Bleeding/Cramping only late at night/early morning?

[Path_Of_Sight]

Hey,

I've recently had a pretty nasty flare up of crohn's. I've just been in hospital for two weeks on IV steroids and am now on an elemental diet, azathioprine and lots of prednisolone...

Generally, everything's improved dramatically- most of my day is pain and diarrhea free. However, between the hours of around 11pm and 10am I get frequent mild cramps followed by bloody stools. Has anyone else got this? Any idea why it's so time-specific?

I take my medication in the morning around 8am, so I don't know if perhaps this has something to do with it? Could it be the meds wearing off or something? Or is my gut just particularly active at night for some reason?

I'm really eagre to crack this, because it seems to be the last thing in my way; all other symptoms have virtually gone...

Any ideas or insight would be greatly appreciated

 

[littlebaby]

:confused2:
Hi
I which I could answer your question ,but I can"t because I too have the same symptoms and same times also.
I figures it takes time for meds to work
Sorry I can"t give you a answer . Take care

 

[Kev]

Hey POS.. Welcome to the forum. Hope you find this place inviting and helpful

Your description mirrors what I went thru... despite the fact I take some of my meds right at bedtime (always have).. cramping is always worst at nite (and that assessment seems to tie in with other common illnesses or health issues too). And, during the night, first thing in the morning, my diarrhea was always the worst. Again, I spread the meds I'm on over the course of the day, so its morning noon N nite. It doesn't seem to be when one takes their meds, least not in my case.. But, I did come up with a theory.. that, during the nite blood pooled in me... in the morning hours, enuff collected to act like an 'enema'. It is only a pet theory... but my morning diarhea abated AFTER I got my bleeding under control. I still had diarhea, but it was consistently spread throughout the day. you might try the old breakfast like a prince, supp like a pauper routine.
Biggest meals in the morning, progressively lighter N lighter meals from then on

 

[Path_Of_Sight]

Thanks for the input I'll keep that meal thing in mind; just started eating some normal food today (elemental diet etc.) just had some ground rice/polenta type thing. Seems to have gone down with no ill effects, so hopefully I won't be on this liquid stuff for too much longer.

It's reassuring to know that the night-time cramp/blood thing's common, I guess I'll just get used to it and hope the azathioprine kicks in in a few weeks.

Would be nice to know just why it occurs when it does though... hmm...

And yea, I find this place extremely inviting and very helpful! Glad I signed up!

 

[Guest]

hi POS, & welcome

its weird, i've never thought about the timing of my symptoms until i read your post just now, and yes - you're right. evenings from 9pm onwards are my worst times, sometimes early morning too, but quite often during the day things are pretty quiet.

maybe there is a connection there with being tired... ?

 

[beautiful_disaster]

Yea that is kind of weird, and I think that Kev might be right about the big breakfast and a smaller supper. I always eat a small breakfast and a large supper so maybe its just more food for your stomach to digest which causes the cramps. I previously thought it was just maybe from where my pred was wearing off but maybe its a mix of both... hmm

and the tiredness makes sense too... I hate them rough nights...

 

[Wiles]

I've always found that I feel the worst in the morning and evening.

 

[sibelius]

My pain always came slightly earlier -- after 5 or 6 in the evening. I only remember waking up once in the middle of the night -- usually, it's pretty bad between 5 and whenever I go to bed. When my symptoms were really bad, I'd have pains throughout the day, but the frequency and intensity always went up after 5 or 6.

This past month or so, I've been going into remission, so I've been almost pain-free -- but still, when I do get pain, it is almost always in the evening.

I guess I'm not the only one! I wonder why it's like this.

 

[Kev]

Well, when my bleeding was uncontrolled, my diarhea was worst in the AM. Even after we got the bleeding under control. my energy levels, overall feeling 'blah', etc., was worst first couple of hours after I got up. But my cramping, belly noises, even gas... for whatever reason, those hit their peak late nite, around bedtime.

But I've found that with other illnesses too, before IBD hit me. A cold or the flu always presented the worst symptoms at nite. I just thought this was normal.

 

[Path_Of_Sight]

The tiredness thing may be the key for me; thing is, last night, I had a pretty decent night sleep, only woke up 3/4 times due to cramps/diarrhea, and these were relatively brief and painless compared to other nights, hence I managed to sleep most of the night.

I think it may be down to this; I usually stay up 'til I'm like "really" tired, due to tv or something distracting me from sleep. Last night however, I knew I had to get up early for blood tests, so I made sure I got to sleep a little early, so I avoided the whole "really" tired phase... Maybe avoiding this had an impact on my symptoms? It was only one night, so I'm gonna try to keep this up and see if it things continue to improve... I'll let you know if it works

Equally it could be the meds becoming more effective, but I'm skeptical regarding that theory as I'm on azathioprine, which takes up to 6 weeks to work, and I've only been on it a week...

Thanks for the continued response, it's been really helpful

 

[Kev]

Oh, it goes without saying... eeer, skip that, that could be part of the problem.. It is hard to accept it, BUT, once this IBD makes its prescence felt, one of the 'best' things one can do is realize that getting enuff rest is extremely important. you're battling a disease that... partial remissions, or contrary flare-ups aside, AFFECT us 24X7. Although at first I was 'loathe' to do it, I soon realized taking naps helps.

 

[Path_Of_Sight]

Yeah, naps seem key. Thing is, at uni, it's all rather hectic; and playing in a band etc. doesn't help. Nightlife is big in my world. So I'm gonna have to work a bit harder at a *regular* sleeping pattern, and LOTS of naps... Hopefully it'll all work out...

