Prolonged bowel movements / Water

Hi guys,

I'm currently flaring, although since my last post I am now taking a mesalazine suppository nightly and have upped my oral mesalazine intake. This seems to have got rid of the blood (in addition with being on 20mg Pred which I'm tapering).

BUT every time I go to the toilet, blood or not, it starts off 'normal' then slowly becomes looser and eventually turns into a very watery based diarrhea. I rely on a 2mg imodium/loperamide capsule daily to combat this. Once there's no more stool, it is simply water coming out, which causes me to make many visits within a short space of time to relieve this. The thing that baffles me is that stool and water never all come in one quick movement. It's almost as if the stool is all spaced out in my colon. It takes alot of straining and effort to defecate and this normally leaves me feeling tired after.

My inflammation is limited to my rectum, so is this just symptoms of an inflamed rectum?

As I said above, I rely on immodium daily to stop diarrhea MAYBE this approach is causing constipation and the water I experience is my body naturally trying to speed things up?

Any advice or tips would be much appreciate.

Kind Regards
C

You're not on enough rectal meds for sure....but for you to have watery stool so long after a more formed one (which is probably because of the Imodium)...something needs to be increased.

You say limited to the rectum, do you know how much exactly?

I'd say to stop the Imodium. You're not on enough meds and with the symptoms you're having you shouldn't be tapering the prednisone yet.

How much did you drop from to get to the 20?

Have you had stool testing to make sure you don't have something else going on?

Are you on any probiotics? fibre supplements?

q

Sorry you are deal in with this. I too suggest ditching the Imodium and see what your poo is like after that. How quickly do you think your transit time is? How many poos are you having a day?
When did you find out how infected your rectum was? The disease may have progressed since then and you might need enemas to reach higher up if it has.
glad to hear the rectals are helping. Thats a step in the right direction!

I would try going without the Imodium for a few days and observe the change and then re-evaluate.

To me c.diff is all pain - and of course watery diarrhea.

But for 10 months I have nothing but water diarrhea. Not a single semi-formed or soft-serve type poo for almost a year!

So - could be. Def reach out to your GI about your symptoms.
Let us know if you went off the imodium and what your results were :)

Update 3rd Sept

It's now 11:30AM here and I have been fairly active since 7:30 this morning. I've been out and done some chores around the house.

Been off the loperamide 3 days and have not noticed any difference in the consistency of my stools. Still experiencing the same pattern of firm stool > Mushier stool > Water.

I first experinced these symptoms during my last flare last year. I was taking a lopermide capsule in the morning and at night - My GI specialist recommended cutting down to 1 per day as this may be a symptom due to constipation and that worked - although I may have been getting physically on the inside as I was on many other tablets at the time to try and get me out of the flare.

Is it down to this time arounds flare or is there a chance C.Diff is playing part? Is one more prone to C.Diff or bacterial infections when flaring?

It's definitely signs of rectal inflammation. I have water with the feeling of tenesmus which I would say is one of the more brutal UC symptoms.

Was in contact with my GI specialist and he prescribed me a PredFoam enema although I would like to try 4g Rectal suspensions instead for now. Awaiting prescription for those.

Hi Cactuar. Thanks for the updates!

I would at this point consider making changes to your diet, and I would also suggest adding psyllium to see if you can bulk your stool up. Add psyllium slowly over a few days or weeks and see if that makes a difference. I use the capsule form and now take 4 capsules daily.

Once you've got the psyllium on board I would experiment with diet by eliminating gluten. You need to do this for a solid 2-3 weeks to see if this is causing your diarrhea. Since you have no notable inflammation elsewhere in the large bowel, I suspect that something in the small bowel is not getting digested properly and is making things move too fast. Gluten seems like the most likely candidate IMO.

It could be lactose intolerance, but if that were true I think you'd be complaining more of gas in addition to the diarrhea. But it may be worth a shot - lactose is simple to eliminate and results are apparent within a day.

I would just go ahead and go GF. Tell yourself it's just for X weeks. Make a plan and then stick to it. If you get relief from this diarrhea you will never want to go back. If you don't, then just cross gluten off your list.

I'm sorry you got stopped up on the psyllium. Try leaving it at one scoop per day for a week or so and see what happens.

If you haven't been tested for C.diff yet then you really should get tested. C.diff can be easier to treat than a UC flare.

If you have watery diarrhea then there is a decent chance it's c.diff.

Update - 1st Oct

I saw my GI on Thursday, 25th Sept. It turns out it was transition appointment from pediatrics (childrens) to adult services at Kings College Hospital London - NHS.

So after meeting my new GI, I now have a flexible sigmoidoscopy scheduled for in the next two weeks. I have also submitted a stool sample, testing for C.Diff. Along with this I have had my normal blood tests to check how the Azathioprine is doing.

For now, I have been told to remain on the 1g Mesalazine Supps. My new GI seems confident that he will get symptoms under control quickly. After two years of disruption hopefully now I can finally look for a full-time job in full confidence and not have that feeling of "Will my disease let me do this?"