DEAR DR. GOTT:
I am a 62-year-old female, 5’ 11” and weighed 165 pounds before all the problems.
In August 2007, during a four day stay at my beach house in Mexico, I developed watery diarrhea up to 12 times a day. Four days after returning home I saw my physician and he said I must have picked up a bug in Mexico. I have been going there fore 35 years and have NEVER gotten anything before, but thought there is always a first. He prescribed Cipro for seven days with no results so I was given another seven day round. When that failed to help, I was given Flagyl and had blood work and stool samples taken twice. Everything was negative. He then switched me to another medication but I was still having the watery diarrhea up to eight times a day, mostly during the morning and evening. I started losing weight.
I was then referred to a specialist who continued my last medication and ordered a colonoscopy, despite my having had a normal test two years ago. I went along with it because I was told this physician was the “best”. For various reasons I did not go back to him and never will so I took the results to another physician. He diagnosed me with collagenous colitis but was unsure how I got it. I was told there was no known cure and that I would have to take medication for the rest of my life. Fortunately, I was also told it was not life-threatening. I have lost more than 20 pounds and continue to have watery diarrhea up to six times a day.
I have tried to do my own research on this condition but haven’t come up with anything useful. How do people live with this? When I get up in the morning, it takes at least two or three hours of trips back and forth to the bathroom before it is relatively safe for me to leave. Then after dinner, it is the same thing. Occasionally I have an “attack” in the middle of the day and unless I am immediately near a bathroom, it can be devastating because there is no warning. I want to have a normal life again.
DEAR READER:
Collagenous colitis is an inflammatory condition of the colon that causes chronic watery diarrhea. It is similar to lymphocytic colitis and some researchers believe that they are simply different stages of one disorder. They are often both referred to as microscopic colitis.
Some individuals develop patches of swelling in the colon lining (collagen) while others have swelling along the entire length of the bowel. It is more prevalent in people ages 60-80.
The most common symptom is chronic watery diarrhea that often starts suddenly. This can be consistent or cyclic (occurring in cycles of improvement and worsening) and can cause from three to 20 bowel movements a day. Other symptoms can include abdominal pain/cramps, dehydration, nausea, abdominal bloating, fecal incontinence and modest weight loss.
There is no known cause for either collagenous or lymphocytic colitis. Some researchers believe that toxins released by bacteria or viruses may trigger the inflammation but others have theorized them as autoimmune. Many individuals with the conditions also have one or more of the following conditions: celiac disease, diabetes mellitus, Sjorgen’s syndrome, thyroid problems, CREST syndrome, rheumatoid arthritis, scleroderma and pernicious anemia.
Diagnosis is often made by a gastroenterologist with the aid of blood and stool samples, colonoscopy or flexible sigmoidoscopy and biopsy.
The good news is that most cases resolve on their own in a matter of weeks and do not need treatment. Unfortunately you do not appear to be in the vast majority. Treatment usually includes lifestyle changes such as a low fat diet, cessation of caffeine, lactose, spicy foods and alcohol, and limiting intake of raw fruits and vegetables (which can cause gas and resultant diarrhea). If this fails to help, medication may be necessary. These include over-the-counter Imodium or Pepto-Bismol and prescription Lomotil, Colazal, Azulfidine and others. If medications and lifestyle changes fail to produce improvement, surgery to remove the inflamed areas may be necessary. It is important that the dietary changes are continued to ensure the symptoms do not recur.
I suggest you speak with your gastroenterologist about this. You may also wish to go online and get a copy of the collagenous colitis/lymphocytic colitis information from the Mayo Clinic. It is available at http://www.MayoClinic.com/health/collagenous-colitis/DS00824.
To give you related information, I am sending you a copy of my Health Report “Constipation and Diarrhea”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.
About Dr. Gott