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Re: Diarrhea after colonoscopy

Subject: Re: Diarrhea after colonoscopy
From: SJ Doc
Date: Thu, 22 Sep 2005 23:33:48 -0400
Newsgroups: sci.med
On Thu, 22 Sep 2005 20:33:11 GMT, "John Temple" wrote:

>Following many months of unexplained fatigue and weight loss I had a
>colonoscopy and gastroscopy performed last week with multiple biopsies done
>of each. Initial observations were normal - but I'm still waiting for the
>biopsy analysis.
>
>Both procedures went fine (I don't remember anything about them) and I felt
>fine for a couple of days afterwards. Third day however, I had abdominal
>pain, vomiting and severe diarrhea. The vomiting has now subsided but 5 days
>later I'm still going to the toilet at least 30 times a day and invariably
>just passing water (exactly like the laxative preparation I took prior to
>the procedures). I haven't passed any blood.
>
>I've spoken to the hospital and they've said that it's unrelated to the
>procedures (probably just a bug) or I would have had problems within the
>first 2 days. I've never had anything like this before - and I find it
>difficult to believe it's just a coincidence. Are there any other
>explanations? Any feedback appreciated.

Jeff (commenting earlier) has the right of it.  The gastroenterologist
who performed the endoscopy needs to know about this.  The prep 
for a colonoscopy or barium enema is such that the large bowel's 
"production line" has been cleared of what you might call it's normal 
intermediate steps in the progression from completely liquid material 
(which passes from the small bowel into the cecum down in the 
right lower quadrant of your abdomen) to formed stool in the 
sigmoid colon (left lower quadrant and caudad).  

I hesitate to make any recommendations for fear that you'll fail to 
contact your GE specialist or one of his/her associates, but in many 
cases where a lower GI prep and study is followed by the sort of 
diarrhea you're describing, I've had some success with the introduc-
tion of a stool normalizer such as calcium polycarbophil (see
http://www.gicare.com/pated/polycarbophil.htm), which is a syn-
thetic bulking agent (the calcium salt of polyacrylic acid crosslinked
with divinyl glycol) first marketed as Mitrolan and more commonly 
known today as Fibercon.  It started out as a prescription drug, 
but very soon went over-the-counter (OTC), and is available in 
low-cost generic tablet forms.  Though commonly considered a 
laxative, it's not (just as surfactant ["wetting"] agents like Colace
[sodium docusate] are not).  Because it is effectively a water-
soluble fiber, calcium polycarbophil tends less frequently to cause 
flatulence than will the insoluble fiber supplements (oat bran, 
psyllium - Metamucil - and suchlike).  

Taken appropriately (and I mean with low-dose introduction 
and gradual ramp-up), I've been able to use calcium polycarbophil 
to re-establish that "production line" in the large bowel for a number
of patients who had been thoroughly washed-out and were rolling 
liquid content directly and rapidly from the ileocecal valve to the 
anal ampulla, with resulting discomfort and frequent watery bowel 
movements.  

But for ghod's sake, talk to your gastroenterologist (or even one 
of his/her office nurses) about this before you do anything.  They
have seen more of this kind of problem than any GP will ever 
have to manage, and I don't doubt that they'll be able to provide 
effective recommendations for your relief.  

-----------------
Unless we put medical freedom into the Constitution, the time will
come when medicine will organize into an undercover dictatorship 
to restrict the art of healing to one class of men and deny equal
privileges to others. The Constitution of this Republic should make 
a special privilege for medical freedom as well as religious freedom.

        -- Benjamin Rush, M.D. 

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