May 26, 2017

Fecal Transplant: Slow diarrhea and urgency so good bacteria can colonize

Q: How do I slow diarrhea with my case of Ulcerative Colitis? At this point I am having a hard time and there are sudden urges and bloating that I can often barely make it to the bathroom most of the time. What do you recommend I do with my diet, are their any drugs or dietary or herbal supplements that can help too? Also how can I retain a fecal transplant enema long enough for it to work when I’m having all of this diarrhea?

A: There are several question here, however the first thing is to slow the diarrhea that is such a problem with Crohn’s Disease, Ulcerative Colitis and Irritable Bowel Syndrome (IBS). Slowing diarrhea can help good bacteria from pro-biotic supplements or fecal enemas become established faster and more effectively. Here are several different options grouped by category.

1) Anti-spasmodic drugs

These drugs calm the muscles in the bowels which slows urgency and the frequency of diarrhea that you have.

Immodium (generic: Loperamide) an over the counter drug which calms muscle spasms. It is effective, however it only lasts 4 hours and make interact with certain medications.  This can also be used before you may have diarrhea, for example an hour before you eat or before the Fecal Transplant enemas.

Anti-depressants or anti-anxiety drugs – Many anti-depressants, especially tri-cyclic anti-depressants are anti-spasmodics, that is they also slow muscle spasms and responses in muscles in the intestines which slow the rate of bowel movements. In patients without digestive disease many drugs considered to be anti-spasmodic can cause constipation. However if diarrhea is a problem, this can be a good way to treat it.

I had good results with the drug Silenor (Generic: Doxepin 6 mg tablets) which is prescribed for sleep maintenance. However Silenor is just a lower dose of Doxepin an off-patent tri-cyclic anti-depressant which might be even more effective for slowing diarrhea for an extended period of time at higher dosage levels. Side effects can include drowsiness.

Gas-X (Generic: Simethicone)

This is not an anti-diarrhea drug itself, however Simethicone helps ease bloating caused by gas which often happens along with diarrhea and can contribute to urgency. Immodium Advanced is a drug that contains both Loperamide, an anti-spasmodic and Simethicone.

2) Supplements

Peppermint Oil – I found this to be pretty effective with the added advantage of fresh breath. Peppermint oil is a natural anti-spasmodic. You can get this from Peppermint candy that has actual peppermint oil in it like Altoids, or Peppermint tea. However enterically coated peppermint oil capsules like Pepogest and Peppermint Plus are more effective because the oils are not digested until they reach the intestines.

Soluable fiber (Benefiber) – This is very helpful as a stool thickener, it helps soak up excess water and also is a good pre-biotic which can help “good” bacteria from fermented foods, yogurt and pro-biotic supplements become established.

Digestive enzymes and pro-biotics – Health food stores like WholeFoods has the best selection, however you can also find effective ones at drug stores and grocery stores. Basically enzymes like lactase that help break down the lactose in dairy foods and others like Beano that includes enzymes to break down the sugars in certain beans, fruits and vegetables. However it might be more helpful to just avoid some foods like dairy and other foods which have a higher chance of causing digestive problems.

3) Foods and dietary changes

A basic rule of thumb is to eat foods that thicken stool and avoid foods that are high in fiber or stimulate the muscles of the digestive track.

Low residue diet – This basically includes avoiding food and drinks that are irritating to the digestive track including those containing caffeine. Other irritants to avoid include foods with high amounts of insoluble fiber including nuts and many fruits and vegetables.

Eat foods that thicken stool

This comes from the old stand-by of the BRAT or bland diets that have been used for many years to combat active diarrhea.

Applesauce and bananas contain soluble fiber, a form of fiber that may thicken your stool by absorbing water from digestive wastes. Apples and bananas also provide potassium, a mineral that you may lose if you have watery stool.

Banana bread – In the midst of persistent diarrhea I have sometimes basically lived off of banana bread which helps thicken stool. I used the recipe from the aforementioned link, although I later substituted rice flour for wheat flour while attempting a gluten-free diet.

Bread, pasta and rice also contain starches and fiber that can help bind watery stools. Eat refined white breads, cereals, pastas and skinless potatoes rather than whole-grain breads and cereals to prevent diarrhea. I tried substituting gluten-free breads, however they did not always offer the same amount of stool-thickening help. I think this may be because they had more insoluable fiber.

So there are a few ways to deal with diarrhea and urgency, often before it happens, and also to enhance your ability to retain a fecal enema.

