This is something that has been on my mind for quite some time. I suffer from certain spinal-cord injury-related gastro-intestinal issues which have plagued me for the duration of my time as a paraplegic (12+years). Over this time I have seen myriad doctors and have been given myriad diagnoses (lack of fiber, irritable bowel syndrome, food sensitivities, etc.) yet I have experienced NOTHING in the way of relief from this ferociously embarrassing and agonizingly frustrating problem of sudden and intractable diarrhea.
Over this time, I have learned-out of sheer determination never to let what had happened to me several times in the past happen to me again-one surefire way of controlling this menacing problem; huge, daily doses of Imodium A-D (loperamide HCL) as a prophylactic treatment. And when I say “huge” I really mean it. According to the bottle, the maximum daily dosage of this medication is 4 capsules in 24 hours. I will regularly take four or even five times that amount in one day.
Now I know this is not a great idea but I honestly have NO other option. When you’ve shit yourself totally unexpectedly in a few public places-one even when you were on a date-as well as a number of other humiliating experiences, you quickly become adamant as a functioning adult that such occurrences are absolutely not acceptable.
What my question is is what are the potential problems from such a habit? This has been going on for a number of years now; probably about 5 or so consistently. I haven’t noticed any ill-effects at this point but I’d like to know what I might be doing to myself.
In high enough doses, for a long enough time, or taken with many common drugs (or even enough black pepper) it acts like an opioid, crossing the blood brain barrier. Central nervous system depression, including slowing your breathing and heart rate, as well as physical addiction to the drug and needing increasingly large doses to be effective are potential problems.
Given your health conditions, it’s worth a conversation with your doctor to determine if these risks are outweighed by the obvious benefits, or if something else should be tried instead.
IANAD, IANAP, IAMA biology graduate student with some knowledge of physiology.
Excuse the phrase, but i’ll be talking out of my ass from here on out.
Reading the wikipedia page for Loperamide
I note a few passages which may be of interest.
Loperamide appears to work by inhibiting nerves in the gut. Specifically those that control smooth muscle. I imagine that very high doses might also effect your esophagus and you might have trouble swallowing. I also suspect that if you’re taking very high daily doses that these nerves might acclimate to the inhibitor such that when you come off it they may become hyper active. Meaning if you stop, you might get the shits even more.
Maybe lay off the Black pepper? because of the following.
and
So it seems that loperamide circulates and generally only effects the PNS because it’s blocked by the Blood Brain Barrier and ion pumps in the CNS. If you take too high a dose some gets through and might act like a typical opiod would. Read: it may be mildly addictive and I suspect you may have withdrawal symptoms.
Ack! This gives new meaning to your many past threads in which you complain of inaccessible bathrooms!
I myself once suggested (about a year ago or so?) that you should protest by dropping your pants right there in front of everybody when you need to go, and leave it to everyone else (proprietors of the establishment in particular) to be embarrassed or humiliated. But I didn’t really have this in mind :eek:
Yeah, I’ve shit myself while I’ve stared desperately at rows of empty yet inaccessible toilets more than once. All because the person who went into the handicap stall before me “didn’t see any handicap person around when they went to use it”.
Logic tells me lack of movement in the gastrointestinal system might lead to the acid staying in your stomach/gut too long hence leading to the gastroacidic reflux.
Ugh. I’m sure. And there really just isn’t all that much to try, sadly. It pretty much all comes with the same dangerous long term side effects. Seems like the gut should be a pretty easy, mechanical thing to fix, and it just isn’t. My SO went though the gamut after his ileostomy (from loperimide to lomotil to dilaudid)…and it’s a pretty short gamut. Sucks.
I know this is going to sound like a facile suggestion, and I only mention it because I have a relative with bowel-control problems, but adult diapers truly don’t seem to be that awful.
I know regular ones are a PITA even in the privacy of a home bathroom, but there seem to be a few flushable ones on the market. I bet you could manage that with not much more difficulty than a normal bathroom break.
I have a similar problem, though not for the same reasons as you. Imodium doesn’t work for me and neither does Lomotil.
What has worked is an injectable medication, Octreotide. The brand name is Sandostatin but I take the generic. I inject it with an insulin syringe. I am not in any way a medical professional and I have no idea if it would be appropriate for you or not, but you may want to ask your doctor about it.
It’s not a standard medication. Drugstores don’t carry it and it has to be special ordered, so your GP may not be familiar with it. A gastroenterologist would probably be familiar with it.
A BIG issue related to uncontrollable diarrhea afflicting those who don’t have use of their legs that such a solution (adult diapers) wouldn’t really address is getting the soiled clothing/diaper off after the ‘deed has been done’ without further smearing yourself, your clothing and/or your wheelchair cushion with liquid shit. Removal of such pieces would involve a lot of yanking, tugging and bouncing; especially if being done in the awkward quarters of a public restroom stall.
I took Prilosec for a while and it gave me horrible diarrhea, it may be exacerbating your problem. I’m taking something called Ranitidine HCL now, IIRC, which doesn’t bother my gut and has the added benefit of being quite a bit cheaper as well.
That’s pretty much what I was thinking - alternatives to Prilosec.
Ranitidine (generic Zantac) works via a different mechanism to Prilosec, Nexium and the other proton pump inhibitors.
Whether that’ll be of any benefit or not, of course it doesn’t address your original question (though if such a switch reduced the trots, you might be able to reduce the Imodium).