chronic diarrhoea every time I eat a meal

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cathytoss
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by cathytoss on Sat Jul 13, 2013 11:11 pm

chronic diarrhoea every time I eat a meal

hello! tapping on my phone, but I will try to keep the mistakes to a minimum... I've had diarrhoea for about five years now. sadly, I don't mean on and off. I mean every go. if I eat more than a fistful of food in one sitting, I will need to have a bowel movement within twenty mins to an hour. it will be liquid, it will be explosive and I will have about thirty seconds from the time I feel it to the time I need to be on the toilet. I just typed a bit more, but it was too long for the entry field. can you help? kind regards, me

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Dr Anton Emmanuel
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by Dr Anton Emmanuel on Sun Jul 14, 2013 9:37 am

Re: chronic diarrhoea every time I eat a meal

Sorry to hear of this very limiting symptom.

It is a normal response to get gut contractions after a meal, and many healthy individuals have an urge to have a bowel action after a meal. However, this should not be a loose motion necessarily, and you should not have such urgency that you worry you may not make it to the toilet in time.

This needs to be assessed by a health professional. It may be more than your diet that needs addressing - not to find a worrisome cause (which is very unlikely if the diarrhoea has been chronic), but rather to understand if there is a problem with control mechanisms or gut inflammation. So, before reaching for the loperamide in advance of every meal, do seek help.

Best wishes

cathytoss
Posts: 12
Joined: Fri Jul 12, 2013 12:27 pm
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by cathytoss on Sun Jul 14, 2013 11:47 am

Re: chronic diarrhoea every time I eat a meal

Hello! I'm on the computer now, so can tap a bit better.
I've been discharged by the gastro after them working for four years on it. I can't use loperamide, binders, or anything else they were able to prescribe for me (most of the time i either vomited or it didn't work or there were worse side effects, or all three). I've had a colonoscopy. I've seen the dietician (result is that apples make me gassy, do not eat). As far as i understand from the tests they've done, there is no inflammation, except that expected from a gut that goes through what mine does. They've never mentioned 'control mechanism'. i know gastrocolic reflex is a normal thing, but mine seems to have gone haywire!
I did see a colorectal consultant and had some biofeedback early on, which i think is the thing that most often saves me from total embarrassment. I usually just don't eat if i'm going out of the house for any stretch. The one medicine that seems to help (gives me a coupla minutes to get to a toilet) is lomotil, which is currently unavailable in licensed form, apparently. i was on codeine regularly for ages, but i need my brain back, and have also been suffering from migraines and cluster headaches (sez the neurologist), so codeine is a no no to prevent reflex headaches.
Other symptoms that i have are tachycardia, palpitations, quite low blood pressure, lots of nearly fainting, total lack of energy most of the time, much muscle pain, a back spasm mid-back usually on the right hand side every morning, and now sometimes during the day, tinnitus, light sensitivity. i'm not sure what is cause and effect (i'm sure my energy levels are going to be a bit bad due to long stretches of not eating!), but i would really like to be able to manage some of these symptoms, to be able to get out of the house regularly, to get back to work, to enjoy life again. I've got a five year old, and i'm not being a very good example for him! i've been told lots of times that there is 'nothing sinister', but that only reassures me i'm not going to die from anything. it doesn't make anything manageable. So! Do you have any managing tips? or ideas of what the collection of things might be?
kind regards

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Dr Anton Emmanuel
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by Dr Anton Emmanuel on Sun Jul 14, 2013 12:20 pm

Re: chronic diarrhoea every time I eat a meal

Thanks - very helpful to have the extra information.

One thing is to be sure that the anorectal control mechanism is not at least part of the problem (especially as you have had a child, and labour is a common cause of this problem). If lomotil has been helpful, this suggests a degree of abnormal motility. One other diagnostic possibility is bile acid malabsorption.

Finally, there is a bit of evidence that a low FODMAPs diet can improve bloating and diarrhoea.

cathytoss
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Joined: Fri Jul 12, 2013 12:27 pm
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by cathytoss on Sun Jul 14, 2013 10:10 pm

Re: chronic diarrhoea every time I eat a meal

Urgle. sorry, i don't always remember everything that's happened. Before I had the biofeedback, i had a ... test... can't remember what it was called, but it was to show what the muscles were like, to see if anything had ripped or torn. I had an open episiotomy wound for about three years following our son's birth, and the diarrhoea by the time i saw him, and the gynie surgeon suggested i go to colorectal to see if there was any connectors or fistulas or any colorectal surgery needed (they would have done it at the same time). Colorectal found me structurally okay. The first thing the dietician did was say FODMAP for eight weeks. I did it, and found out that apples do me wrong, but for gas, and there was no change to the diarrhoea.
I also had a bile salt malabsorption test, the SeHCAT, and was found to have mild to moderate bile salt malabsorption. but, the gastro said that it was not a diagnostic test, and that because the sequestrants had no effect, or made me ill, the malabsorption could not be causing the diarrhoea.
I was then referred to health psychology, which has been useful to certain aspects of this all, like trying to keep my self esteem up and depression down, etc. but, diarrhoea? no change. four years, no change.
kind regards, cath tyler

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Dr Anton Emmanuel
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by Dr Anton Emmanuel on Mon Jul 15, 2013 7:43 pm

Re: chronic diarrhoea every time I eat a meal

Thanks - you have been through the mill.

I think since the bile acid malabsorption has been demonstrated it is the one thing worth pursuing - there are newer, better tolerated and more effective, sequestrants.

If there is no colonic cause of loose stools, then it may be a control issue still, worth looking at repeating the anorectal physiology studies with a view to possibly considering sacral nerve stimulation.

cathytoss
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Joined: Fri Jul 12, 2013 12:27 pm
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by cathytoss on Tue Jul 16, 2013 1:35 pm

Re: chronic diarrhoea every time I eat a meal

thank you very much! i will consult with my gp (gastro has discharged me in frustration). Can you suggest a particular sequestrant? I've had cholestyramine, colesevelam, and colestipol. I'll work on that first, and then ask about retesting at colorectal. thanks for hanging on through the storm! kind regards, cathytoss

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