods-high-in-water)
How does this affect my wound healing?
Our skin relies on adequate hydration to stay healthy; dehydration can lead skin to become dry. Wounds need moisture to optimise healing and minimise scarring and without enough water a wound can take longer to heal, and scars can be more severe.
The stages of wound healing are:
Haemostasis – blood vessels constrict to restrict blood flow from the wound, scab begins to form.
Inflammation – an increase in fluid to the area, causing swelling. This allows repair cells to move to the wound site and damaged cells, pathogens and infection to be removed.
Proliferation – the wound is rebuilt with a mixture of collagen and an extracellular matrix. New tissues are built, and the wound contracts and the edges are pulled together. The new (granulation) tissue has an uneven texture and is usually pink or red in colour. New blood vessels are formed to ensure the new tissue has a healthy supply of nutrients. Finally, the wound is ‘resurfaced’ by cells called epithelial cells. This happens fast if wounds are kept moist and hydrated.
Maturation – This phase normally starts around 21 days after the wound is formed and lasts up to about two years when the scar reaches maturity. Collagen is remodelled and laid down in a more organised manner, and the wound closes completely. This increases the strength of the scar.
In some cases, excessive collagen formation, or increased collection of extra cellular matrix can cause a different scar appearance known as hypertrophic or keloid scars.
If you are dehydrated during this process, it will delay the blood being able to carry oxygen and nutrients to the wound, prolonging wound healing and can lead to larger scars and also allow time for infection to enter the wound.
Occasionally when a wound is healing well and you are well hydrated, the wound can weep clear fluid, known as exudate. This is normal and healthy and is your bodies way of hydrating the wound and reducing risk of infection.
Just as important is the maturation and scar forming stage of healing and maintaining moisture levels of the scar is really important to help your scar fade and flatten.
Some people have an increased likelihood of developing a thickened (hypertrophic or keloid) scar;
- A wound taking more than 2 weeks to close.
- Younger people.
- Those with darker skin.
- Hereditary history of abnormal scarring.
- Scars over joints or the breastbone.
How else can I help maintain the hydration of my scar?
The gold standard of scar care is the use of medical grade silicone. This can be as a gel, or as a sheet. Silicone is clinically proven to prevent and manage keloid and hypertrophic scars, helping them to flatten by maintaining hydration and regulating collagen synthesis. Scars lose much more moisture than normal healthy skin, the body then increases the collagen production and can lead to formation of these ‘abnormal’ scars.
The use of a silicone gel or sheet will reduce the moisture loss, so the body stops the production of collagen in the area and the scar heals flatter, more flexible, is less red and less irritated, and generally heals more quickly.
Scar massage can help with maintaining the flexibility of your scar, adding hydration with the use of a good quality oil or cream.
Products we recommend at Prime Physiotherapy and Wellbeing Services are:
Scarban silicone sheet
The silicone sheet functions as a protective layer, covering the skin. This helps the skin to better retain moisture and improves its moisture balance. The gold standard treatment for keloid scars.
NAQI Repair Oil
100% Rosa Canina Oil. This natural oil contains a very high percentage of essential fatty acids (omega 3 & 6). Use this for approximately 2-3 weeks, ideally as soon as the skin has healed or from when scar therapy begins.
NAQI Skin Optimising Oil
Follow up care. This product is a blend of nourishing oils and also contains Rosa Canina but less concentrated. Skin Optimising Oil also contains a high percentage of essential fatty acids (omega 3,6 &7) for optimal healing. This product can be used as long as required. The Skin Optimising Oil reduces the scarring and improves the barrier function of the skin.
NAQI Cica cream
NAQI Cica cream can be used as an alternative to the skin optimising oil, but in cream form. This cream contains a high percentage of essential fatty acids (omega 3,6 and 7) to reduce scarring, but also helps repair the barrier function of the skin and moisturises fragile and sensitive, often itchy skin. Can be used as long as required.