He has taken every medication I can imagine, including Humira injections into his stomach. At present, he is taking hyoscyamine and Apriso plus pain medication when it gets too severe. He has a colonoscopy every year. When he has one of these “attacks,” the pain is so severe that he gets in a fetal position and can barely walk. He has been to the hospital at least 15 times in the past two years. He recently went twice in one week and before that, in just a three-month span, he went seven times.

He is unable to work because he is sick or too weak to function at least five days a week. He has never used drugs, alcohol or tobacco. Surgery has been suggested, but we are trying to avoid that if possible. He has seen at least six different doctors, and we are now hoping that you can help us. Please.

DEAR READER: Crohn’s disease is a type of inflammatory bowel disease (IBD). It can be debilitating and may lead to life-threatening complications, so it should be taken seriously by the sufferer and the treating physician(s). While there is no cure, there is good news. Today’s treatments can greatly reduce symptoms and may even lead to long-term remission.

The most common symptoms include diarrhea, abdominal pain and cramping, reduced appetite, weight loss, ulcers and blood in the stool. Others, especially those with severe Crohn’s, may also experience inflammation of the liver or bile ducts, arthritis, fever, fatigue, skin disorders and eye inflammation. Children may experience delayed growth or sexual development.

Complications include bowel obstruction, malnutrition, anal fissures, ulcers, fistulas (an abnormal connection between different parts of the intestine) and more. There is also an increased risk of colon cancer; however, the vast majority (more than 90 percent) of sufferers never develop it.

There are several types of treatment available. The first type is anti-inflammatory drugs, such as the Apriso (mesalamine) that your grandson is on, as well as azulfidine and corticosteroids. Immune-system suppressors are also used. Your grandson was placed on at least one of these, Humira (adalimumab). There are several others in this category. Antibiotics, which may be helpful in treating some of the complications, such as ulcers, abscesses and fistulas, may also be beneficial for those without complications, as many researchers believe that antibiotics will reduce levels of harmful bacteria within the intestine, as well as suppress its immune system.

Commonly used medications include pain relievers, antidiarrheals, iron supplements, laxatives, vitamin B12 injections, calcium and vitamin D, and/or special diets, such as nutrients introduced directly into the veins, which can bypass the stomach and intestine, thus reversing malnutrition.

Finally, surgery. If diet, lifestyle changes, medication and other treatment fail to relieve symptoms, surgery to remove a damaged portion, close fistulas or remove scar tissue may be recommended. Unfortunately, at best, surgery can provide years of remission, but it will be temporary. Nearly three-quarters of patients who undergo surgery will experience recurrence, with approximately half of them requiring a second procedure or more. Even if signs and symptoms improve, medication is often prescribed following surgery in an attempt to reduce the risk of recurrence.

I suggest your grandson try some of the following lifestyle and home remedies and at least meet with a surgeon to discuss his situation. He is clearly suffering, and if medications have not worked for him thus far, surgery may be his best option.

There is no evidence that diet can cause IBD, but certain foods and drinks may aggravate symptoms. He should limit his dairy intake; eat smaller meals; drink plenty of fluids; eat foods lower in fat, especially if the Crohn’s is affecting his small intestine; consider taking multivitamins to supplement lost nutrients; avoid foods that worsen symptoms; experiment with fiber to find the foods that cause the least upset but help reduce diarrhea; and finally, consider consulting a dietician familiar with the disorder to get further suggestions. He should also try to keep his stress levels down by exercising within his limits, practicing relaxation and breathing techniques and, perhaps, even learning biofeedback. He may also wish to see a Crohn’s specialist at a nearby teaching hospital.

To provide related information, I am sending you a copy of my Health Report “Irritable Bowel Syndrome.” Other readers who would like a copy should send a self-addressed stamped envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Also, my heart medications are potassium and torsemide. Lately, my feet and ankles are swelling more than usual, and my physician’s assistant wants me to double the torsemide. Would this injure my kidneys? How long is it safe to take? I usually take half a tab, but I would then be taking one whole pill. Is there a way to swallow my larger pills more easily?