Comments

  1. betty markosovic says:

    Dear Reader,
    The article above makes no sense to me: IBS basically arises from our habits of eating the wrong diet, namely that of grains, and specifically WHEAT which is laced with very poisonous toxin called ‘mycotoxin’ known to irritate the digestive system, hence our problems with COlitis and other bowel problems. That said, I would advice to not eat either Corn because all corn is GE hence its full of same toxins. So what’s left? well… eat organic as much as you can efford it, but stay away from even organic wheat because wheat has been GE over decades and its a grain our ancestors did not invent and so our digestive system is still in the process of getting use to. But on the bright side: search for bread that is made from ancient grains like our genes, so it is: Millet, Spelt, Quinoa, Korahsan=Kamut, rye. Also I ahve discoverred that even with organic wheat I would get cravings for sugar and so my Hypoglacemia would take effect and I would often faint. SO now no wheat = no Hypoglacemia= no fainting = no sugar cravings = weight loss!!! I have proven my doctor very wrong!!!

    • Thank you for commenting. I assume you meant to address your comments to the writer or author of this blog rather than another reader.

      As you have seen on my blog, I tried many different things to resolve a severe case of Pan Colitis which lasted for 12 years and from which I was on the brink of surgery. Perhaps I should be more clear in this article that all the things I describe were things that I did myself to help the Fecal Transplant process and successfully CURE myself of Ulcerative Colitis. While I have been symptom free for 15 months after 12 years suffering from Ulcerative Colitis (Pan Colitis) and I am not taking any drugs to maintain my current state, I still do have Irritable Bowel Syndrome (IBS) symptoms sometimes including diarrhea and gas. However I have not had a flare which resulted in blood in stool since immediately after my last colonoscopy. As far as I can tell I have not had any more bleeding ulcers in the intestines.

      For years the bland and BRAT diets were commonly used to deal diarrhea from IBS. My Grandma went on the bland diet while in college to deal with IBS.

      The impact of diet is something that I considered early on when trying to deal with Colitis. I was raised on the Feingold Diet to help with ADHD and continue to mostly follow the diet as an adult. To address Colitis I tried Specific Carbohydrate Diet (SCD), a gluten-free / dairy-free diet, even a liquid elemental diet. My experience was that diet alone or combined with drugs was not enough to bring about a sustainable remission. To the extent that I was not getting adequate nutrition to repair damaged body tissue, overly restrictive diets might have made things worse by slowing recovery from flares to the point where it was one chronic flare. I was not aware of this until I learned from blood tests that I had a low red blood cell count and low albumin levels (proteins required to repair damaged intestinal walls.)

      Now that I am not strictly following any of those restrictive diets I still attempt to avoid problem foods. This includes unfermented dairy, I try to avoid cow’s milk, although I still eat yogurt and cheese. I also try to limit the amount of vegetables and fruits, fibruous citrus fruits seem to cause diarrhea. Essentially I try to avoid foods that cause gas, diarrhea, etc. however I have had these symptoms for my whole life, so I generally just suck it up and deal with it. Many trigger foods contribute to symptoms that resolved within a day or two, not a flare with blood in stool. Emotional stress definitely plays a role, probably because it interfere’s with digestion and impacts neurotransmitter levels which impact bowel motility. I have found Valerian root extract to be effective in reducing diarrhea in ways that are comparable to anti-depressants.

      I think that while chronic diarrhea CAN contribute to inflammation and ulceration by creating an environment which favors certain pathogenic bacteria and makes it more difficult for other helpful or otherwise benign bacteria to colonize, it does not necessarily mean diarrhea will lead to ulceration without the prescence of certain harmful bacteria.

      As for stool-thickening foods and avoiding wheat, it is quite possible to do. I made stool-thickening banana bread using rice flour in an attempt to avoid wheat and bought gluten-free bread products. I looked into gluten being a problem food and can’t rule out that it isn’t. However I can say that bread does not cause gas or diarrhea for me, instead it seems to thicken stool.

      So, while I can’t speak for everyone I can say that in my experience, while diets may have helped somewhat at times they were not a cure by themselves. What was helpful for me was.
      – re-colonizing the gut with bacteria that suppress or kill off inflammation-triggering bacteria.
      – Avoiding foods that speed bowel transit time while having active diarrhea and instead choose foods that slow transit time and thicken stool.
      – Getting adequate nutrition for the body to rebuild, this includes iron, pre-digested protein and other vitamins and nutrients.
      – Calming my gut to slow bowel transit time. This includes using anti-depressants and later certain herbal supplements like Valerian while avoiding others like St. John’s Wort which seems to stimulate rather than satiate the gut. Once again this helped by slowing bowel transit time.

      Once again I invite anyone to try what I did or share what has been effective for them and what results your plan of action has yeilded. And if you run into any challenges or obstacles just ask.

