[kreink]

Hey gang, I went to my doc the other day to talk to him about some bowel issues I have been having. (Note, I might get descriptive here, so dont read further if poo poo talk bothers you)

I have PN in my feet and hands from Diabetes, as well as Gastroparesis (a form of neuropathy that effects the stomach)

In the last few months I have had increasing symptoms of messy bowel problems. At first I thought maybe I had eaten something that disagreed with me or perhaps the bacteria in my system were causing me to have excessive gas and loose stool. Its not really diarrhea but its messy.

It has continued to get worse to the point I am having to change my underpants twice a day. I dont always feel it when it leaks out but I have gas all the time. I have had a few occasions when I have soiled myself during the night in bed.

This is obviously an issue, and can make teaching middle school a little tricky. There have been a couple days when I spent a good part of the morning on the toilet before I felt I could even walk out the door.

My doc thinks that maybe the Acid reflux medicine I am on might be causing the symptoms he wonders if I am digesting my food fully. He has taken me off it for now, to see. Its been over a week with no change.

Has anyone experienced this with neuropathy. I undstand that diabetics can get constipated from neuropathy or from medications but this is hardly constipation.

Other meds I am on include

3600 mg Gabapentin
30 Mg Cymbalta
20 units of lantus insulin.

if you have any suggestions of things I might try to alleviate symptoms short of wearing depends I am all ears.

[Megan]

Sounds very, very distressing for you!

I have been diagnosed with idiopathic Neuropathy (2007) and now Gastroparesis (2009). I now have the constipation (am on a totally liquid/pureed diet) but not usually the diarrhoea - only occasionally.

Does the particular Acid Reflux medication you are on typically cause diarrhoea? I guess that is the first and obvious thing to eliminate (hehe)! Is it possible that the neuropathy has affected your whole bowel motility and sphincter control?

I hope you get some resolution to this .....and quickly!

Hugs Megan!

[kreink]

The Acid reflux medicine I am on is Omeperazol (Prescription Prilosec) I have been taking it since Last July and never had a problem with it. Because some of the issues I had with Gastroparesis seem to be improving, his thinking was that perhaps the medicine was causing my stomach to produce too little acid to properly digest my food and it is now emptying partially undigested.

When I was first diagnosed I was put on a low fat/low fiber diet. I have been able to re introduce much of the foods I used to eat and if anything I am eating more fiber than I was when I was diagnosed. So I dont think adding more fiber would fix the problem.

The only thing I can think of is 1) This is nerve damage related - although with my stomach getting better that seems odd. or 2) This is medication related.

I dont take Metformin which would be the most likely culprit for something like this in a diabetic. I take Lantus insulin instead. The other medicines I take are Neurontin (Gabapentin) and Cymbalta. Both of these are for pain from my peripheral neuropathy. I know that my PN is getting worse. The whole situation is a little frustrating.

Now when I go places, I check where the bathroom is first - Just in case.
One more thing to stress over

[mrsD]

Gabapentin can cause fecal incontinence.

Lefthanded had this problem. You might message her for
more details.

Yes it is true that acid blocking drugs will affect protein digestion and make more gas, due to bacteria fermenting the undigested protein.

Also a big culprit can be fructose. So avoid all fructose for a couple of weeks and see if it is better.

If this all fails, consider: Are you eating low fat foods with Olestra in them (chips etc)? This will liquify stools. So will Alli the OTC diet pill.

Check any dietetic candy you may be using. The ingredient sorbitol is a laxative. Hershey's is even putting it in REGULAR candies now, so read all your labels to see if you are getting sorbitol. Sugar free gums, mints included.

Also becoming incontinent may be a result of cauda equina syndrome...a stenosis in the lumbar region. This is considered a medical emergency and should be evaluated ASAP.
Loose runny stools suggest something else, however.

Cymbalta can also cause diarrhea. But if you have been on it a while, this is not likely. It mostly does this side effect at the beginning of treatment. (increases serotonin in the GI tract).

Another rare cause could be Carcinoid syndrome. It would be a last resort if other solutions do not work. Carcinoid would be made worse with Cymbalta.

[Grizabella]

Are you taking one of the anti-cholesterol drugs? That might have something to do with it.

And to help with digestion, yogurt is very good.

Also, a stool softener might help. Even if you're not constipated, it still helps keep your s**t together, so to speak.

[mrsD]

Originally Posted by Grizabella

Are you taking one of the anti-cholesterol drugs? That might have something to do with it.

And to help with digestion, yogurt is very good.

Also, a stool softener might help. Even if you're not constipated, it still helps keep your s**t together, so to speak.

Oh, I don't agree! Colace will make this mess much worse!
I know many patients without PN who get this leaking running type stool they can't control! For patients not taking opiates Colace can be very disasterous!

[Grizabella]

Well, it works for me. And when I had my adult care home, the home nurses told me that even though it's called a "stool softener", it also has the opposite effect because it causes stool to sort of "gel". That the term "softener" is misleading because it's so often used along with a laxative in it to prevent constipation or treat it. Just a straight "stool softener" without a laxative added is helpful for a lot of people having diarrhea type problems.

I guess it depends on the person.

[lefthanded]

I had an issue with gabapentin increasing my issues with incontinence, but in my case, lacking a colon makes incontinence a critical issue as it leads to burns and inflammation and scarring.

If you are having any pain sypmtoms, you may want your doctor to check you for fissures. This can occur when your sphincter goes into spasms. Those spasms can contribute to incontinence.

Any time you experience this without a known cause it is wise to check with your physician. The fact that you have gastroparesis might be a clue. I would see a good gastroenterologist or colo-rectal doctor.

[kreink]

Thanks for the replys, I will check with my doc about possible side effects from medicines. I am taking 3600mg of Gabapentin. It may be that it is causing this issue. Or, it combined with the cymbalta.

[mrsD]

If you have some inflammatory thing going on in the bowel, that is independent of your food intake, there are a couple of things you can do.

1) Beano is a must for anyone eating alot of veggies. It blocks gas production. (I use this myself)

2) Frequent runny type stools may be firmed up with Metamucil type bulk laxatives. This absorbs excess fluid, and also acts as a sponge to absorb toxins that may be irritating the bowel.
Some low grade food toxins, stimulate bowel parastalsis.

3) OTC there is Imodium. I find that 1/2 tablet is enough for me when I need help. You can then increase to 1 tablet if necessary. It is easy to get rebound constipation using it however.

4) Gas-X (simethicone) can help you pass gas more normally, but it does not get RID of gas production.

Colitis or other inflammatory conditions/bowel infections may be present. So if this does not resolve, you need to be evaluated for those.

There is a theory that long term use of acid lowering drugs, promote bowel infections. This is because the high acid normally found in the stomach is nature's way of killing off undesirable bacteria that are eaten with our food. When you reduce that acid you not only impair protein digestion, but you allow then these invaders a free pass into your gut.
I believe much illness has resulted from overuse of acid blocking drugs.