DEAR READER: Let’s start at the beginning. H. pylori is a bacterium that infects the beginning of the small intestine or stomach. This bacterium is said to be present in 50 percent of all people worldwide. There are instances when H. pylori is present but there are no symptoms, and a person is completely unaware he or she has it. When symptoms are present, they include weight loss, nausea, vomiting, a burning sensation in the abdomen and more.

H. pylori enters the body through the mouth and passes into the digestive system. In developed countries, infection in children is unusual, but it becomes more common during adulthood. Complications can include inflammation of the stomach lining, certain types of stomach cancer and ulcers in the stomach and small intestines.

There are several tests available for analysis, such as blood and stool testing, breath testing and endoscopy. The latter utilizes a flexible tube with a camera attached that allows a doctor to look for irregularities in the digestive tract and to take biopsies.

Treatment might include medication to reduce stomach acid, H2 blockers such as ranitidine, cimetidine, antibiotics and several others.

Finally, to answer your question, there is no direct connection between H. pylori and the side effect of diarrhea. That said, the bacterium could cause gastritis — inflammation of the stomach lining. Gastritis can be tied in with diarrhea, but I haven’t found a reputable source that lists it as a common symptom.

Torsemide is a diuretic (water pill) that makes the heart’s job easier. Its purpose is to increase urine output. It causes large amounts of potassium to be excreted from the body and is why you have been prescribed potassium. Side effects include headache, stomach upset, blurred vision, loss of appetite, dehydration, dry mouth, heart arrhythmias and constipation or diarrhea. Some of the symptoms are unusual and don’t affect everyone; however, I believe you may have the answer here. Speak with your physician to determine whether he or she can switch you to another diuretic or potassium pill or modify the dosage of your current meds.

This medication can lead to water and mineral depletion, so you should take it as your physician directs for as long as necessary. I am unaware of any issues with long-term use. Your doctor is attempting to reduce the swelling in your feet and ankles; however, I would hate to have your diarrhea become so disruptive as to prevent you from leaving home or causing you to lose control over evacuations.

Pills too large to swallow can be crushed inside a plastic bag before swallowing or taken immersed in a teaspoon of applesauce.

To provide 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 No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Gas pains can occur for a number of reasons. Perhaps you have acid reflux, indigestion, hiatal hernia, gallbladder disease, peptic ulcer, are lactose intolerant or have an undiagnosed abnormality of the digestive tract. You also don’t appear to be digesting your food properly, as evidenced by the diarrhea. Naproxen and other OTC NSAIDs can also lead to nausea, gas and diarrhea.

If you are unemployed and without insurance, apply for state aid. This will remove an enormous burden from your shoulders. Then make an appointment with a physician for an examination and possible lab work and X-rays so you can determine the exact cause of your pain. If necessary, request a referral to a gastroenterologist. I know this sounds extremely daunting, but you shouldn’t have to continue with the symptoms you are having and the distressing diarrhea that follows. Once appropriate testing is accomplished and a diagnosis can be made, proper treatment can begin. Until then, it’s anyone’s guess.

To provide related information, I am sending you a copy of my Health Report “Constipation & Diarrhea.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

I hope you can share this with your readers and perhaps improve the quality of life of someone out there. It has been wonderful for me.

DEAR READER: IBS is a malfunction of motility of the colon. Stress, medications, specific foods, caffeine, alcohol and gas contribute to symptoms that include abdominal pain, flatulence and diarrhea/constipation. The medication you have been prescribed can cause identical symptoms.

Colesevelam (WelChol) reduces the amount of cholesterol and specific fatty substances in the blood. It is sometimes prescribed with other cholesterol-lowering statin drugs toward this goal. This drug binds bile acids in the intestines to form a product that is ultimately released from the body. It is also prescribed for some type 2 diabetics to control blood-sugar levels. Drugs that have been manufactured and marketed for one purpose are often used for other, seemingly unrelated conditions and work well. My guess is that the reduction of fatty substances in your colon curbed your diarrhea and related symptoms. Or you are less stressed, have modified your diet or medications, and have taken other steps without realizing the positive impact they have had.

