What's the straight dope on diarrhea?

Factual Questions
41

This sounds like the place to ask this, then.

Ok - large colon - paste enters and turds exit, right? When I’m finished pooping, what’s behind the turd I just finished with? Is the colon closed behind? Air?

Am I being clear? Is the colon a tube with lumps of crap traveling down it or is it more like a pea-pod, closed tightly on either side of the lumps of shit? How do fart bubbles work into this?

What actually makes the turds travel down the path? Is it muscular like the throat or is it the crap behind pushing?

The mechanics of poop making, only on the Straight Dope.

42

Another “iron gut” question:

I used to have something of an iron gut. Then, about 10 years ago, at age 25, I had a bad bout of food poisoning. (Emergency room, several bags of fluid, and lots of drugs. It took me several weeks to get better.) Understandably, I got gastrointestinal distress at the drop of a hat for a few months afterward. I eventually returned to “normal,” but it wasn’t my old normal. No more “iron gut.”

So does it make sense that a bout of food poisoning could permanently change one’s digestive sensitivity. Or am I just nuts?

43

I have a question, if I may.

How is it that some foods seem to “make you sick” almost instantly after you consume them? There’s no way the food has had time to reach the colon, yet there I am, pooping like mad and swearing I’ll never eat that particular food again (while cursing because I know I likely will.) Sometimes, you haven’t even had time to finish the meal before it hits you.

What’s up with that?

44

Good question. It’s like most foods take a good, leisurely twelve hour trip through your bowels, but sometimes you take a few bites of something and it hits the express elevator down, and you’re running for the toidy before dinner’s even over.

And here’s another question. Why does hot pepper make me feel really sick about five minutes before it’s ready to come out? I’m not even aware of it the rest of the time, just those horrible moments right before. I’m not talking about the scorched-butt burning effect. This is before that. It’s more like, “God, I feel really sick, I wanna throw up but the sick feeling isn’t in my stomach.”

45

For Belrix:
The colon is more like a pea-pod, although the colon will inflate a bit with gas due to swallowed air and bacterial fermentation. Muscular contraction moves things along, like stripping toothpaste out of a tube. The colon normally contains (moving from cecum to rectum) liquid, semisolid, and solid material at any one time; the closer to the ‘exit’, the more firm the stool. Colonic transit times vary by person and diet, but can be from 12 hrs to 5 days. The colonic lining has a number of pressure and chemical sensors that help it determine the consistency of it contents. Local networks of neurons in the bowel wall coordinate the muscular contractions of the colon and rectum. These sensory/motor control loops are very finely balanced under normal circumstances. Thus you can (normally) fart without crapping your pants. After pooping, the rectum and far end of the colon will be collapsed down, awaiting filling from the upstream segments.

for Green Bean:
It’s possible that you had some subtle but lasting change in your population of gut bacteria, but it’s also not unusual for bowel ‘sensitivity’ to change over time for no clear reason. My father, for example, loved mushrooms until he was in his fifties, at which time they started giving him terrible cramps. Dunno why.

for Levdrakon and Lissa:
There are a number of causes for a ‘dumping’ response like the one you mention. In response to distention of the stomach (by food or even by balloon), the gastrocolic reflex leads to the urge to defecate. You may have a normal reflex that becomes hyperactive in the presence of certain food compounds like fat, alcohol, or spices. Dumping syndrome is a pathologic response, in which the stomach empties into the small intestine too rapidly. The sudden load of food (typically carbs give the worst response) and acid in the duodenum causes cramping and diarrhea. Dumping syndrome is rare, and occurs most often in people who have had stomach surgery or congenital stomach abnormalities. You could also be ingesting something contaminated with preformed bacterial toxins or chemical irritants that can cause a brisk reaction, although those would normally be associated with nausea as well.

Even under the worst-case scenario, it still takes hours for material to move from the stomach to the rectum. When patients need to have their entire gut cleaned out in preparation for abdominal surgery, they are given one or more liquid preparations that are designed to be nonabsorbable by both the small bowel and colon: indeed, they may cause a lot of secretion of fluid by the bowel as well. Even with this tailored chemical assault, it still takes many uncomfortable hours for everything to get flushed through.

levdrakon’s pepper pains also bring up another point: the bowel does not have the same type of pain receptors that the skin does. Gut pain tends to be poorly localized (‘around my bellybutton’ as opposed to ‘43 centimeters downstream of my ligament of Treitz’) because of the way the nerve fibers are hooked up in the gut and spinal cord. Intestinal pain receptors are most sensitive to excessive stretch and/or ischemia of the bowel wall; they are pretty insensitive to cutting and heat/cold. This is why the spicy Mexican food does not burn constantly along every inch of bowel. Normal skin sensation picks up again along a fairly distinct margin called the dentate line in the distal rectum. While the rectum is only sensitive to distention, the anal canal is much more discriminatory. In fact, part of ‘fart control’ is the sampling reflex in which the internal anal sphincter relaxes and allows some rectal contents to enter the anal canal, where the superior sensors are able to determine whether it is gas, liquid, or solid. It sounds like your anal canal is noticing the irritant properties of the pepper oils and setting off the alarms. You would not be consciously aware of this as scorched-butt because this is a local reflex loop. You’re plenty aware of it after the oils hit the sensitive surface skin of the anus, though.