  2. Hi! I would appreciate your feedback. Right now I am on day five of fecal transplant enemas. I am under the care of a regular doctor who does research at a University. He has also done years of treatment and research with fecal transplants on C. difficile patients. Following his protocol, I did 6 1/2 days of antibiotic conditioning. I took three types of antibiotics and also nystatin and antifungal for that time period. Then I took Picosalax to clear my system on the morning of December 20. In the afternoon of the same day I ingested 27 triple coated pills containing good bugs in my donors stool. The doctor wanted to commence the enemas that same evening, however, there was not enough stool sample to do an enema as well. On December 21, I ingested 34 poop pills, and later that evening we did the first enema. After the first enema my husband and I have been doing them on our own since the doctor could only train us how to do it that first time. So now we are doing this procedure in our own house using all our own equipment probably much as you did.
    I am so happy to have found your blog, I have begun to get discouraged with this process. Your blog is encouraging! The biggest problem, is that I have only been able to retain the enemas for about six or seven minutes. My colitis has been quite bad for about four months. So, the doctor Has speculated that if we did the antibiotic conditioning for two weeks instead of only six days, maybe the enema would be easier. At any rate, it’s too late to go back to that now, unless I were to completely start over. But I am taking your hint at trying to use
    Imodium to help with the muscle spasms. For the enema this afternoon, I will take Imodium one hour before. I really hope this might help! The doctor had actually suggested taking Valium, but this drug seems a bit too extreme for my liking. I would rather stay away from it.
    I also found your comments about small flares that happened during the recovery process to be useful. A few days ago, I noticed that the blood was gone from my diarrhea. This lasted about 48 hours. But, this morning it’s back again. So, I am encouraged by what you have written, and I will not give up yet! Actually, my doctor told me to do the enemas for seven days straight. After the initial seven days, he has Told me to do the enemas chest once a week. I think I will discuss with him about your suggestions, and see if he thinks a longer duration might help.
    God bless you, and thank you so much for the encouragement and for sharing your recovery. If you are the type who prays, please say one for me! I am finding this process Very tough. Thank you! Catherine.

    • Hi Catherine,

      It looks like you’ve got a lot of good things going here. I just noticed you had already posted this after responding to the other post.

      True, a longer course of anti-biotics might have been helpful in terms of reducing the amount of bacteria that the donor bacteria has to compete with, however as you mentioned that ship has sailed unless you want to start over, which may not necessarily be a bad thing since you will be much more experienced and efficient in your approach if you started again from the top. I was still able to be successful without pre-treating and I think after a certain point where the new bacteria has at least partially colonized then slowing bowel transit might actually be more effective than continued enemas. Interestingly enough, my big breakthrough happened after I had taken a week off of the enemas and then started taking anti-depressant drugs with anti-spasmodic properties (Silenor 6 mg and then later about half of a 10 mg capsule of generic Doxepin) as well as Buproption Immediate Release 100 mg.

      I think your doctor is on the right track by suggesting Valium, and think it would be more effective than Immodium in the long run since it lasts longer, whereas Immodium needs to be taken every 4 hours. I think that anti-spasmodic drugs that either take longer to break down will be more effective in helping the new bacteria colonize this includes a variety of anti-anxiety or anti-depressant drugs. As I mentioned above, Valerian root standardized extract has been a cheap and highly effective supplement not only for better sleep / being more calm, but for also for lack of urgency and better-formed stool. As long as it does not irritate the bowels I think it could possibly be as effective as prescription anti-depressant or anti-anxiety drugs.

      So based on my experience I think limiting number of bowel movement per day is key to establishing the donor bacteria. I also think continuing the enemas every day past about a week might not have helped and might have actually slowed the bacteria becoming established because it triggered continued bowel movements. In addition to this, being able to get adequate nutrition in the form of vitamins and protein to rebuild the intestinal walls will also help speed your recovery. Another thing I never considered at the time but that might also be helpful are vitamin injections (like B12 or B complex) and / or lozenges to help get nutrition without irritating the bowels and with much better absorption.

  3. Catherine says:

    Thank you very much for the reply. Yes, you suggested that maybe we should just start this over from the top, and that is indeed what we are doing! You are right, I now know much more about the process and I am very hopeful that it will work this time. i just started Wellbutrin, 300 mg per day, yesterday. This was a direct result of your advice, so thank you very much! Also, I have been feeling very discouraged and down lately. So, I figured That The anti- anxiety element of this drug would also be helpful. The doctor agreed, and I have noticed an improvement in my symptoms. It’s probably too soon to say, but the last 24 hours were much better in terms of Less trips to the bathroom.
    This time, I will be on the antibiotics for a total of 17 days. I am also sending in a stool sample today, as the doctor has requested, so he can find out if I have antibiotic resistant bugs. This could alter the type of antibiotics that I take.
    It’s a funny thing how this disease works. A person really wants to do a fecal transplant because he or she is so very sick. But then somehow, this person needs to get better, (quite a bit better) before The fecal transplant can work and be effective. I did not realize this before, so I really hope that this time my colon will be significantly healed.
    I am curious if you know anything about the type of “poop pills” That my doctor is using as part of this process. Because the enemas didn’t go so well for me last time, he has proposed that I could possibly solely take the pills this time. This makes the treatment more complicated though, because I don’t live in the same city as the doctor. Do you think the pill method is equally effective as an enema? I don’t think there’s enough research to actually know the answer to this question, but I am curious what your opinion would be.

