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
DevonTexas 
I appreciate the length of your ‘article’ about diarrhea; we with ESRD seem very vulnerable to intestinal situations! Maybe you could also pursue some comments on issues with constipation which I know would be quite common for transplant patients and begin to cause havoc for us in ESRD. If you’ve already pursued this topic maybe you could give us a link. I think a lot of patients swing between the two because the ‘normal’ just seems to have disappeared!
THANK YOU! Excellent points! Add to that, the Iron supplements we’re given that cause constipation and, yes, we do go back and forth between diarrhea and constipation. I’ll add this to my list of things to blog about. I’m just relieved (pun) to get diarrhea out there to be discussed. I dislike that some patients quietly suffer with this predicament and if we share our experience, perhaps it’ll help others.
I found that alternating Immodium and an old prescription drug Lomotil worked FOR ME. Buy start early with the first hint of tummy distress. As for the placque, no doc has ventured a guess, but it may have been genetic or diabetes. It m ight have been Tums or my binder but my diet is l ight on dairy.
I,too,have suffered with various digestive problems over the years…seen doctors,even a gastroenterologist…none of them suggested what ultimately solved all of these issues.I used to take a lot of antibiotics and I thought they ruined my stomach/digestion for good.I now take probiotics …my upset stomach is gone (I used to throw up a lot),I rarely get diarrhea and if I do,an extra probiotic does wonders (if it doesn’t,it’s usually because I overindulged with dairy,which I do very rarely & then an Immodium helps,:))…and I can even have milk in my morning coffee and can occassionally eat dairy products and I don’t need to take laxatives anymore (another dialysis side-effect).
As always, your posts are so helpful. You know, looking at the meds one takes is always a good idea whenever anything out of the ordinary starts happening. Sometimes those meds can be responsible.
That is so sweet that you still hugged that woman, despite the “smell”. Kudos to you for having such a big heart.
Thank you for writing this blog!
I am 22 and having diarrhea for almost 1 year. By the way, this is so far best resource I read about diarrhea. You bring some very vital points. I am taking ginger tea, banana, and cocunut at home. Pray for me.
You got to learn what ur body will tolerate. Bananas help with diarrhea n Cornflakes n milk help loosen things up! 🙂
Bananas are a surprise in ESRD. They are top of my doctors list of “DO NOT EATS” because of the high potassium content.
Great article! I enjoyed reading it, very well written, and some great tips. I would just like to add another great tip. Dried blueberries are great for curing diarrhea. They are a good source of antioxidants. They help to reduce the stomach inflammation to reduce the effects of diarrhea.
For more great tips check out How To Get Rid Of Diarrhea
-Thanks Alex
Very helpful article. My doctors insisted there is no connection between dialysis and diarrhea, and one suggested treating it with Pepto-Bismol. He had tried a steroid which kicked my blood pressure up 50 points. That medicine was so expensive it put me in the doughnut hole in two months. Then the GI doctor huddled with the kidney doctor and agreed to prescribe something that would “kill your kidneys.” And my output dropped from one liter to 500 ml. That’s when we turned to the Internet.
Bill Stewart
Vancouver, WA
Who knows what connection may exist if there’s one at all but the simple fact is that many, many dialysis patients suffer from diarrhea. I suggest that it could be due to the many medications we take and it is coincidental with dialysis but a careful study that would determine the causes would be helpful.
I think what you published made a ton of sense. However, what about this?
suppose you typed a catchier title? I ain’t suggesting your information is not solid, however what
if you added a headline that makes people want more? I
mean Dialysis and Diarrhea | DevonTexas is kinda vanilla.
You ought to look at Yahoo’s home page and see how they
create article headlines to get viewers interested.
You might try adding a video or a picture or two to grab readers interested about what you’ve
got to say. In my opinion, it would bring your posts a little bit more
interesting.
Thank you for the suggestion. I will endeavor to “spice up” my headings in the future but you need to understand that this is a site catering to dialysis patients and I’m not trying to attract a lot of attention. Rather, I’m trying to reach out to patients looking for information about specific topics. Also, if you noticed there’s a pattern that I started a couple years ago. I titled most every article as “Dialysis and…” So, it’s not real flashy but it’s to the point. That’s a lot like me.
Within days of starting dialysis, the diarrhea started. Getting unhooked and trying to get to the bathroom quickly with a walker was quite dicey. Sometimes I didn’t make it. One day a nurse gave me Immodium. That solved my problem.
The frequency of bouts of diarrhea has diminished greatly. Maybe once every month or 2 now. But when it occurs, I have no idea what triggers it. And sometimes painful heartburn joins in. I have no idea what triggers the heartburn either. I keep Immodium at home and in my purse. So far that’s all I need.
An update to my earlier comment: I stumbled acoss an old generic that works on the diarrhea — Lomotil. It’s fairly cheap, and blessed by my new GI doctor. He also says the earler diagnosis by another GI specialist was a shot from the hip because the proper tests needed for a diagnosis of “microscopic colitis” were never done. The new doc thinks the problem lies with the cocktail of meds we take. Thus far the only down side of Lomotil is that I gurgle a lot.