46

Thank you, thank you! How I wish more doctors would be as forthcoming as you have been, brossa. All my potential surgeon would tell me is that it’s “contraindicated” but not why and not why this might be a problem even in someone whose case is as mild as mine. I scoured the Internet and found nothing more anywhere. Thank you and thank the SDMB.

May I respectfully ask a few more questions? Here’s some background: I wished to pursue the procedure known as the Biliopancreatic Diversion with Duodenal Switch. Although this is often recommended in cases of severe morbid obesity, my BMI is only a modest 36 (but I qualify for bariatric surgery for other reasons, such as OSA). The reason I preferred this was because I have an abnormally low energy expenditure level (1608 Kcals/day) and not only do I eat very little, I often have to force myself to eat much of anything at all; therefore, reducing the size of my stomach would have virtually no effect. I exercise, but this doesn’t help enough. For this reason, I concluded that a malabsorptive surgery was pretty much my only option (especially since my apnea is severe and no treatment has worked).

Here’s a hypothetical: If I insisted on the BPD, and considering the great mildness of my current colitis, in your opinion would a surgeon be foolish to perform the surgery anyway? Say, if I provided some sort of waiver of responsibility? Would I be foolish to risk it? Can you suggest any alternative that I might explore further?

Please don’t feel pressed to answer; I feel guilty asking so much. Especially if you feel it’s an awkward, unfair or unreasonable question. It goes without saying that I hold you to nothing whatsoever!

Thanks again.

47

Gabriela,

Thanks very much for all the info on diarrhea and other subjects.

Colostomy? It’s not my bag. But thanks for the reassuring thought that usually you aren’t chained to the damned thing.

I am suffering from diarrhea at the moment. I was terrible pain last night, from the cramps, and I kept vomitting and shitting what felt like piss it was so thin, so I went to the hospital and they gave me tablets called U-OSCINE (Hyoscine - N -butylbtomide 10mg) which I think is not an antibiotic, and I took two of those and I felt fine in about 15 minutes. I still had this kind of very slight fluey feeling of chill and aching in my limbs though, which I put down to toxins coming from my gut into my blood. Funnily enough, I forgot to mention the fluey feeling at the hospital, and therefore was most impressed to read that my diagnosis was flu on one of the papers. They also gave me some orange flavoured oral rehydration salts powder to mix with water, that I found very pleasant to drink.

I liked your remark: “Inherited kludges, one building on the previous one”

Like all of your writing that I’ve seen, it’s theatrical and thought-provoking. I hope you’re writing books.

48

That should be Hyoscine-N-butylbromide.

49

I think you might have discovered a new branch of physics: poop mechanics. Bullshit makes the world go round, money only lubricates it. Once you know you’re shit, you don’t need to know anything else. Shit happens.

50

Dr_Paprica, I will try to get some Cipro. Thanks for all you valuable contributions to this thread. “local carnival crap” had me laughing out loud. Pondering your post it occurred to me that birds and fish don’t need to conserve water so much. Birds can fly to water easily, and fish, well…

51

I am a Brit, but putting an o in my diarrhoea makes it harder. :slight_smile:

52

It could simply be the ageing process. A lot of things go down hill, including the ability to get a good night’s sleep, hence, “sleep like a baby”. I sleep way worse than I did five years ago.

I had open chest surgery in my early twenties after a mishap, and a big blood transfusion, and I noticed that my guts, which hadn’t been directly involved, were not like they were. In the twenty years since then, I’ve had to avoid stress, and eat slowly, or I’ll get a mild tummy ache. Also arguments can cause me to get a tummy ache, or just feeling annoyed at someone for not getting to the point. Like Charlie Brown, I wonder if I have a cheap stomach.

So I guess you could be right. As for being nuts. Douglas R Hofstadter wrote that each of us is at least a bit of lunatic. If so, it might be something to do with the brain being a matter of kludges upon kludges to paraphrase gabriela. :slight_smile:

Don’t kids wolf their food down while drinking an ice cold Coke and then run from the table to the playground? You won’t see an old person doing that.

53

Yes, that is indeed convenient.

