Any suggestions for how to improve my poos

[Handloomweaver]

Hello all. My apologies for the title of this post, but I didn’t know how to phrase it.

I was diagnosed with GCA in January 2023 and have been on Prednisone ever since, along with other meds that are given to mitigate the side effects of the Pred. I also started Methotrexate this January. My first attempt to taper off the Pred last year failed because I went too fast. I got down to 5mg (without Methotrexate), my GCA symptoms returned so I was put back on 20mg in September but with a much slower tapering plan.

Now I am on 8mg Pred, about to taper to 7mg, and feeling well and positive, except for one thing. My poos are really wet ( No 4 on the Bristol stool chart I think) and it takes 4-5 trips to the loo every morning to deal with. I have no stomach pain, I eat plenty of fibre as I have mostly a plant based diet. My CRP level in below 1 every month when tested.

I just can’t seem to get my bowels to act normally. This has been going on for months. I expect this is probably being caused by the cocktail of meds I am taking - Methotrexate, Prednisone , Omeprazole, folic acid, Alendronic Acid, statins, and Vitamin D.

However, I am wondering if there is anything I could be doing to improve this? Suggestions gratefully received.

[PMRpro Ambassador]

If it were me, I would start with the omeprazole! I would ask to switch to a different stomach protection medication, preferably an H2-inhibitor such as famotidine or cimetidine or another member of that group of drugs. Omeprazole has form for causing GI problem despite being for gastric benefits.

If that doesn't make a difference, I'd also ask to stop the AA for a while until you have got some evidence.

It is obviously bothering you but I think that means it isn't a No 4 - it is one of the healthiest stool forms!! 6 or 7 is really loose ...

verywellhealth.com/bristol-...

PS - don't stop too much at one time because you won't know what is what!

[Handloomweaver in reply to PMRpro]

Thank you for your suggestions. I thought No 4 was the only one that looked close, but my problem is much softer, more messy, and very lightly coloured, also there is such a lot of it! So I didn’t identify it as ‘healthy’.

That aside, I was wondering about the Omeprazole. I think I will start by ask my Rheumy about changing it. I have access to an Adviceline which is very helpful.

Kind regards

Mary

[PMRpro Ambassador in reply to Handloomweaver]

If they aren't helpful, try the GP. They can do it too. Whether they take it seriously is another matter. But you can get H2 antagonists OTC so you could speak to the pharmacist too.

[SheffieldJane in reply to Handloomweaver]

Lansoprazole seems to have the opposite effect on me, you could try stopping your Omeprazole for that - you might get it just right. I have had some success with capsule form fibre Psyllium. My bowels are often unhappy with diagnosed Diverticulitis and possibly sensitivity to some drugs and maybe IBS.. I occasionally take stool softeners if it goes too far the other way. Do you experience pain? It may be worth seeing a gastroenterologist to ensure that nothing else is going on as opposed to drugs side effects. Some of the things we take are pretty harsh and can damage the GI system as I discovered.

[Merryfield]

If it were the other way around, I could help🤪 Sounds like you don’t just a poo problem. Phrased another way, you could say you have persistent diarrhea, which sounds like a medical issue to talk to the doc about. Whether meds, or something else, could be time to get to the “bottom” of it.

[marionofnorwich]

I get a similar problem if I take Lansaprozole which is supposed to protect my stomach but just gives me very soft sticky stools. I believe that Omeprazole is similar. Also question whether you need Alendronic Acid. Have you had a Dexa scan to see if you have any sign of osteoporosis?

[Sophiestree]

have you tried inulin or a probiotic.

I have a similar issue which was completely different to the whole of my life so a big shock. Inulin works too well for me but if it's bad I do take it.

I have found that red meat is now a big no no.

[Karendeena]

Lansoprazole did this to me when I started with PMR in 2021, I have never been the same since. Switched to Famotidine and saw improvements but bowels have never really recovered fully

[Broseley]

As most of you know I have had persistent morning diarrhoea for the last year or so. I tried stopping omeprazole, stopping AA, pre and probiotics of all kinds and nothing worked. Stopping red wine helped a bit. I could not find any link to my diet. A colonoscopy was normal.

Someone on here, who I would like to thank but can't remember their name, suggested Saccharomyces Boulardii. I bought some capsules and take them daily. The diarrhoea took about 3 weeks to stop but now my bowel movements are normal and have been for over a month. I get more wind, but that is normal for me. I am so pleased and so grateful.

[Handloomweaver in reply to Broseley]

Wow. I am so glad that you found something that works for you. I assume you are still needing to take the PMR or GCA meds? I will look into trying Saccharomyces Boulardii. thank you

[Broseley in reply to Handloomweaver]

Yes I still take pred and all the associated meds! Good luck with your efforts!

[S4ndy]

I agree with PMRPro, the Omeprazole might be your culprit. It certainly was with me. I am on an H2 antagonist instead, Cemitidine, which certainly eased the problem. I have IBS anyway and have identified the foods that cause me to flare by doing the FODMAP diet. I am rarely constipated, more often normal unless I deviate and eat something I know affects me like Mango or Apple. However, I am also on opiate type pain meds and paracetamol and don't get constipated so that's a bonus

[Handloomweaver in reply to S4ndy]

Thank you for your insight. Much appreciated.

[dphu]

Any stress can trigger auto immune diseases. Have you considered that the ‘stress’ factor of having GCA may have triggered Coeliac Disease? There is a blood test that can identify If that might be a possibility. CD symptoms are many and varied, sometimes none at all. I was diagnosed from having ongoing low hemoglobin.

[anutycrixp in reply to dphu]

Body changes over time naturally as we age. You may need less fibre.I have noticed this myself and friends have suffered like this as well. However persistent diarrhoea should be medically checked out.Try simple to start, reduce fibre.After all the quantity must come from what’s going in! Best wishes

[Maisie1958]

I had horrible stomach issues when using Omeprazole briefly. It sounds as if your problems started before using MTX but it did make me looser in the first 6 weeks or so, fine now. The improvement also coincided with an increase in folic acid tablets to 5mg six times a week rather than once weekly. Conversely a friend had more problems with the folic acid tablets than the MTX. Sorry not much help but hope you get sorted. All the best .

[gingerraspiller]

I take anti-diarrhea medication Loperamide (Imodium) at the first sign of softening stool. It has been an on-going issue for me throughout. I also added psyllium husks to my diet but that alone doesn't take care of it.

[Handloomweaver in reply to gingerraspiller]

I was wondering about taking that, thank you

[potterylady]

I have the opposite problem! Yikes.

[Rosebud17]

I would reiterate what PMRpro says, Omeprazole caused very loose stools with me. After pro’s advice I asked my GP to change the prescription and he precribed Nizatidine which is fine. I have also upped my intake of live natural yoghurt and a daily probiotic capsule to recolonise the gut with some ‘good’ bacteria. All systems go nicely now😊

[Handloomweaver in reply to Rosebud17]

Brilliant! I’m going to follow that up with my GP. Thank you.

[Rosebud17]

Good luck!