 

[BWS1982]

Since I follow suite here and fall in line (worst at night, and 1st couple hours in daytime), my own pet theory had devoloped into being diet related. My thinking was that the 12 hour average (or so) that my food has in transit throughout my GI tract is just coming around to my inflammed area around night time from my morning food, and in the morning from my evening food, that my nights were actually the busiest time for my colon, and days were calm and quiet because 12 hours prior to the daytime, I was asleep, not eating. For example, if eat breakfast at 10 AM, it's around 9 or 10 pm when it's reaching my colon, hence worsened symptoms, then, around morning of 11AM, my last few meals are coming around the colon, from the prior 11PM of the night before (I sleep from about 2 am or so to about 11AM or so)...That theory made complete sense since I almost always notice food taking around 10-12 hours to go through me while I've been flaring the last 9 months at my worst, and the colon is getting it's workout as food comes through, and a resting time when I had an absence of it last night....makes sense to me for my situation...

 

[Colt]

It's very common. This time cycle used to get me into a world of trouble too. Back in high school I would wake up and try to get ready for school only to collapse on the floor half of the time screaming in pain. This resulted in me missing school. Later that day I would feel pretty much fine. So I'd go out and do stuff with my friends, or I was really interested in theater back then so I'd miss school and then show up ready to sprint around changing sets in the dark come 6PM. This pretty much convinced everyone around me that I was in no way ill and I was just trying to skip school. After all, why is it so conveniently timed that I'm only sick during school hours? (In reality I had to abort my plans to do the evening stuff quite often as well but no one noticed that)

Anyway, from my understanding and my doctor's the timing is due to digestive timing. The way the body normally works is that you eat all day long and build up the food in your body. The food is moving through your digestive system, but digestion is very slow while you are awake and active. When you are relaxing at the end of the time and especially when you are sleeping your digestion speeds up.

Not only does speeding up digestion generally exacerbate crohn's but by morning, after you've not eaten for 8-12 hours, you've gotten a big traffic jam going on in your colon that is further congested by inflammation limiting your ability to stretch and accommodate the large volume with your small intestines empty and an entire day's worth of food now in the large intestine.

Most people with crohn's have it worst in their colon and the last bit of the small intestine so this is when irritation is at it's strongest. This is also when you have the most fuel for that wonderful diarrhea.

 

[Path_Of_Sight]

Thanks alot Colt, that makes a lot of sense to me... I just wish there was a way to manage it a little better...

Though in that case it seems that eating small/frequent meals instead of large ones shouldn't make much of an impact... as you'd still just get the issues at night as it's just going to build up anyway...

But I'm sure it's still a better idea, I guess it allows your body to get through some digestion in a more manageable fashion before the rush hour traffic...

Cheers for the input, tres helpful

 

[BWS1982]

My theory has some backing now, hmm. Thanks Colt, I guess...

Although I've heard at night that digestion actually slows, (although it slows while being VERY active too, like lifting weights and jogging) and it's fastest while just sitting around or standing around, so I'm slightly confused on the speed part, but not the timing part (which is what my post above addressed).

 

[Kev]

I wonder if one can change their 'circadian' rythym enuff to tailor it to suit their life? Like, I wonder if 'night owls' fare better than 'morning larks'.... and if one opts to 'breakfast like a prince and supp like a pauper' would lessen the effects that appear common to most of us.

 

[jed]

after hyaving the same thing (pain at night), my doctor would always have me break up my meds in halfs so i could have half in the morning, half in the evening.

it really seemed to even the pain out.

 

[Kev]

Hmmm, Jed, not sure I understand. You mean the doc had you actually split your pills... cut them in two? that wouldn't work so well with the 5-ASAs. I did it with pred during a taper, and the taste factor was not to be believed. Just to clarify...?

 

[jed]

Hmmm, Jed, not sure I understand. You mean the doc had you actually split your pills... cut them in two? that wouldn't work so well with the 5-ASAs. I did it with pred during a taper, and the taste factor was not to be believed. Just to clarify...?

yup, thats correct.

but if i remember correctly, 5-ASA's are mesasaline yeah? i was taking 4 of those tablets per day, so it was 2 in the morning, 2 at night. that was an easy one


at the moment i've just started methatrexate (once per week), then another tablet called plaquinel (along with pred which i have to taper at the moment).

cutting plaq's in half beats pred's taste hands down, it is truely horrible!! but i just cant handle the feelings i get from having a full one yet. doc said i should get used of it after a while.

 

[Colt]

It doesn't really matter what time of the day you're awake, just when you ate. If you do all your eating at night mixed with sleeping and then fast all day long you'll just have trouble towards the end of your day of fasting. It's just a matter of where your food is in your digestion. If you were to eat the same amount of food and space it out over the course of the day in small meals (including during sleeping periods) it would improve the situation. People usually have a hard time getting up at 3AM to eat a sandwich though.

 

[Kev]

Well, I must be the exception.. I eat about 1/2 dozen small meals thru the day, but I start with my largest in the morning, and wean down to my smallest @ about 4 - 6 hours before bed.. Yet my pains were always worst at bedtime, and my "D" worst in the morning. I know the typical meal pattern puts most of the workload on the digestive system at nite... but mine is counterbalanced just the opposite.

And, whether it was flu, or asthma, or any other of a number of other illnesses, the symptoms around my household, my parents household, etc, all held to a pattern where things are worse at nite. I don't know of any parent who got a nites sleep when their children got sick with anything, cause of this "pattern".