Update: 7/8/14: The other side of the coin… constipation. I posted about this in “Dialysis and Constipation”
Update 4/5/13: I’m republishing this article (originally published 10/13/12) as there are several hits every day on this blog site looking for information about dialysis and diarrhea. It’s a very common problem in dialysis patients. While there may be no proven method to prevent or stop it, there are ways to deal with it. If you’ve found a successful method, please leave a comment to help others.
Frankly its not easy to talk about things as personal as diarrhea and constipation but since we all deal with either or both at some time in our dialysis “adventure”, I figure it’s worth the risk of embarrassment. I’m seen often in large meetings and many people know me from this blog but someone has to speak up. Diarrhea and Constipation are painful, uncomfortable, and important issues so they must be discussed. Here’s my experience with the former and I’ll cover constipation at a later date.
When I started dialysis in August 2008, I began having digestive problems. I suffered through it for a couple months, not sure what it was. I recall that first Thanksgiving I spent in absolute pain. Fortunately it didn’t start until after dinner was finished but the drive home was memorable because of all the pain in my lower intestines and colon. If I didn’t know better I would think it was colitis. I saw a gastroenterologist a couple times about this problem but he couldn’t seem to figure out what to do. An endoscopy showed some evidence of Diverticulosis but that was further up in the large intestine. This was too low to be diverticulitis. But in the middle of all this, I had a bout of diverticulitis and that only confused the issue. I was never sure if my symptoms were one or the other.
For the next couple years I had problems on a fairly regular basis. It was not just diarrhea, it was intense, burning pain in my rectum and colon. I was referred to a rectal surgeon and the exam was excruciating but I bore through it because I needed some relief badly! He recommended surgery for what he diagnosed as Anal Fissures. Surgeons usually do recommend surgery. They are notorious for seeing a surgical cure to every aliment. I was reluctant because didn’t think that was the problem or the solution. I saw him a couple times and he still had the same proposal. After the third time, he was ready to book the Operating Room.
I needed a second opinion before I underwent something as drastic as rectal surgery. I spoke with my Primary Care Physician and was referred by him to another, different gastroenterologist. Fortunately I was able to see him quickly.
The new doc looked at all the medications I was taking and said, “No wonder you’re having digestive problems! Look at all the meds you are taking!” The proverbial light went on in my head. It now made sense. I needed to look at what I was taking and perhaps get rid of what I could and figure out a strategy for dealing with my situation. Some of the medications were from while my kidneys functioned (CKD Stages 2 and 3) and it made sense that all those chemicals were not getting along with the others and fighting it out in my digestive tract.
One medication I was taking was Furosemide to control edema (fluid build up). I had been taking this for a couple years before I started dialysis and continued taking it because… it was prescribed. Now that I was on dialysis and my kidney function was close to zero, why should I be taking a medication “used to reduce the swelling and fluid retention caused by various medical problems… It causes the kidneys to get rid of unneeded water and salt from the body into the urine.” It didn’t make sense. Where was the fluid to go?! My kidneys didn’t work. I didn’t make urine anymore. So I talked with my nephrologist to make sure it was okay and stopped taking the Lasix (furosemide). I reviewed all the meds with the various doctors to see if there were any I could stop taking. I got rid of a couple more that way.
I immediately got some relief from the pain, gas, and discomfort in my colon but still had some problems with diarrhea. So, I tried taking Imodium, I took the typical dosage of two tablets but then I would get constipated. So, I took one tablet and that seemed to cure most of my problems. Only occasionally now do I have any problems with diarrhea. My regimen now is to take one Imodium at night and that seems to be just enough. If I have problems with diarrhea in the morning, I take two and if it continues, two more. Sometimes, diarrhea just happens, right?
I came across a recent study titled, “Intestinal Microbial Flora Altered By Chronic Kidney Disease” which found that:
Chronic kidney disease changes the composition of intestinal bacterial microbes that normally play a crucial role in staving off disease-causing pathogens and maintaining micronutrient balance, according to UC Irvine researchers.
This profound alteration of the gut microbial population may contribute to the production of uremic toxins, systemic and local inflammation, and nutritional abnormalities present in patients with advanced renal disease, they said.
That would certainly apply to my situation. The combination of medications and the changes in my digestive tract due to CKD and kidney failure would explain all the problems I had. It’s ironic they would say “inflammation”. I was talking to one doc and describing my symptoms and I used the term “inflamed”. He responded, “Inflamed is not a symptom. It’s a diagnosis”. Whatever! It’s friggin burns like Hell! You can call it whatever you want. I’ll call it Inflamed. (I didn’t stay with him very long.)
One reason I decided to write about this is because there was a lovely elderly lady at the clinic who was wheelchair-bound and had similar problems. There were a couple times that she was not able to control her bowels during dialysis and it was terribly embarrassing to her. As I went to give her hug one time, she said, “Don’t come too close. I smell bad.” I responded, “Hon’, that doesn’t bother me one bit” and gave her a hug nonetheless. I felt so bad for her because she shouldn’t have to suffer and be embarrassed. I think my attitude made it a bit easier for her. She passed away not long after that.
I strongly suspect digestive problems are shared by the dialysis community so let’s just get this out on the table and share our experience so others can be helped and we can all learn.
DevonTexas © 2012