Functional IBS and uncontrollable diarrhoea - what can help?

My IBS-C has recently become IBS-D and I have had several bouts of uncontrollable diarrhoea. I have been seeing a gastroenterologist who has done every possible test all of which have been clear. He told me on Friday he could not help me any more because it was "functional". I do understand what that means! This has triggered a bad bout of diarrhoea. I am taking colpermin and dicycloverine hydrochloride for pain and they work well. Could either of these be causing diarrhoea. I don't find that what I eat affects me. Any advice on how to deal with functional IBS gratefully received.

[Boogie]

My understanding of functional is that there is not a knows cause of the problem but the function of the bowel is affected. This (again my understanding) could mean your neuro system may have got out of sync and its telling your bowel to move the contents through fast - so causing diarrheoa. It could be you have been triggered by a minor tummy upset that has thrown the bacteria in your gut out. There is any number of things that can alter the function of your gut - hormones, neuro, learned habbit, stress, bacteria and probably a lot more besides.

What he means by functional is acknowledging that you have a problem with the function of your gut but there is nothing showing on any of the tests he knows to do that is out e.g. your bile acid is fine, bloods good and no obvious bacteria overgrowth in small intestine and you don't have a serious pathology - cancer, celiac etc.

IBS is classed as a functional disorder so its all the usual things people suggest to try - diet control, hypnotherapy, acupuncher, mindfulness or meditation etc etc. The evidence base is not good for most of them so its just trial and error to find what works for you.

Regarding your medication, if it says on the info leaflet they they could cause diahhoea then there is a chance they could be. Do not stop them as they give you pain relief, go and speak to the pharmacist for ideas of alternatives then go and speak to your GP, or just go straght to GP. I suggest pharmacist as they specalise in drugs and a good one might be able to give you so really good advice on what to ask your GP to try. Your GP is always the decision maker but he or she may appreciate you taking a interest and trying to help them get you right.

If your don't have a dietician now ask your GP at the same appointment for a referral. The bacteria in your gut might have changed and foods that once agreed with you are now causing you probs. A good dietician can help you figure out what to try.

Good Luck

[Hidden]

Thanks Boogie - that is very helpful. It is very much how I understand "functional". As you say it is trial and error as to what will help. When I first saw this gastroenterologist I was taking Colestyramine on the suggestion of Dr. Read. I was told to stop this but I must admit I have dug it out again as I am not sure if the bile acid test has been done and it certainly helped the diarrhoea. I will also talk to the pharmacist as you suggest. My own GP is away next week and I am away the weekafter to it is some time before I can see him. I could see a partner but I know my GP very well.

I have to admit I was very disappointed that after he had told me he could not help me any more he would not give me any advice at all.

[Hidden]

Have you tried a dairy/lactose free diet - that controls my symptoms.

Also a lot of tablet medication contains lactose including immodium and ibuprofen

[flirtygert]

Hi Brandywell, I also have been diagnosed with a functional problem after over 4 years of tests. At first my symptoms were only occasional but now I suffer almost daily. (morning diahorrea, nausea, fatigue, headaches, dizziness). Thankfully I dont work and my mornings are usually spent in bed with a hot water bottle if I am feeling really crampy, or lazing around on the sofa watching tv. I am 42 but my 82 year old mother has more energy. I have lost intests in so much and really feel for my 3 children who have to hear the usual (cant go there as mummy not feeling well!!!) Thankfully my morning rush is just that (in the mornings) and if I have energy I can go anywhere in afternoon without worrying. My gp is now advising me to keep a food diary for the next 2 weeks plus a stool diary (yuk!!) to see if anything I am eating is causing this. he is also repeating my coeliac and lactose screening. It is so frustrating as no one knows what its like to not feel well on a daily basis.... initially I lost quite a lot of weight (not eating due to nausea) but most of it is now back on. I am so grateful I have nothing worse (Crones, UC) but would love to get this sorted. The next step is to see a dietitian with my gps findings and after that maybe antidepressants which have been proven to help IBS. If i could get the morning problems, nausea etc under control I would be happy.

[mary53]

Hi Hubby had D for many years limiting daily life. Now at the age of 60 diagnosed with Bile malabsorbtion...ended paying privately for the bile radiation test. Now on colostymin (dont know how to spell it). Life changing experience. Now able to fly and go out for meals etc. Not completely perfect but sooooo much better. What I am trying to say is if you haven't been tested for the bile thing then it is a thought.

[Grandad3 in reply to mary53]

Hi Mary53 - your Hubby's previous condition which limited him going for meals and flying etc... sounds very much like my current lifestyle - you say he is now on "colostymin" - can you double check the spelling as I tried to google this with no result.

[mary53]

hi I had to wait until I was home. This is a wiki entry google.co.uk/url?sa=t&rct=j... stuff is called Cholestyramine and the brand name is questran.

I do hope that this helps. One of the signs of bile acid problems is D with urgency with stools being yellowy on occasions (Hope not too much detail). Hubby had to fight to get test. When he saw the consultant she would not believe him but agreed that he was right after the radiation test.

Hope this helps mary

[mary53]

Hi I have copied this from some one elses post here.

To everyone who has diarrhoea-predominant IBS please read this…

10 replies

About 3 months ago my GP prescribed me a trial run of cholestyramine as she’d been looking into bile acid disorder (BAD) as one of the causes of IBS-D (which I'd had for 3 years) and this medication seemed to be very successful in treating it. I can’t tell you how glad I am that I gave it a go!

Results were almost instant – no more diarrhoea (1 bm per day only), no more pain, nausea, gas or bloating and the freedom to eat whatever I like – high FODMAPs included.

It’s taken me this long to put this post up on here as I’ve been trying out all the foods I was previously unable to eat just to be sure of what I was saying but, as I’m pretty certain I’ve now got through them all, it’s time to pass on the info.

It's taken me a while to get the dose right as it’s very much an individual thing and I still fiddle around with it depending on what I'm going to eat and when.

I recently came across an article on the web about BAD and, very interestingly, the following quote from the IBS Network’s Dr Nick Read was included in it:

‘I diagnose bile acid malabsorption quite frequently in people with IBS and I find that cholestyramine is a very effective treatment. I’ve seen patients who have had diarrhoea for years dramatically improve using this treatment. Unfortunately, the impact of bile acid malabsorption in IBS is not well recognised. I would estimate that fewer than 20 per cent of gastroenterologists treat it.’

The only time I have any problems is if I don’t measure the dose properly and overdo it, I then get a bit of wind and bloating - and that serves me right for not taking care!

I hope this helps somebody else out there.

Roz

[Hidden]

Dr. Nick Read suggested cholestyramine to me some time ago and I took it and found it worked. When I saw the gastroenterlogist last November because of other problems, he told me to stop taking it so I did. Luckily I still had some in the cupboard and got it out three days ago and it is working already! I don't think I have had the bile malabsorption test but I don't think I really need to as the cholestyramine works. It is amazing to me that so few gastroenterologists take this problem seriously!