DEAR DR. GOTT: I have suffered for 30 years with IBS. I am presently going through the cycle of severe chronic diarrhea, where everything I eat goes right through me and I don’t always make it to the bathroom in time. This goes on 24/7. I am being treated with dicyclomine and colestipol and take Digestive Advantage lactose intolerance daily. I also use Imodium in the morning. I am better to the point that the diarrhea is mainly in the mornings now but am still dealing with it.
I am a 53-year-old female and had a laparoscopic partial hysterectomy (uterus only was removed) a year and a half ago. My bowels had been normal for three years prior to the surgery and I have been dealing with this ever since.
A friend of mine told me that a few years ago you had an article about something over-the-counter to take but he’s not able to find the article. A friend of his took your advice and tried it and was back to normal within four years. Do you recall what it was? Someone also suggested eating ginger root but I haven’t tried that yet. Any advice you have would be great. Thank you.
DEAR READER: Irritable bowel syndrome is a common disorder that affects the digestive tract. The exact cause is not known but there are certain triggers such as specific foods, hormones and stress that can worsen symptoms.
Symptoms may be mild and of little-or-no concern to severe and troublesome, such as those that you are experiencing. They include gas, bloating, abdominal pain and/or cramping, mucus in the stool, chronic constipation or diarrhea, or alternating bouts of both.
I believe the OTC medication that your friend is referring to is Digestive Advantage Irritable Bowel Syndrome; however, upon investigation, it appears that the manufacturer no longer offers this product. Other than the Lactose Defense Formula that you take, there is also a Gas Defense Formula, Constipation Formula and Intensive Bowel Support. It is my guess that this last option takes the place of the IBS formula I had previously written about. You can learn more about each formula at: www.DigestiveAdvantage.com.
Treatment depends on which type you suffer because options that help the diarrhea type may worsen constipation. For sufferers such as yourself, you may benefit from anti-diarrheal medications (such as the Imodium you already take) but it is important to take it only when necessary and at the lowest dose that works for you to prevent future complications. Anticholinergic medication (like the dicyclomine you take) can help relieve painful bowel spasms that may occur with diarrhea but can worsen constipation. Increasing dietary fiber can help constipation but may cause gas and bloating if introduced too quickly. Supplements may be preferable. And finally, tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) may help, especially in those who experience depression. Tricyclics are beneficial for those with diarrhea and abdominal pain. SSRIs may be more suitable for those with constipation and pain.
I would like to point out that the other prescription you are taking, colestipol, is a non-statin cholesterol-lowering medication that can be used in the treatment of chronic diarrhea. The most common side effect is constipation, but for some it can cause diarrhea. For this reason I urge you to speak to your physician about a trial at a lowered dosage or stopping it altogether to see if your symptoms improve.
Regardless of the type, drinking plenty of liquids and exercising regularly can help prevent dehydration (diarrhea), soften stools (constipation), and regulate bowel function. Probiotics, such as those found in the Digestive Advantage products and other brands, have shown some positive results but further research is necessary before a definitive answer is available. Eliminating high-gas foods will also help all types of IBS.
There are two medications with FDA approval for IBS treatment; however, both carry serious side effects and are only used when all other options fail. The first, alosetron can only be prescribed by certain physicians with special approval and is only for the treatment of women with IBS-diarrhea. The second, lubiprostone, can be used by both men and women and is available only for those with IBS-constipation.
Unfortunately, there is little else that can be done to help IBS sufferers. Until more is known about what causes IBS, finding a safe and effective treatment will be difficult. At this point you appear to be doing everything that you can. Keep hydrated, avoid foods that worsen symptoms, reduce stress, exercise, and follow your gastroenterologist’s advice.
Readers who are interested in learning more can order my Health Reports “Irritable Bowel Syndrome” and “Constipation and Diarrhea” by sending a self-addressed, stamped number 10 envelope and a $2 (for each report) US check or money order to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from my website, www.AskDrGottMD.com.
