After reading all your comments about
the burning from bowel movements and the diarrhea I did some website digging and came up with this information about
bile and it's influence on burning diarrhea. Apparently, this burning diarrhea is often misdiagnosed as irritable bowel syndrome or Chrone's disease, or it may be connected with both. It appears bile acid malabsorbtion could be the problem, and the treatment is a Bile Acid Sequestrant.
Check out these links:
https://en.wikipedia.org/wiki/Bile
https://en.wikipedia.org/wiki/Bile_acid_malabsorption
https://en.wikipedia.org/wiki/Bile_acid_sequestrant
https://en.wikipedia.org/wiki/Colesevelam
Here is a quick sample of the content:
Bile acid malabsorption--------
Bile acid malabsorption is a cause of chronic diarrhea. It can result from malabsorption secondary to gastro-intestinal disease or be a primary disorder. Treatment with bile acid sequestrants is often effective.
In addition, diarrhea may be caused by excess bile salts entering the colon rather than being absorbed at the end of the small intestine (the ileum). The condition of bile acid malabsorption occurs after surgery to the ileum, in Crohn's disease, with a number of other gastro-intestinal causes, or is commonly a primary, idiopathic condition. The SeHCAT test can be used for diagnosis. Bile salt diarrhea is a side-effect of gallbladder removal. Bile acid sequestrants may reduce diarrhea in these patients.
Bile acid sequestrant ----------
The bile acid sequestrants are a group of medications used to bind certain components of bile in the gastrointestinal tract. They disrupt the enterohepatic circulation of bile acids by sequestering them and preventing their reabsorption from the gut. In general, they are classified as hypolipidemic agents, although they may be used for purposes other than lowering cholesterol. They are used in the treatment of chronic diarrhea due to bile acid malabsorption.
Diagnosis ----------
Diagnosis of bile acid malabsorption is easily and reliably made by the SeHCAT test. This nuclear medicine test involves two scans a week apart and only very limited radiation exposure. Retention of SeHCAT at 7 days is normally above 15%. Values less than 15% predict a response to bile acid sequestrants. Older methods such as fecal bile acid quantification or the 14C-glycocholic breath test are no longer in routine clinical use. The SeHCAT test measures multiple cycles of bile acid excretion and reabsorption over 7 days. This test is not licensed in the USA, and is underutilized even where it is available.[10][11]
Prevalence --------
Bile acid malabsorption is common in Crohn's disease but not always recognised. Most patients with previous ileal resection and chronic diarrhea will have abnormal SeHCAT tests and can benefit from bile acid sequestrants.
Patients with primary bile acid diarrhea are frequently misdiagnosed as having the irritable bowel syndrome as clinicians fail to recognize the condition.[10] When SeHCAT testing is performed, the diagnosis of primary bile acid diarrhea is commonly made. In a review of 18 studies of the use of SeHCAT testing in diarrhea-predominant irritable bowel syndrome patients, 32% of 1223 patients had a SeHCAT 7-day retention of less than 10%, and 80% of these reported a response to cholestyramine, a bile acid sequestrant.[13]
Estimates of the population prevalence taken from this review [13] suggest that 1% of the adult population could have primary bile acid diarrhea (Type 2 bile acid malabsorption).
Treatment----------
Bile acid sequestrants are the main agents used to treat bile acid malabsorption. Cholestyramine and colestipol in powder form have been used for many years. Unfortunately many patients find them difficult to tolerate; although the diarrhea may improve, other symptoms such as pain and bloating may worsen. Colesevelam is a tablet and some patients tolerate this more easily
Colesevelam ---------------
Trade names Welchol, Cholestagel
Colesevelam is a bile acid sequestrant administered orally. It is developed by Genzyme and marketed in the US by Daiichi Sankyo under the brand name Welchol and elsewhere by Genzyme as Cholestagel.
{Note by Cry4Help: this is actually marketed as a cholesteral reduction drug.}
Clinical use -
Colesevelam is indicated as an adjunct to diet and exercise to reduce elevated low-density lipoprotein cholesterol (LDL-C) in patients with primary hyperlipidemia as monotherapy and to improve glycemic control in adults with type 2 diabetes mellitus, including in combination with a statin. The expanded use of colesevelam in adults with type 2 diabetes mellitus is an example of drug repositioning.
Colesevelam is one of the bile-acid sequestrants, which along with niacin and the statins are the three main types of cholesterol-lowering agents. The statins are considered the first-line agents. This is because of side effects from the other two types, including bloating and constipation (bile-acid sequestrants) and skin flushing (niacin). These side effects often lead to low patient compliance.
Side effects -
In controlled clinical studies involving approximately 1,400 patients the following adverse reactions have been reported in patients treated with colesevelam. When reporting to the very common (≥ 1 / 10), common (≥ 1 / 100, 51/10), uncommon (≥ 1 / 1000, 51/100), rare (≥ 1/10.000, 51/1000) and distinction very rarely (51/10.000), including individual cases:
Investigations Common: serum triglyceride increased; Uncommon: serum transaminase increases
Nervous system disorders Common: headache
Gastrointestinal disorders Very Common: flatulence, constipation; Common: vomiting, diarrhea, dyspepsia, abdominal pain, stool abnormalities, nausea
Musculoskeletal and connective tissue disorders Uncommon: myalgia
The background incidence of flatulence and diarrhea was in patients in the same controlled clinical trials, the placebo were higher. Only constipation and dyspepsia were shown to occur in a higher percentage of patients who received Cholestagel, compared to the placebo reported. Side effects were generally mild or moderate in severity. In the application of colesevelam in combination with statins, no unexpected frequent side effects occurred.
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I suggest you review this with your doctors and see what they think.
I hope this helps someone! I haven't tried it yet but will check it out with my doctor tomorrow. She originally diagnosed Candida, which I have decided is not the problem. I will report back any success or failure.
SHORT TERM RELIEF
For immediate relief (while waiting for diagnosis and for treatment to work) I tried this and it helped:
- Avoid using Vaseline or any gels or creams in or too close around the anus to soothe it because it just makes the area so lubricated that the gel seeps into the anus and mixes with what is inside, causing more feces and bile to leak back out and spread around the area, making it burn even more. Just use water to clean yourself as described below.
- Get one or several large clean bottles with a small
opening (like an empty liquid detergent squeeze bottle or something that size) that can shoot water out in a stream when held upside down. Fill the clean bottles with plain water. Use this to rinse yourself off with cool water while sitting on the toilet rather that using too much tissue. Or use a bidet if you have one. Just use plain cool water and use however much it takes to rinse yourself as clean as you can get.
- Use a water enema ($2 at any drug store) to rinse yourself out on the inside. It takes about
10 - 40 minutes to relax into this and allow the enema to go in and come out. Take your time, and go easy. This cleans all the feces and bile from around your anus, inside and out, so the burning stops and you can rest for a few extra hours without going to the bathroom. Use the water bottle described above to rinse off while you are going to the bathroom to reduce the burning from the bile acids during this process. This process can burn and be uncomfortable inside while it is happening, but for me it felt much better as soon as I was done. This complete rinse cleaned off all the feces and bile acid so my skin could recover. I have done this a couple times and it really helped both times.
- Take Immodium or any anti-diarrhea over-the-counter medication to just stop the intestinal contractions for awhile and allow your body to rest and recover.
Post Edited (Cry4Help) : 4/24/2012 10:09:42 PM (GMT-6)