Diarrhoea

[LMali]

Hi, I posted here last year when I was very sad and in pain and you were enormously helpful. On advise from this community and endorsed by GP, I increased my dose of pred to 8 mg and now back down to 5 mg, exercising regularly and feeling pretty good.

One of my many sources of sorrow last year was persistent diarrhoea. That cleared up, tests revealing nothing. I have had it again this week although feeling no other symptoms. I did a lot of reading about adrenal insufficiency / steroid use. I am sure I read somewhere, that if you have diarrhoea, you should double your dose of pred. Which seems a bit of a bald statement and I cannot re-find it. It is true that the diarrhoea went last year when I increased to 8 mg but maybe it would have cleared up anyway? The only other tiny coincidence is that I have had diarrhoea on Tuesday and Thursday morning this week, after going swimming Monday and Wednesday evenings. Surely not?! The diarrhoea does not make me feel bad, but it is a worry. I know it can interfere with absorption of nutrients and medication. If that advice is true (double pred dose) is it just to counteract the washing away effect of diarrhoea, or does it actually cure the diarrhoea?

[SnazzyD]

Hello, when you say diarrhoea what do you mean exactly? What is the frequency and amount (in whatever measure you see fit!) and for how long? Does it smell particularly bad? What colour is it? Is it particular times of the day? Does your stool return to normal at any point?

[LMali in reply to SnazzyD]

So I woke this morning at 5 am and it was liquid, bad smell. I went again at 7 am and then again at about 7.30. Both liquid and bad smell. I think it is all out now. It is brown. On Tuesday similar thing, 2 or 3 visits, very liquid, bad smell, all out after a couple of morning visits. Around 2002 I had IBS which lasted about 2 years. I also had RSI when I was about 25. I did wonder, when diagnosed with PMR whether I have some kind of pre-disposition for inflammatory conditions.

[PMRpro Ambassador]

I can't think of any reason for doubling the dose of pred just because of diarrhoea unless it is severe and persistent enough to make you feel ill, Pred is absorbed from the stomach within an hour so I doubt diarrhoea would affect that.

There are many reasons for bowel irregularity and it isn't unreasonable to speak to the GP about it. It is a symptom seen in some primary adrenal insufficiency patients - what we have is secondary adrenal insufficiency but similar symptoms may occur. This

ncbi.nlm.nih.gov/pmc/articl...

suggests that there is some similarity to IBS (irritable bowel syndrome) and also suggests that patients tend not to mention lower GI problems possibly related to adrenal insufficiency as often as upper GI gastric symptoms so it is possibly more common than they think.

If it IS adrenal insufficiency, a bit more pred will probably improve it.

[CaraDee]

Are you on lansoprazole or alendronic acid?

[LMali in reply to CaraDee]

Alendronic acid

[PMRpro Ambassador in reply to LMali]

Alendronic acid can lead to bowel problems so it might be worth trying some time without without taking it to see if it could be that

[Marijo1951]

Do you take methotrexate? I ask, because I had diarrhoea when I first started taking it at 20 mg per week. I told my rheumatologist and she reduced the dose to 15 mg which evidently did the trick as the diarrhoea stopped. I stayed on 15 mg for some time and it was later reduced to 10 mg, and I haven't had the problem since.

[LMali in reply to Marijo1951]

No, I just take Pred.

[agingfeminist]

speak to your gp and meanwhile get over the counter loperamide/ imodium. Take 2 tablets immediately after a bout of diarrhoea. Follow the instructions on the leaflet for subsequent dosing. It can help enormously but also keep your doc in the loop. Hope this works for you.

[Thelmarina]

Hi - as this either has an underlying cause, is a response to your meds or an adrenal issue I would advise talking to your GP (if you’re in the UK) or rheumatologist before taking any other action. It sounds as if you could do with a scan or even a colonoscopy. I had the one and was discovered to have diverticula’s disease and a large polyp requiring removal with the other! The only other support for your gut that you could seek is a reputable probiotic and live Greek yoghurt, full fat. All best 😀

[Broseley]

You could also try a prebiotic such as psyllium. It's just soluble fibre and helps your gut to absorb water. I have had persistent diarrhoea for a while now, once or twice a week. It occurs in the mornings only, but takes me unawares so on a bad day I can't go anywhere and have to stay near the loo. No pain, just gurgling then an emergency dash. I think I have finally cracked the cause: I have developed an intolerance to red wine! I've stayed off it (had white wine instead) and had no trouble.

The problem with loperamide or immodium is that it can stop you up, so don't take any more than is really necessary. You do get cramps as a result of this, and I feel more unwell than when I have the diarrhoea.

[PMRpro Ambassador in reply to Broseley]

Have you tried an antihistamine? My response to red wine was similar to yours but far more extreme ' woken with a gurgling gut about 2am which eventually had a similar ending to yours but utterly horrendous. The immunologist said typical food reaction - try an antihistamine before unkonwn red wine! Worked a treat, confirming her suspicions. ANd in fact, if I took a double dose when I woke with the signs, it went away/

[Broseley in reply to PMRpro]

Thanks! I'll definitely give that a try, and get back to you!

[Sophiestree]

Since diagnosis my intestines play a constant game. Prior to investigations it was the opposite (common with an underactive thyroid) where I would be lucky to go to the loo 3 times a week, then suddenly twice a day. If I overdo it on anything I pay the price the next day and feel I can't really go out just in case I need the loo. It is a new phenomenon for me but I am now working out what to do. I did have issues from my LVV with my intestines and liver and guess that's all part of it. Never been so regular in my life! However, having said that, if I don't eat food that would help in that field, then I won't go to the loo at all, so it's all a guessing game sometimes.

[Jbobby]

I sympathise. Isn't it the case that Pred causes leaky gut (or symptoms equivalent to SIBO)? The longer you're on it the more it plays havoc with your adrenal function, raising your cortisol levels, as does stress. I don't know if you take supplements but I also find that certain magnesiums don't help. I've recently moved to Magnesium Glycinate and things have improved. It was suggested to me to take a probiotic too..... Ive also stopped taking AA as it had other side effects I couldn't cope with. I think PMRpro has good info on all this...

[PMRpro Ambassador in reply to Jbobby]

Not sure where you got your information from but your assessment of the effect on adrenal function is the opposite of the case - while pred is present the body registers that LESS cortisol is required as there is adequate corticosteroid for the body to use in the areas where it is required so stops producing it.

There are alternative practitioners who allege pred causes leaky gut - probably on the basis of a single study suggesting that this happens (sorry, don't have a reference) - but there are also studies suggesting that pred improves disrupted epithelial function due to cytokines. I', no expert but I suspect that really the jury is still very much out on the fact.

[Jbobby in reply to PMRpro]

Apologies...think I had a bit of brain fog when I wrote that. yes, I know less cortisol is required. I should have left it at 'plays havoc with...'

[PMRpro Ambassador in reply to Jbobby]

No probs!!!