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Suggest Treatment For Persistent Diarrhea In An Elderly Person

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Posted on Mon, 19 Dec 2016
Question: Hello. My 91 yr old father has had diarrhea for the past 2 weeks. He was finally diagnosed with an e coli infection 2 days ago and given flagyl to treat it. Is that a common treatment for this infection?


A little more information.
He had severe diarrhea about 2 years ago that was never really diagnosed. Flagyl was prescribed at that time too. When it didn't work, his Dr. ordered a Colonoscopy. Nothing was found but the diarrhea immediately stopped after the test was done. My Dad is insisting that he wants to do the colonoscopy prep now because he is sure that is what stopped the diarrhea last time. My main question, is it safe for him to do the colonoscopy prep. He is very frustrated, weak and feeling pretty desperate.
doctor
Answered by Dr. Rahul Tawde (1 hour later)
Brief Answer:
Following diarrhea remedies...

Detailed Answer:
Hi XXXX,

I am sorry for the health situation your father is going through.

Your father 91 years old is having diarrhea for the past 2 weeks. Already diagnosed with E.coli infection.

Please keep in mind that E.coli is found normally in the colon. However, some strains like E. coli 0157:H7 can cause fecal infection. Treatment is based on stool culture and sensitivity testing results where the most susceptible antibiotic is found.

Usually, e.coli is causing urinary tract infection (UTI) but rarely can cause stool infection.

If susceptibility testing is determining metronidazole as the most sensitive drug, then, it can treat it adequately.

However, probiotics should be added to the therapy to stabilize intestinal flora; pepto bismol or tasectan to stop diarrhea. Oral rehydration salts are recommended to restore the lost fluids.

Colonoscopy prep contains a laxative preparation to clean your colon before coloscopy is run. Plus it contains electrolytes to replace the lost fluids.

But I think he should run stool culture first before asking for colonoscopy.

Wishing him a fast recovery.
Dr.Sejdini


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Rahul Tawde (38 minutes later)
Thank you Dr. Sejdini. Well, it sounds like the Dr just prescribed metronidazole as a possible treatment, before the stool sample could be cultured to see what would work best. Dad doesn't want a colonoscopy necessarily. He just wants to do the prep because that seems to be what stopped the diarrhea he suffered 2years ago. I guess my question is it safe for him to do the prep? He wants me to pick up a kit for him but I need to be comfortable with doing that for him. He has been on probiotics up til this started.I'll make sure he is still taking them.
doctor
Answered by Dr. Rahul Tawde (29 minutes later)
Brief Answer:
See explanation below

Detailed Answer:
Hi back,

Now, let me explain a few things to you:

- the colonoscopy prep contains laxatives. Laxatives make diarrhea worst. So, it won't make sense using it now as he is already having diarrhea. Don't you think so too ?
- It also contains electrolytes, that he can perfectly take by using oral rehydration salts mixed with plain water.

I do not think colonoscopy prep stopped diarrhea that time, perhaps it has been due to mechanic pressure to anal sphincter by inserting the colonoscopy fiberscope when running the procedure.

Wish him a fast recovery!
Dr.Sejdini

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Rahul Tawde (25 minutes later)
Thank you again for your quick reply. I agree that it doesn't make sense to cause more diarrhea. That said, I'm not sure about the mechanical theory because, as I understand it, diarrhea is watery stool that can't be stopped from coming out no matter how strong the sphincter muscle is. And, there is a lot of gas involved as well.
I just talked to him again and he is doing better today and acknowledges that the medication may be doing its job. He is finally willing to relax and give it a chance to work. I told him to increase the probiotics he started using again and to keep drinking the bottled water that has electrolyte salts. He seemed okay with all that. Hopefully things will continue to improve.
doctor
Answered by Dr. Rahul Tawde (29 hours later)
Brief Answer:
Explained below...

Detailed Answer:
Hi back my dear,

It's great that your father is getting better after the advice given. I hope he will be fine again very soon.

Now, coming back to the path-physiology of diarrhea, if he thought it was stopped after colonoscopy, that is not related to the procedure.

Sometimes, it happens that there could be a contradictory effect of diarrhea especially if laxatives are used such as colonoscopy prep. Instead of further diarrhea, some patients could experience constipation.

Another explanation could be due to reaction to endoscope irritation, more like a reflex type.

In either cases, he should follow these advice to ensure normal functioning of the bowels again.

Wish fast recovery.


Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by
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Dr. Rahul Tawde

General & Family Physician

Practicing since :1980

Answered : 1 Question

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Suggest Treatment For Persistent Diarrhea In An Elderly Person

Brief Answer: Following diarrhea remedies... Detailed Answer: Hi XXXX, I am sorry for the health situation your father is going through. Your father 91 years old is having diarrhea for the past 2 weeks. Already diagnosed with E.coli infection. Please keep in mind that E.coli is found normally in the colon. However, some strains like E. coli 0157:H7 can cause fecal infection. Treatment is based on stool culture and sensitivity testing results where the most susceptible antibiotic is found. Usually, e.coli is causing urinary tract infection (UTI) but rarely can cause stool infection. If susceptibility testing is determining metronidazole as the most sensitive drug, then, it can treat it adequately. However, probiotics should be added to the therapy to stabilize intestinal flora; pepto bismol or tasectan to stop diarrhea. Oral rehydration salts are recommended to restore the lost fluids. Colonoscopy prep contains a laxative preparation to clean your colon before coloscopy is run. Plus it contains electrolytes to replace the lost fluids. But I think he should run stool culture first before asking for colonoscopy. Wishing him a fast recovery. Dr.Sejdini