54

I am happy to have been of some help, ambushed. The people best positioned to give you advice are your gastroenterologist and prospective surgeon, preferably in communication with each other. It is entirely reasonable, even prudent, to get opinions from more than one gastro and bariatric specalist. I am not a bariatric surgery specalist.

As a point of general information, a gastric bypass is also a malabsorptive procedure, and is at least theoretically reversible. A duodenal switch is a one-way ticket: you can’t be put back together if something goes wrong. The length of the ‘common channel’ in both the duodenal switch and gastric bypass can be altered to meet the patient’s needs. Gastroplasty and the lap band are strictly restrictive procedures.

55

If diarrhea is generally caused by bad germs in the contents of the guts, rather than in the tissue, how do people ever recover from diarrhea? How can white corpuscles, antibodies or whatever else the immune system has to offer get at the bad bugs when they are mixed up in the shit. Surely antibodies and white corpuscles work only within tissue?

56

Street Deep, you have been too kind. One of my great defects as an answerer of questions is that I can only post from home, generally only in the early mornings. So I run in, blather, shout “Ta-daa!”, and disappear, leaving brossa and others to tell you what you need to know.

I do hope your flu and diarrhea are getting better. Sounds like a distressing experience, and one which you might have died from without medical care. (That degree of fluid loss through the toilet can lead to dehydration, which can be fatal, particularly if you are not a young healthy person.) But the hyoscamine, a med with which I am not familiar, seems to have dried you right up, which is grand. Keep us updated, please.

One reply to an old note of yours I did want to make. You did not feel sick and fluish because of toxins absorbed from your gut. You don’t absorb toxins from your gut unless you are so sick you are at death’s door. You felt sick because you had the flu. And it was not specifically the flu virus which was making you sick, but your body’s response to it.

When your cells have been hijacked by a virus, which is turning them from useful citizens into factories for the production of more insidious virus, one of their last acts as citizens is to secrete some interferon. Interferon interferes with viruses (thus the name). It doesn’t do anything for the hijacked cell, but when it reaches all the cells nearby, they realize there’s an imminent viral threat, and they stiffen up their fortress guards and close up their pores (speaking metaphorically now). When the hijacked cell explodes from inside, dying as it release thousands of virus particles, all the nearby cells that got the interferon message are immune. Any that weren’t, release more interferon as they are hijacked.

About twenty years ago some cancer researchers got the bright idea to give interferon to people suffering from certain forms of cancer, to see if it would tune up their immune systems to the point of killing off the cancer cells. Away they go, injecting the stuff every day. The cancer patients immediately started getting fever, muscle aches, nausea, weakness, and that all-encompassing sense of not-right-with-the-world that is called “malaise”. The symptoms were so powerful that most of them left the trial. They said they’d rather have cancer.

When you feel like shit, so to speak, and you have the flu, it’s usually your own interferon that is to blame. It’s your body trying to burn the viruses out. It’s helpful to a certain degree, but like all our kludgy responses, it can go overboard and do actual damage. So I’m glad you got a helping hand from medicine.

57

Hang on. Only the worst diarrheas are caused by bad germs in the contents of the guts - the ones I called the equivalent of terrorists releasing sarin gas. E coli 0157:H7 works by a toxin. Cholera works both by a toxin and by clamping onto your mucosal cells and doing direct damage to them.

Most diarrheas are caused by invaders. And those the body can attack inside the comfortable confines of its own mucosa.

But what makes you think white cells and antibodies don’t work within the shit? The body secretes millions of them into the shit when you’re sick, and some every day. In fact the antibody most commonly produced by cells that line the gut, IgA, has a secretory piece to help it get out into where the trouble is.

I would venture without literature to back me that the big problem with secreting stuff into the gut is the ratio between freedom fighters and bugs. It’s a kamikaze raid out there. Still, whatever works.

58

Incidentally, for some reason (and I’m blaming lack of sleep here), gabriela’s enjoyable diatribe on drying the shit made me think of those World Dryer Corporation bathroom handwarmers. The ones Cecil did a column about. The ones “installed for your well being” which had the warning about the “dangers of disease that may be transmitted by cloth towels or paper towel litter”. Maybe it’s time you stopped eating tissue and J-cloths during your next vacation; give your colon a break.

59

God forbid you should buy your airbreathing prokaryotes at full retail price!

60

Is it harmful to take Immodium for reocurring diarrhea? My system is wonky (yes that is the medical term :wink: ) ever since having gallbladder failure and resulting surgery earlier this year. I usually end up taking a dose or 2 of immodium about once a week or so. I know usually ‘healthy body=healthy pooping’ so all the craziness has me worried about long term effects. I realize my diarrhea is probably not caused by bacteria but my body’s inability to digest things as well as before? So is it ok to ‘stop the leaking’ so to speak or am I just fixing the symptom and not the problem?