How to control chronic diarrhoea?

[ArnieandBob]

You would like to think that after suffering from IBS for over two decades I would know the answer to this but I don't and it drives me insane.

Despite avoiding my trigger foods (dairy, certain fruits and veg and artificial sweeteners) and following a very boring low fodmap diet I still have almost daily issues with my bowels. Fibre is my nemesis, just a tiny bit too much and it really upsets my digestive system, I tend to keep low on the fibre.

I go to the loo anything between 1-3 times a day. No two days are the same for me. I can have a day or two of passing 'normal' looking stool and then it will change to much looser (and sorry if tmi!) but sludgy/mud-like stool (often starts as normal and gets looser each time I go). I have lots of gut symptoms throughout the day including excessive gurgling, bloating, gas and gas like pain. I hardly ever have a calm gut and the mornings are awful. I also suffer from a lot of acid and nausea.

I have resorted to taking Imodium a few times a week to try to control the sludgy stool but tbh it doesn't do much, all it does is slow my gut down, the stool will stay the same. I have tried all the standard IBS meds such as Mebeverine but they have very little effect. I listen to gut directed hypnotherapy every day too but that has little effect either.

I have had colonoscopies, endoscopies, a bile acid malabsorption test and lots of scans and all ok and so they can offer no more help.

I am at such a loss though, I don't want to keep waking up every day, needing the loo as soon as I wake up and spending the rest of the day feeling dreadful within my digestive system. I can't function well for the first half of the day worrying I need the loo to clear it all and then spend the rest of the day frightened to eat in case I trigger it off again.

Surely there must be something that can help and give me back the normal functioning gut I had before all of this started?

Btw, I promise I am not a poo troll just a normal 51 year old menopausal woman trying to get through the day living in fear she may crap herself if she leaves the house 😩

Probiotics?

I have tried a few but they seem to make it worse for some reason.

How are your eyes and anxiety levels? My stomach doesn't like either.

However, a couple of months ago I was given oral steroids for a chest infection. Horrible things to take but one of the benefits seems to be that they've reduced the inflammation in my gut and it's pretty much how it should be. I don't know if they'd be something that the GP would be willing to try or if they'd be licensed for IBS.

Probiotics create a die off effect so you have to keep taking them until that has happened.

If I were you I'd do a total exclusion diet. Low fodmap is ok but if you have a non-ige allergy to something in that diet then it won't show up on any of the tests youve had done.

I know you say you've tried various diets but don't mention gluten - have you tried cutting that out? I suffered for years and turned out to be a relativly easy fix!

I can't lie, my anxiety levels are quite high as I help care for my mum who has dementia. I do try to level it all with yoga, the Calm app daily and the hypnotherapy. Sorry, I don't quite understand by the eyes comment?

I will talk to my GP regarding antibiotics.

I did take the probiotics for quite some time but they just made me feel progressively worse until I really had to stop.

I do feel that I need to re-evaluate my diet. I have been low fodmap for a long time, too long. This is the problem with NHS dietitians, they put you on something, see you for a few weeks then discharge you and leave you to it, sadly I can't afford to see anyone privately so will have to try and do it on my own.

Oh, sorry I should have added that in my op. Yes, I am gluten free but I have to be so careful with gf products as many of those seem to upset me so I tend to stick with naturally gf foods which narrow things down even more.

You have my sympathy, you sound so like me. It's like a vicious circle - I'm constantly on edge about needing the toilet, the pain can also be debilitating. But I'm also aware that anxiety has a big impact on IBS.

I can't tolerate onions, garlic, peppers, dairy, greasy meals, oats (which are supposedly safe), large meals.

I can go months feeling stable and then months feeling awful. So I think the main culprit now is anxiety and stress.

I'll keep following this, hopefully you'll get some advice that will work for you.

Oh gosh this is me to a tee, same foods trigger me too.

I have kept a food diary for years and can never see a definite link to some of the things I have eaten that day or the previous. I am really starting to think my hormones and stress are playing a big part but it's strange because I can have a really stressful day and feel ok yet another time I can have a relatively calm day and feel dreadful. It makes no sense.

I was recently ( about 3 months ago) prescribed Questran light and although it's not perfect, it's made a massive difference - in that I can now pretty much plan go out in the morning without fear of having to run to a toilet several times , and now also am able eat most vegetables ( and some pulses again)..
I do get some bad days still but these are usually when I have been too over ambitious of things like dairy fat and nuts and seeds but absolutely nothing like previously, when I ended up on a hardly being able to eat any veg and some days id be afraid to leave the house until the afternoon.