    • Wellburtin did seem to help for me and the likelihood of side effects is comparable to other anti-depressant drugs at 300 mg per day or less. I started by using the immediate release 3 times a day because that is what I heard some other people used, however I later switched to the once a day version with good effects too. Also iron supplements can be taken in much higher levels than the recommended daily allowance if you are actively losing blood. Liquid iron supplements or forms of iron that are more gentle on the digestive track like Iron Bisglycinate can be very helpful.

      In the short term, using Prednisone to get a flare under control along with high amounts of pre-digested protein supplements can be helpful. In my case going back on Prednisone for a short period of time allowed me to rapidly taper off of it, but I think it helps by stimulating my appetite and giving the gut a chance to heal a little too.

      In my case stool tests did not reveal any known bacteria or parasites in my stool. This leads me to believe that it was a pathogen or pathogens for which there is no test, but that donor bacteria could kill off or crowd out by being more dominant than the bacteria that caused the inflammation.

      I had not heard that “poop pills” were available yet, although the ease of dosing would make this an attractive option – as long as you don’t think about what is inside the capsule too much. However I have my doubts for how effective they would be for Ulcerative Colitis which is confined to the colon. Without knowing specifically how this capsule works I think it’s possible the bacteria could be mostly released in the small intestine or the upper part of the colon and aren’t making it down the colon or to the lower part of the colon and rectum. My illness started in the lower colon and rectum and then progressed up through the colon while most of the worst inflammation stayed in the lower colon and rectum. This is why Mesalamine suppositories and enemas were more effective for me than enterically coated tablets like Asacol – they made it to the site of the inflammation without being diluted.

      In any case I don’t see any reason why the “poop pills” or nasal gastric tubes would be effective for Colitis while the enemas would not be. No matter how the bacteria are introduced to the colon or where they are introduced they need favorable conditions to colonize which means:

      – Calming muscle spasms and diarrhea (anti-depressants, Immodium, foods and fiber supplements to soak up excess water) as well as limiting the number of bowel movements as much as possible.
      – Limiting further inflammation and ulceration of the cell walls, in the short term this might mean Prednisone, which was part of my path to health. If it is only taken for a few weeks such that your addrenall glands have not shut down yet, you can more rapidly taper off of it than if you have taken it for months at a time. As I shared in my story, my GI doctor instructed me to rapidly taper off of Prednisone.
      * However caution should be used when taking Prednisone due to its possible interactions with other drugs like Bupropion and impact on blood sugar levels. Prednisone can lower seizure threshold so don’t take when you are hungry if you are sensitive to low blood sugar, wait a half hour to an hour after a meal before taking it and consider not taking it within an hour or so of taking a dosage of Bupropion. Doing these things will limit the low but possible risk of a seizure.
      – Adequate nutrition for the intestinal walls to rebuild (especially protein) will be very helpful as well. Your blood Albumin levels might be low after extended period of inflammation in addition to red blood cells. Pre-digested protein shakes with high amounts of L-Glutamine in them will help the cell walls rebuild. Most body builders shakes like Muscle Milk, which is what I used, contain this and contain much higher amounts of protein per serving than other meal replacement shakes like Ensure. B Vitamins could also help too by helping to overcome anemia (try losenges liquids or injections for better absorption along with iron supplements – I used a liquid supplement called Angstrom Iron.

      I think part of the reason Prednisone was so helpful for me was that it stimulated my appetite so that I got adequate nutrition in addition to limiting inflammation. When I was taking Prednisone while trying to maintain a highly restrictive diet I didn’t get better. If you don’t want to go back on Prednisone then an all liquid diet of meal replacement shakes or protein shakes plus rice milk and olive or other oils and for a few days followed by a limited bland diet with starches like white bread, rice and bananas while still taking protein shakes several times a day could be an alternative to Prednisone too.

      I think that since you can do enemas at home without a doctor’s visit it is worthwhile to try those out. Or at least give the Wellburtin a chance along with protein shakes and a BRAT diet to calm things down a little before going back to the “poop pills” or enemas.

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