# Diarrhea after surgery



## nogutsnoglory (Dec 13, 2011)

I'm one of the crohnies who didn't usually have D before surgery. Now out of surgery almost all my poop is diarrhea with the occasional solids. What's going on? Is this normal, temp or for life?


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## CyCrohn'sGuy (Dec 13, 2011)

Ditto.  Post surgery all my BM's are mostly very loose.  I assume its for life since I had 80 cm of large bowel removed. There simply isn't the space to form into solids.


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## DustyKat (Dec 13, 2011)

It can depend on the amount of small bowel removed, the more removed the higher the chance that it will continue for an extended period of time or for good. It is due to the lost ability to absorb bile salts and to some degree water. 

My daughter had about 70cm of bowel removed 5 years ago and it continued to be a problem for her but she has found psyllium husks works well and she now only goes once a day when she takes it. Having said that she does watch what she eats and one of the things that causes her the most problem is oil, whether it be salad or cooking. 

My son on the other hand had a little less than 30cm of small bowel removed in April and although problematic at first it seems to have taken up quite a bit since then. He originally was using psyllium at least daily but I notice he rarely uses it now. 

Dusty. xxx


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## CyCrohn'sGuy (Dec 14, 2011)

I hope they are both doing well DustyKat.


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## DustyKat (Dec 15, 2011)

They are thanks.  

Dusty. xxx


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## jess (Dec 15, 2011)

I had about 12 cm removed less than 2 months ago and have been having only D since then. I was wondering if anyone has had any luck with D medications or probiotics?


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## nogutsnoglory (Dec 16, 2011)

They gave me something to replace the bile salts or absorb them or something and said its temp.


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## CyCrohn'sGuy (Dec 16, 2011)

I've been taking Cipro and Flagyl on and off since my surgery last year (also Humira and pro-biotics) and I have not seen any difference in my BM's.


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## DustyKat (Dec 16, 2011)

nogutsnoglory said:


> They gave me something to replace the bile salts or absorb them or something and said its temp.


It would be Questran and it is to absorb bile salts. It's the inability to absorb bile salts that causes the diarrhoea. 

Dusty.


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## CyCrohn'sGuy (Dec 16, 2011)

I wonder if I should ask my GI to prescribe Questran for me...... I read online that it is very effective and the only side effect is bloating.  

If it will lessen or better still stop the dreaded D then it may also help my friendly fissure to heal (which incidentally has opened up again with a bit of a vengeance).


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## DustyKat (Dec 16, 2011)

I definitely would! Sarah was prescribed it post surgery but found it too unpalatable, she was young at the time though so wouldn't persist with it. It did work though. 

The psyllium husks she uses work by bulking the stool up, absorbing the salts and water. 

Dusty.


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## nogutsnoglory (Dec 16, 2011)

CyCrohn'sGuy said:


> I wonder if I should ask my GI to prescribe Questran for me...... I read online that it is very effective and the only side effect is bloating.
> 
> If it will lessen or better still stop the dreaded D then it may also help my friendly fissure to heal (which incidentally has opened up again with a bit of a vengeance).


I'm not having as much D but it's still soft and gooey so not sure it's working. Ask whether that or Imodium would be good?


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## DustyKat (Dec 16, 2011)

I wouldn't look so much to the consistency but rather the frequency. If the diarrhoea is reducing then it is working. There can also be room for tweaking the dose too. 

Dusty.


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## CyCrohn'sGuy (Dec 18, 2011)

Would you recommend Psyllium Husks or Questran, DustyKat? From what I understand they both carry out the same function thus assisting in the absorbtion of nutrients. 

Presumably by bulking up the stools and at the same time absorbing nutrients this would lessen frequent trips to the bathroom and ultimately also help with weight gain.

Have I understood this correctly? So many questions, such little time!!! :smile:


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## nogutsnoglory (Dec 18, 2011)

I'd be very concerned about psyllium husk if you have any inflammation
Or scarring. I think it's high fiber. What's the ratio of soluble versus insoluble?


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## CyCrohn'sGuy (Dec 21, 2011)

I spoke to my GI yesterday regarding me taking Psyllium Husks and he laughed and said that they are not designed for "people like me" only for people who are constipated.  

I told him about my online research and how they absorb salts and water therefore bulking up the stools and he replied with "ok, go ahead and try."

Now, I'm not sure what I should do.


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## nogutsnoglory (Dec 21, 2011)

CyCrohn'sGuy said:


> I spoke to my GI yesterday regarding me taking Psyllium Husks and he laughed and said that they are not designed for "people like me" only for people who are constipated.
> 
> I told him about my online research and how they absorb salts and water therefore bulking up the stools and he replied with "ok, go ahead and try."
> 
> Now, I'm not sure what I should do.


Sadly most medical professionals know nothing about diet. Most med schools do not offer even one course on nutrition.


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## DustyKat (Dec 21, 2011)

Oops, sorry I have missed this. 

Hmmmm, I think your GI may have to do some researching himself. :lol: If you have been researching it you would no doubt have found that it is indeed recommended for the take up of bile salts and water in people that have diarrhoea associated with ileal resection. Yes, it is marketed to the wider community as a remedy for constipation but has the opposite effect in those with absorption issues due to surgery. 

Sarah's GI recommended one of the more commercial brands of psyllium years ago when she found the Questran too unpalatable. Unfortunately she found it also gave her cramping and bloating, much like the prescribed medications did. It wasn't until she tried the natural husks that she hit on a winner for her. 

Either way you need to do something to improve your quality of life and to be honest you won't make a wrong decision whatever you choose. Your GI is obviously dismissive of psyllium so why not have him prescribe you Questran and start with that. 