To provide related information, I am sending you a copy of my Health Report “Irritable Bowel Syndrome.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Magnesium citrate is an over-the-counter substance used to treat constipation. It is taken by mouth in liquid form that can be mixed with water or juice. The dose depends on the reason a person is taking it. Magnesium citrate works by pulling water from tissues into the small intestines, thereby stimulating a bowel movement within 30 minutes to three hours. When smaller doses are taken, especially when taken with food, the process slows. Following each use, a person should drink two additional glasses of water to replace the fluids that will be lost during evacuation.

Side effects can include nausea, bloating, abdominal pain and a loss of normal bowel response if the magnesium citrate is used on a long-term basis.

Laxatives can result in diarrhea. This, in turn, can cause a loss of electrolytes, essential nutrients such as potassium and other fluids in the body. If diarrhea occurs, a person should replace those lost fluids with two to three quarts of sports drinks or other fluids daily until the diarrhea stops. Some brands of magnesium citrate contain sugar and should be avoided if a person has a history of diabetes.

I am unsure why you are taking the product. If you have regular bowel movements and don’t suffer from constipation, perhaps you don’t need the weekly cleansing. Instead, you might consider a trial of eating more fresh fruits and vegetables, including cereals with bran for breakfast and drinking up to three quarts of fluids each day. If you do suffer from constipation on a regular basis, I recommend you make an appointment with a your physician or a gastroenterologist to review your medical history and medications to determine the cause. Certain medications can contribute to constipation, so that would be an easy place to begin.

To provide 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 No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

A brief medical history is called for. In September 1995, at the age of 55 I was diagnosed with colo-rectal cancer and surgery was performed to remove the diseased areas. I had 31 radiation treatments and one year of chemotherapy. In August 1996 I was able to return to my teaching position. However, in February 1997, I developed an intestinal blockage due to the radiation treatments and needed surgery. Due to the effects of the surgery and radiation, I was forced to resign. I was diagnosed with radiation enteritis and am now classified as permanently disabled.

The long-term effects of the above treatments began to develop and a gradual loss of independence and freedom followed. I started having frequent, urgent and sudden bowel movements on a daily basis. I continue to have bouts of diarrhea and most frustratingly, I have episodes of fecal incontinence. I have been prescribed Asacol, Colozal, Rowasa, and Cortenema all with little or no relief. The symptoms I’ve described continue to be debilitating and almost paralyzing. I’m now reluctant to leave my house and if I do, it is for very brief periods of time. When doctor appointments are needed, they must always be scheduled late in the day and no food can be consumed until after I return home. I am forced to have people run many errands for me and must request other people to transport my wife to her appointments. Needless to say, attending church services and social gatherings are now an impossibility. In short, I’ve lost almost all independence and freedom of choice.

These many years of living in the way I’ve described have led to a few conclusions. Medical science may have saved my life but it certainly didn’t restore it. I never expected to be the person I was prior to the diagnosis and treatment of cancer, but I didn’t expect to be one step removed from becoming a shut-in either.

I now firmly believe that individuals in the various fields of medical science who develop treatments and therapies for diseases such as cancer also have an equal responsibility to develop ways to deal with the long-term effects of the treatments that are applied. Failure to do so almost gives one the impression they have become the “victim” of a cure, left to fend for themselves now that they are cancer free. I would like to see the treatment for the long-term effects of cancer therapies be as aggressive as the treatment for the disease itself. I wonder if cancer survivors who read about declining death rates for those diagnosed with cancer become curious about the quality of life that may result. Certainly, my experiences tell me that surviving cancer can come at a very high price.

I cannot predict your reaction to my letter and you may or may not offer a reply. That is your choice and I realize you are under no obligation. Nevertheless, I believe that experiences like mine should be made known not so much to be merely critical but to encourage the development of more refined and less debilitating treatments.

DEAR READER:
I have chosen to print your letter in its entirety because you have made many valid points.

As far as science has come in understanding and treating cancer and other serious conditions, it still has that much farther to go to develop treatments that are not as potentially harmful. You have experienced very serious side effects from your life saving procedures. I am not an oncologist and therefore cannot say if the severity of your problem is common as a result of your treatment. I hope it is not.

Physicians have a duty to explain the potential harmful effects of any given treatment as well as the benefits. This simple step can help a patient decide if the risks outweigh the benefits and if they are willing to take that gamble. Thankfully, most treatments are benign and side effects are minimal but as the disease becomes more severe, so do the treatments.

