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How can fatty stool diarrhea for about 8 weeks along with excessive bloating and discomfort be managed?

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Posted on Mon, 26 Nov 2018
Question: Hi, I've had fatty stool diarrhea for about 8 wks or more...4-8 x day, excessive bloating from sternum down. Not a lot of discomfort but getting sore in upper abdomen. Have a hx of severe migraines for 50 yrs, fibromyalgia and cfs for about 30-35 years.

I had several weeks of the fatty diarrhea a short time ago, it got better for about a $12k then started again, no idea why it lessened or got worse. So far, I don't see a correlation with medications or food although I have almost no no dairy and not a more of wheat.

Testing has ruled out celiac disease and infection. I'm thinking perhaps malabsorption disease, my doc is out of office until 2-26.
doctor
Answered by Dr. Ramesh Kumar (9 hours later)
Brief Answer:
You most likely have irritable bowel syndrome.

Detailed Answer:

Hello,

You are most likely suffering from irritable bowel syndrome. IBS is usually a diagnosis of exclusion which means, despite all possible investigations nothing comes out and yet the patient is symptomatic, we consider it to be IBS.

In IBS, the structure of the intestines is normal, only functional abnormality occurs in this condition. Therefore, it represents a functional disorder of the gastrointestinal tract without the presence of an anatomic defect. Therefore, the patient is symptomatic despite all possible tests.

In layman language, till date we are not sure what the exact cause of this problem is. So the million dollar question is how to repair a system when you don't know which part of it is faulty (Some say it can be the brain, others say it can be hormone anxiety, age etc).

Some patients have symptoms of unformed stools, diarrhea, some have bloating and some may have severe constipation. Some patients have occasional symptoms whereas others may have symptoms for a long period of time. As seen above, every patient is different. The intensity of symptoms in every patient is different and so is the response to medicines and lifestyle change. A patient may respond well to one medication while another is totally unresponsive to the same.

Our goal:-
Every drug is not effective in every patient so we have to try different therapies till we find the drug which suits our patient the best. All the below mentioned drugs slow down the motility of the intestines, hence will decrease both frequency of motions as well as increase your power to control them.

Treatment for you:-

Dicyclomine is an anti-cholinergic drug. An anti-cholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. Anti-cholinergics inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells.

Mebeverine is an antispasmodic medicine and is very useful in IBS and is well tolerated by patients with minimal side effects. Mebeverine works on certain muscles in the wall of your intestines, causing them to relax.

Clidinium bromide is an anti-cholinergic (it specifically helps symptoms of frequent stools).

Chlordiazepoxide works by increasing the action of GABA, a chemical messenger which suppresses the abnormal and excessive activity of the nerve cells in the brain. It can be used in combination with the above mentioned medicines.

Ask your gastroenterologist to start you initially on Clidinium Bromide and Mebeverine combination initially for 21 days.

Take isapghula husk 2 tsp daily. It swells up in the intestines and forms bulk. It is natural. Eat a cup of fruits and green salad daily.

Follow medications properly. Though it can't be fully cured yet it could be treated, so don't worry.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Ramesh Kumar
Gastroenterologist
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Ramesh Kumar (3 hours later)
Am I correct in thinking that Mebeverine is meant for colon problems? From extended research I’m thinking the small intestine may be where my problem is occurring.

I’m not having abdominal cramping just a slight discomfort in area above my waist. That is also where much of the bloating is occurring.

Along with fibromyalgia for 35 yrs, I’ve been dx’d With IBS and am familiar with its swings back and forth. This, however, seems different. Often, I have diarrhea only an hr and a half after a meal. I’m trying to eat nutritious food...protein, vegetables, salads, etc. Bananas, applesauce, yoghurt also to try to calm things down but no apparent benefit.

Would an endoscopy with small bowel biopsy be indicated with my symptoms?

Thanks.
doctor
Answered by Dr. Ramesh Kumar (22 hours later)
Brief Answer:
Follow up

Detailed Answer:

Hello,

Mebeverine is an antispasmodic and can be given to relieve spasms any where in the intestine.

You have fatty stools 8 times a day. It is not necessary that all symptoms are always there like spasm pain and stools. As told earlier, IBS is a diagnosis of exclusion which means despite doing a colonoscopy, endoscopy, a CT abdomen and other basic tests, there is nothing wrong with the system, then the patient is labelled as having IBS on the basis of their symptoms.

Definitely yes, an endoscopy and a colonoscopy with a biopsy both should be done. Both these tests would make things clearer.

Hope I have answered your query.

Regards,
Dr. Ramesh Kumar,
Gastroenterologist
Above answer was peer-reviewed by : Dr. Kampana
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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

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How can fatty stool diarrhea for about 8 weeks along with excessive bloating and discomfort be managed?

Brief Answer: You most likely have irritable bowel syndrome. Detailed Answer: Hello, You are most likely suffering from irritable bowel syndrome. IBS is usually a diagnosis of exclusion which means, despite all possible investigations nothing comes out and yet the patient is symptomatic, we consider it to be IBS. In IBS, the structure of the intestines is normal, only functional abnormality occurs in this condition. Therefore, it represents a functional disorder of the gastrointestinal tract without the presence of an anatomic defect. Therefore, the patient is symptomatic despite all possible tests. In layman language, till date we are not sure what the exact cause of this problem is. So the million dollar question is how to repair a system when you don't know which part of it is faulty (Some say it can be the brain, others say it can be hormone anxiety, age etc). Some patients have symptoms of unformed stools, diarrhea, some have bloating and some may have severe constipation. Some patients have occasional symptoms whereas others may have symptoms for a long period of time. As seen above, every patient is different. The intensity of symptoms in every patient is different and so is the response to medicines and lifestyle change. A patient may respond well to one medication while another is totally unresponsive to the same. Our goal:- Every drug is not effective in every patient so we have to try different therapies till we find the drug which suits our patient the best. All the below mentioned drugs slow down the motility of the intestines, hence will decrease both frequency of motions as well as increase your power to control them. Treatment for you:- Dicyclomine is an anti-cholinergic drug. An anti-cholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. Anti-cholinergics inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells. Mebeverine is an antispasmodic medicine and is very useful in IBS and is well tolerated by patients with minimal side effects. Mebeverine works on certain muscles in the wall of your intestines, causing them to relax. Clidinium bromide is an anti-cholinergic (it specifically helps symptoms of frequent stools). Chlordiazepoxide works by increasing the action of GABA, a chemical messenger which suppresses the abnormal and excessive activity of the nerve cells in the brain. It can be used in combination with the above mentioned medicines. Ask your gastroenterologist to start you initially on Clidinium Bromide and Mebeverine combination initially for 21 days. Take isapghula husk 2 tsp daily. It swells up in the intestines and forms bulk. It is natural. Eat a cup of fruits and green salad daily. Follow medications properly. Though it can't be fully cured yet it could be treated, so don't worry. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Ramesh Kumar Gastroenterologist