Brief Answer:
Detailed answer below

Detailed Answer:
Hi, thanks for posting your concern in the HCM.
I think your present problems of abdominal cramps and persistent diarrhoea are related to IBS. From the history it seems that you have diarrhoea predominant IBS. Although researches are going on throughout the world regarding the pathophysiology and treatment of IBS, unfortunately no treatment for complete cure has been established yet. Among the medications, Rifaximin and probiotics are widely used with limited success. But, till date they are the mainstay of treatment apart from SSRI, which are used to address the functional component of IBS.
Now, from your medication history, I perceived that you are having frequent antibiotics apart from cholestyramine and imodium. Although antibiotics can temporarily provide you some relief, frequent use of them will create problems in two dimensions:
1. they would destroy the protective bacteria of your gut,
2. they would create antibiotic resistance among the harmful bacteria.
Furthermore, some group of antibiotics would affect your kidney, particularly because you are a known diabetic patient.
Therefore, my recommendations for you are-
1. Please maintain good oral hydration.
2. Avoid empty stomach for more than 4 hours in the daytime. Have small meals at frequent intervals. Never overload your stomach with bulk of food.
3. Please avoid smoking, alcohol, carbonated beverages,frozen foods and spices. Also try to be more on normal home made food.
4. I usually advice my patients to have Enterogermina oral suspension (a probiotic) twice daily for at least 1 month.
5. I also advice my patients to have Rifaximin tablet 400 mg twice daily for initial 10-14 days of treatment. Rifaximin is a locally acting antibiotic, which is widely accepted in IBS, traveller's diarrhoea.
6. Please try to perform daily exercise for at least 45 minutes if not contraindicated otherwise.
7. Anxiety, depression and stress are killers in IBS. They not only aggravates IBS symptoms, but also delays recovery.
You may continue having Imodium for diarrhoea.
For the initial treatment, I don't suggest SSRI or TCA group of medicines for IBS. I think if symptoms persist even after controlling local copmponents of IBS, e.g. small intestinal bacterial overgrowth and motility problem, I recommend my patients to consult a psychiatrist, who would evaluate functional condition and also the presence of any psychiatric co-morbidity and treat accordingly.
8. I also advice my patients to have Tab Colospa retard or Mebeverine 200 mg twice daily to address the motility problem.
9 Strict control of diabetes and thyroid disorder should also be addressed. You need to have HbA1c and fasting TSH tests done to know the control.
Furthermore, you should try relaxation sessions for 30 min everyday too.
Finally, regarding your diverticulosis and post sigmoid colon surgery status, I would also suggest you to get regularly checked up by your Surgeon and follow his/her advices.
I don't know whether you have had small intestinal biopsy done or not. If not, please consult your local doctor for the necessity of the same. But, before that you should have a stool test (routine examination and OBT) done too. You may also need to have Colonoscopy done to rule out Inflammatory bowel disease, also after checking its feasibility depending upon the surgery you had.
Please also avoid milk and refined carbohydrates for the time being.
Lastly, Small intestinal bacterial overgrowth may cause vitamin deficiencies. I think you should start taking a vitamin complex supplementation rich in vit B complex and antioxidants.
If you are satisfied with my answer, please close the thread and rate my answer. For any further query please write back.
Regards,
Dr. Kaushik

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