Dusty. xxx


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## nogutsnoglory (Dec 21, 2011)

Questran is so gross. What about Metamucil?


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## DustyKat (Dec 21, 2011)

Just for your information and in Sarah's experience...Metamucil is psyllium and is one of the commercial brands that Sarah tried, unfortunately it gave her cramping and bloating, I can only assume that it has additives that the natural husks don't (((shrug))).

Dusty. xxx


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## nogutsnoglory (Dec 21, 2011)

DustyKat said:


> Just for your information and in Sarah's experience...Metamucil is psyllium and is one of the commercial brands that Sarah tried, unfortunately it gave her cramping and bloating, I can only assume that it has additives that the natural husks don't (((shrug))).
> 
> Dusty. xxx


But isn't it just soluble fiber while psyllium has insoluble?


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## DustyKat (Dec 22, 2011)

They are both the same. Metamucil's primary ingredient is psyllium and psyllium is 80% soluble and 20% insoluble. 

Dusty.


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## fishermanj (Dec 22, 2011)

*post op D*

Hi Guys

I've had serious bouts of D, after removal of 45 cm of small and 15 of large (2007). It does come and go, but right now, I'm so flared I'm home from work. Fibre does help. It seems to absorb some of those nasty bile salts that cause us so much grief. The terminal Ileum is where a lot of the bile salts are re-absorbed, according to my research, anyway. I also tried Questran, and after a couple of days, I quit. I told my GI that it tasted like something off of Fear Factor. I use Colestid now. It does basically the same job, it's just in pill form and you don't get the raunchy taste. But... I've found that grease and oils are my enemy! Absolutely no pork, I even pat down chicken with a paper towel to remove any oil. The proteins that I've found to be the least bothersome are fish, turkey and wild meat (ie. Venison). I also eat lots of bran to absorb the salts.
You are right about the lack of knowledge many GI's have about diet! I also wish that some of these dr's would try some of these meds themselves - see how they like Methotrexate or Imuran.
Hope this helps.
J


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## nogutsnoglory (Dec 22, 2011)

fishermanj said:


> Hi Guys
> 
> I've had serious bouts of D, after removal of 45 cm of small and 15 of large (2007). It does come and go, but right now, I'm so flared I'm home from work. Fibre does help. It seems to absorb some of those nasty bile salts that cause us so much grief. The terminal Ileum is where a lot of the bile salts are re-absorbed, according to my research, anyway. I also tried Questran, and after a couple of days, I quit. I told my GI that it tasted like something off of Fear Factor. I use Colestid now. It does basically the same job, it's just in pill form and you don't get the raunchy taste. But... I've found that grease and oils are my enemy! Absolutely no pork, I even pat down chicken with a paper towel to remove any oil. The proteins that I've found to be the least bothersome are fish, turkey and wild meat (ie. Venison). I also eat lots of bran to absorb the salts.
> You are right about the lack of knowledge many GI's have about diet! I also wish that some of these dr's would try some of these meds themselves - see how they like Methotrexate or Imuran.
> ...


I'm on Questran it's really gross but in tapering off. Are you eating the BRAT bananas, rice, applesauce and toast? Very helpful.


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## fishermanj (Dec 22, 2011)

Yes, all of the above, except bananas - alergic. Really, there are only a few families of foods off my eating list. Chocolate, nuts, oils (vegetable and animal), coffee, dairy, and pork. I grow a garden and like to fish a bit, so a lot of our food is unprocessed, that way I can control things like sugar, salt, and fat - I like to think it helps.

I forgot to mention the last and possibly the most evil thing that, I think, seems to make the D worse - Stress - very bad for the guts, and likely my own biggest downfall.


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## nogutsnoglory (Dec 22, 2011)

fishermanj said:


> Yes, all of the above, except bananas - alergic. Really, there are only a few families of foods off my eating list. Chocolate, nuts, oils (vegetable and animal), coffee, dairy, and pork. I grow a garden and like to fish a bit, so a lot of our food is unprocessed, that way I can control things like sugar, salt, and fat - I like to think it helps.
> 
> I forgot to mention the last and possibly the most evil thing that, I think, seems to make the D worse - Stress - very bad for the guts, and likely my own biggest downfall.


I can see that because stress definitely exacerbates or triggers my crohns pain.


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## CyCrohn'sGuy (Dec 23, 2011)

Day two of starting psyllium husks and there is a definite, if slight, change in the "quality" of my BM's.  I'm still visiting the bathroom 6-8 times a day but half of those times there was definite "formation."  Hopefully things will improve further still.


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## DustyKat (Dec 23, 2011)

Thanks for the update! 

There will be trial and error but I hope it works for you.  

Just from my observations the kids were using about two heaped teaspoons each time they used it. Sarah is the one that sounds to have about the same issues as you and she uses every morning and only that now as I think she is only going once a day. But prior to that she used it maybe 3 times a day??

Good luck!

Dusty. xxx


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## Miss Underestimated (Dec 25, 2011)

Welchol works great for me. 2 Tablets about 15 minutes before I eat each meal - 6 tablets a day. No D at all. Well, unless I eat pecan pie with the pecans still in it or something like that.


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## CyCrohn'sGuy (Dec 25, 2011)

Day 4 and my bathroom trips have literally halved. I'm amazed how fast this has worked.  The only side effect I'm having is flatulence but since I live alone that's not a problem :ywow:

Thanks so much DustyKat

Costas x


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## DustyKat (Dec 25, 2011)

Between this post and your other one...:wink:..I am over the moon for you! Long may it continue!

All the best!  
Dusty. xxx


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