I urge you to speak to your oncologist or gastroenterologist about any new therapies or procedures that may be available to combat the side effects of your radiation and chemotherapy. He or she should be up-to-date on the latest breakthroughs and treatments. For example, you might consider surgical removal of the colon followed by a colostomy bag. This will allow you to function in public in a normal fashion and those around you will be completely unaware.

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.

DEAR READER:
Fecal incontinence can result from a variety of causes. The more common reasons are damage to the anal sphincter, nerve damage, pelvic floor dysfunction, diarrhea and constipation. It can be caused by childbirth, stroke, injury, diabetes, multiple sclerosis, radiation, inflammatory bowel disease, and other conditions.

Food affects the consistency of stool and controls how quickly it passes through the digestive system. Therefore, if your evacuations are watery, you might try eating foods high in fiber, such as fruits, vegetables and grains. Stool that is well formed may be high in fiber, contributing to your incontinence. Diarrhea is often caused by alcohol consumption, dairy products, fruits, fatty foods, and sweeteners.

Begin by making a list of the foods you eat and when the incontinence occurs. This may take several weeks to accomplish. A review of your records will tell you what to avoid and what you can eat without side effects. Do not eat and drink at the same time. Space the two functions by a half-hour or so. By diligently avoiding trouble foods and sticking with those you can consume without consequence, you may be able to conquer the problem.

DEAR READER:
Hirschsprung’s disease is a condition of the large intestine. It causes problems with passing stool because of missing nerve cells in the intestinal muscles. It is present from birth (congenital) and has no known cause.

Hirschsprung’s occurs in one out of every 5,000 births and ranges from mild to severe. In mild cases, babies often have minimal symptoms and may not be diagnosed until early childhood. Severe cases may lead to bowel obstruction, necessitating emergency surgery. Most cases fall into the moderate category which usually causes constipation or difficulty absorbing nutrients. The condition is five times more common in boys and sometimes is associated with other congenital disorders such as Down syndrome.

Symptoms can occur immediately after birth or may taken several months or years to appear. In infants, symptoms include diarrhea, constipation, gas, failure to have a bowel movement after the first or second day of life or vomiting (especially vomiting green bile). Older children may experience infections of the colon such as entercolitis, inability to gain weight, abdominal swelling and problems absorbing nutrients which leads to weight loss, delayed/slowed growth and diarrhea.

Hirschsprung’s disease develops while the baby is still in the womb. At some point during development of the colon, the nerve bundles that line it, fail to form. This can occur throughout the entire large intestine or just a few centimeters up from the rectum. The longer the affected area, the worse symptoms tend to be. It is not caused by anything the expectant mother has done or not done.

The only known risk factor is if you have one child with the disorder there is a greater risk of another child being born with Hirschsprung’s (because it is inherited, even if the parents do not have the disorder), and especially if that child has Down syndrome or is male.

The only treatment for Hirschsprung’s disease is surgical removal of the affected area of colon. You stated your grandson has already had this surgery. I suspect his fecal leakage is due to the surgery which carries the risk of muscle, rectal and nerve damage. I urge your grandson’s parents to talk to his gastroenterologist about his problem and see if there is anything that can be done. Older individuals can be helped by medication, surgery or surgical implants and since your grandson is only 10, I cannot see him having to spend the rest of his life with this embarrassing side effect. At the appointment to discuss the leakage, Kegel exercises can be brought up as a possible aid. I am not sure they will be effective but they cannot do any harm.

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.

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.

DEAR READER:
I have two trains of thought. The first is that you could be suffering from food poisoning, but this is unlikely because several of you visit a variety of restaurants and don’t get ill every time.

In all likelihood, your family is accustomed to certain foods at home that are seasoned with certain spices. When you visit restaurants, you are exposed to a variety of foods and additives that make everything taste wonderful, but to which your digestive systems are unaccustomed to. You might try more traditional bland dishes, avoiding rich sauces and desserts when dining out. You may also want to avoid restaurant salads because most wash their lettuces in a sulfite solution that can cause immediate, sometimes uncontrollable, diarrhea in sensitive individuals.