Bill Stewart
Vancouver, WA
Thanks for adding your experience, Bill. It will be helpful to others suffering (and I mean suffering) from the same problems.
Thank you! Thank you! this was so appreciated! I do dialysis treatments for my 81year old father, and he has diarrhea, and he is somewhat fagile…I was looking for something natural to help him out, but this is good to know, and yes diarrhea does happen to all of us from time to time!
I no longer am plagued by diarrhea. But it is at great cost — the “cure” produced a calcium plaque in my arteries. That cost me a foot and three fingers. Then I had a heart attack while in the hospital but still no diarrhea. Next a panel of doctors placed me in “home hospice” with a diagnosis that I might not see the next day. That was six diarrhea-free months ago. I have continued to be active at church and gardening. My advice is to be aware that every cure to diarrhea has negative side effects. And at 74, the thought of death is not frightening.
What was the “cure” you took? Others should be warned of this and calcium plaque build up.
Thank U so very, very much Devon Texas and to Google search! This article is such a blessing to me and hope it will be to many many more individuals throughout the world! My 75 yr old wife has experienced the same symptoms mentioned in the above article for over a year now and consequently; it has resulted in hospital visits and on the last two visits she was diagnosed with severe bladder infections which put her into a deep sleep stage and could not be awaken for several hours. At the ER she she was given three (3) strong antibiotics intravenously and replacement of needed electrolytes. After a few hours she finally awoke and was admitted to the hospital for over a week on both visits and has recovered somewhat but experience mild mental issues from her experience with diarrhea. However, she has returned back to her dialysis treatments twice but again today she is experiencing severe burning sensations from her stool as mentioned in the Devon Texas article and when I read this article which mentioned the drug Furosemide, generic for Lasix, I could not believe my eyes because that’s one of the drugs my wife has been taking for over two years now and common sense says stop taking this drug now! If this helps my wife I will be a crusader just like Devon Texas to help others in this world who may also be experiencing similar health problems as previously mentioned in this article. Thank U again Devon! Bill, Hanover County, Virginia…
Your pleasure with my sharing of a very difficult period of my life only encourages me to keep going! Thank you for your contribution.
Devon
My mother used to give me cook rice and nothing else for the diarrhea. Now I am on dyalisis and it help .try and see.
Regards
Betty
Hi Devon,
Thank you for the article. Im writing on behalf of my father who has been dialysis for 5 years now. He is having difficulties with both diarrhea and constipation as your article discusses.
His experience is that there seems to be a connection to the binder they give dialysis patients. The 1st binder my father was given gave him severe diarrhea, he explained felt like acid/burning. The doctor explained to him that this particular one that is red in color effects many people this way. It is the red in the pill that can effect some people. So on to the next binder that again gave the same results. He is now on a apparently newly approved binder called Auryxia. He is in agony, diarrhea, abdominal pain, acid/ burning from his throat and rectum. I did not see anyone else mention this so I thought I would. If anyone out there can advise on some other approach I would greatly appreciate it.
Thank you so much for sharing your father’s experience. It may help someone else avoid much pain and suffering.
I can completely relate to this. I am 39 years old and have just started dyalisis due to uncontrolled hypertension. (My doctor didn’t take my high blood pressure seriously…to be fair, I was a new patient and that didn’t help my case). At any rate, since beginning dyalisis, I have become a pooping machine. I have loose stools or diarrhea 4 or 5 X a day…lucky me. It’s better than the alternative. At least it comes out alright. I was told to take tums before every meal and snack. Now, I don’t know if this will help, but it may. It is too soon to say because I just started the tums regime.
It’s also noteworthy to mention I have ANCA negative Vasculitis, which was being treated with chemo and predisone. Was…until my creatinine and bun levels dipped dangerously low and I had to begin dyalisis.
Anyways, thanks for the article, I have been trying to figure out why I turned into a human poop machine. It sounds like dyalisis and the medicines probably aren’t helping. Furthermore, who knows what this Vasculitis is doing to my GI tract.
Well, keep me in your prayers, I have more faith in Jesus as our divine physician than many of the quacks out there pushing meds that exacerbate existing symptoms.
Thank you for sharing that. I share your pain. Prayer to you.
Hello Devon. It is very helpful to find this blog. I write on behalf of my father (72 years old). He has been on hemodialysis for more than 8 years and is suffering for diarrhea for several months. He is currently taking ALDOMET to prevent hypertension (hypertension appeared some months ago during the last hour of dialysis and afterwards).. he is also taking LYRICA (pregabalin) to control a neuropathy that causes pain on the legs, that also appeared some months ago, and to prevent insomnia…
he tried LOPERAMIDE but it didnt stop the diarrhea..
Has anyone experienced a similar scenario?? any input will be really helpful to find a solution for this…
Thanks in advance!
Greetings from Peru.
Thanks Devon. My dad has been on dialysis for two years. He is 61. initially his diarrhoea was a little erratic but became consistent for the past two months. It doesn’t seem to respond to immodium. I guess i am going to look for lomotil to alternate with immodium to see how it works. Great blog.