I couldn't get a bile malabsorption test, because of long wait (or pay £££ myself,) but the Doctor agreed to prescribe it anyway to see if it made a difference and it has!
I found out as part of the process of seeking a remedy that I also have high cholesterol and apparently Questran can be prescribed for that also ...( Although I take a separate medication for that) . Maybe worth asking if you can give it a try?

Low FODMAP isn't a lifestyle diet, it's a temporary one to identify the triggers! You're supposed to be reintroducing one food at a time to ID the problems, not living on that restrictive list for the rest of your life.

Have you looked for a private dietician? I saw one for £79 for two appointments. She was NHS but working privately in the evenings.

Oats for me also! I recently tried reintroducing them ( and a few seeds ) because apparently they are so healthy.. Nope!.. Walnuts though, seem ok

I do think anxiety and stress is a problem which is a trigger, but then having an explosive poo problem causes stress and.anxiety in itself !!
Its a vicious circle...🙄

My friend went to the gp about a similar issue and was told to basically eat the same thing every day until the symptoms went away and introduce one new food at a time.

She did that and had a list of things and a tick against them or a cross, for future use.

The thing I found is that my system seems to take three days to complain about something I've eaten. That makes it harder for me to narrow down the trigger. However I've managed via a food diary.

So I'd suggest eat bland food for three days to get everything out of your system and then one new food every three days.

Nothing ultra processed. Stuff you make yourself. No fruit or veg. Start with say gluten free bread, boiled white rice, chicken (you cook yourself or buy cold slices of), eggs, tuna. Drink only tea or water 1.5litres a day.

Sounds grim but it's the only way to work out what's triggering you.

After a week of no upset tummies introduce one new food. Probably potatoes, one serving max (a serving to me being the size of an apple) Eat moderately for three days. Note any symptoms for these days.

Then introduce another food. (Or a drink). Eat for three days in moderation.

Continue.

It should be easy to work out what any triggers are. When you find out stop eating it for three days until you stabilise.

For a long time I could only eat one portion of any fruit or veg a day or I'd be in the loo. I also found regular Pepsi and regular Schweppes lemonade had artificial sweeteners sneaked into it with no mention on the front only in the tiny writing ingredients section. I stopped those.

Good luck.

My GP prescribed me a very low dose of amitryptilene, alongside loperamide, which seems to have helped. My symptoms arose once I'd had my gallbladder removed, and it ruled my day. Good luck.

My gastro has suggested this in the past but when the BAM test came back clear she never mentioned it again but I'll contact her and see if she could prescribe it for me 🤞

I know but I'm psychologically stuck on it because I fear high fodmap foods now. I had an eating disorder when I was younger and only found out years after being put on the diet that it isn't advisable for those with ED past and present!

Where did you find a dietician for such a low fee? All the ones I've contacted are charging at least £150 for one appointment, I'd love to find one charging a lower fee as I've had to reduce my working hours due to my issues. Does she offer remote appointments?

Thank you for that, I have reached a point where I am going to have to go hardcore with it all. I do need to try this as hard as it is.

And you are right about foods not affecting me until a few days later, I'm pretty sure this is an issue for me.

Thank you. I have taken it in the past but I was so dizzy I couldn't drive but I may need to look into this again.

This suggests that you'd need to take a multi-strain probiotic for over 8 weeks to benefit.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6769995/

Hi, OP, cutting out bread and seeds has helped me a lot.

You need to wait at least 3 days to see a response in your food diary. Looking back at that day or the day before is not a long enough lag. You could be eating an allergen on Monday and having a reaction on Thursday.

As this is so disruptive I would just drop right down to eating turkey and pear for a week. It's shit and boring but if you feel better you'll know it's something you're eating. then slowly slowly add foods in

Stress doesn’t help, but I found taking a vitamin d tablet control it, as bowel problems take away a lot of your nutrients. Just a suggestion.

Have you come across or tried Psyllium Husk? I know you are wary of fibre for good reason, but I wonder if the capsules might help?

I take high dose capsules of 4000mg or 5000mg per day, which helps me and really notice diarrhoea returning on the days that I forget to take it.