How common is diarrhea with Crohn's?

[Mehita]

For the last 10 days or so DS has either had mushy or loose stools. He's pretty much settled into the loose watery stools now. I'm a little confused about how "normal" this is for someone with Crohn's. From reading the Forum, this is common place and normal for some people, while others react like the world is ending.

Does inflammation cause diarrhea? What are the mechanics exactly? If he's having diarrhea daily, should we be concerned with malabsorption?

DS says he's stooling 1-2 times a week at school after lunch and then every time we sit down for dinner, just the smell of food seems to trigger the need to go. He is eating small frequent meals throughout the day. I don't believe a particular food is a trigger - just food in general. We are seeing his GI next week and will be changing meds.

Just curious about your experiences with diarrhea...

 

[Jim (POPS)]

I had the big "D" for 20 years before I found out i had crohns. It is normal for some people with crohns to have it alot even when in remission.

Jim
(Pops)

 

[ChampsMom]

My son had it constantly before diagnoses. When he first got sick he was at the end of his ice hockey season. It seemed he would eat a huge protein filled meal, run to the loo, lose it all in the toilet and then go out and play. He had it down to a science (we thought he had a stomach flu). Things improved after his inflammation was controlled. Now it's unusual for him to have it.

 

[Tesscorm]

Stephen was the same as ChampsMom's son. D before diagnosis, not very often now - it may happen but very infrequently.

Sorry... I don't know what causes D to happen??? I know Dusty 's kids had resections and I believe they now use psyllium husks to help firm up BMs, but I'm not 100% sure of this??

 

[Clash]

I've wondered about this too since the GI said remission with full mucosal healing means all will be normal ie no pain, no D or C, etc. Also, when you look at the CDAI scale they use to determine flares in studies D and number of bms is a main factor.

 

[Traumanurse]

The big D has been normal for me every single day. 3-5 times a day in remission and 5-15 with flare ups. My dad and cousin also have Crohns, and we all have It every day. Just depends how many..... I think this is again one of those things where everyone is different.
You might want to talk to the Doc though since this is new.
Good Luck!

 

[Sascot]

Never dealt with diarrhea - hope it settles down without any issues.

 

[Mylittlesunshine]

Lucy has always had big D
On a good day 3-5 times a day but
Have know her go 12 times a day
On a bad day.

 

[CarolinAlaska]

Common, but I don't think this is normal. For J, her diarrhea stopped with remission, and she's had it all her life. I think there are other dietary things that make some people have diarrhea - pancreatic enzyme deficiencies, gluten or milk intolerance, etc.

 

[KWalker]

I had diarrhea for 20 years before starting psyllium. It really is a miracle. I buy mine in bulk at a health food store but you can also find it at bulk stores like the bulk barn. You don't need a prescription or anything and psyllium is the main ingredient in metamucil so you get that without all the additives

 

[Clash]

I agree CarolinAlaska, I do believe it is common but not something that should be happening if you are in deep stable remission. I think it would still happen with clinical remission but if you have full mucosal healing and still having D then other issues may need to be checked.

I also believe that is why "mucosal healing" has become the goal because at that point CD isn't futher damaging your GI tract and you are free from symptoms or restrictions.

 

[DustyKat]

Hey Mehita,

Prior to surgery my kids didn't have diarrhoea but there are a few reasons as to why people do suffer with it and why for some it is a sign that they are flaring.

1. Acute inflammation - can cause diarrhoea because the lining of the bowel becomes oedematous and boggy and therefore doesn't allow for the normal exchanges of nutrients and fluids to occur between the body and the bowel. This speeds up the transit time and as a result diarrhoea occurs.

2. Chronic inflammation - causes fibrotic or scar tissue to form. Fibrotic tissue is leathery, hard and unforgiving. This this then causes the same issue that acute inflammation does, it won't allow for the normal exchanges of nutrients and fluids and again it results in diarrhoea.

3. Resection surgery - For those that have had extensive surgery the same mechanism mentioned above kicks in leading to speedy transition times.
For those, like my children, that have had ileal resections the diarrhoea is caused by the malabsorption of bile salts. This can also be the reason for diarrhoea in those with ileal disease without resection. The bile salts are normal reabsorbed back into the body in the ileum, when this doesn't happen they pass through into the large bowel where they have the osmotic effect of drawing water back out of the body and into the bowel. This then results in watery, diarrhoea type stools. The psyllium works by absorbing the bile salts in the ileum so the osmotic effect is stopped or reduced in the large bowel.

4. One other thing to consider that also may play part is infection. Inflammation causes the intact bowel wall to become breached. The bowel, by its very nature, is not a sterile environment and once that protective barrier is broken infection will likely occur. How much that may contribute to diarrhoea I don't know but is the reason why many people, during initial treatment for a flare, are commenced on an antibiotic like Flagyl.
For those that have had ileocaecal resections, and therefore the valve between the small and large bowel removed, SIBO (Small Intestinal Bacterial Overgrowth) should always be a consideration if their 'normal' bowel habits change.

Hope that helps!

Dusty.

 

[hawkeye]

It was common when I was diagnosed, but now anything watery is rare. I tend to be more on the constipated side.

 

[Devynnsmom]

Not sure how I missed this thread. Devynn has had a lot of diarrheah. She could go from a normal bm, or constipation to diarrheah and back again. But loose bms are pretty normal around here. ESP if she's not feeling well.