Unexplained diarrhea for five months

[concernedmck]

I am a 34 year old female. I suddenly developed diarrhea nearly 5 months ago - three months after I had my first baby (in case that's relevant).  Since then I have not had a normal bowel movement. Every movement is liquidy or at best, very loose. I have 5-10 episdoes a day. It's usually worst in the morning when I get out of bed. I have no other symptoms - no pain, no blood, no discomfort, no mucus. I am generally healthy, I sleep well, I eat a balanced diet, have a good appetite (although not quite a good as before this problem), I eat slowly and am a non smoker/drinker.

I have seen a specialist who has checked/put me on the following and is admitting that he is running out of options.  He is relucant to classify this as IBS due to the severity and continuity of the symptoms:

Treatments/Tests:

fasting - 4 days - no effect
Flagyl - 7 day course - no effect
Full investigation of stomach and colon (colonoscopy) and barium ultrasound - no abnormality found
Celiac test - negative
Stool culture - normal
Various blood tests, inc. anaemia - normal
Questran - no improvement
Pentaza - symptoms slightly worse
Steroids (deltacotril) - slight improvement but insignificant

If you have ANY Suggestions as to what could be causing this, please let me know. I really want to try and cure the problem and am worried that it is not ever going to go away.

Thank you

[Kevin Pho, MD]

Hello - thanks for asking your question.

Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.

You are describing chronic diarrhea despite a battery of normal tests.  Here are some other tests to consider.  

You may be describing what is known as secretory diarrhea which characteristically continues despite fasting.  Further testing in patients with secretory diarrhea may include stool cultures to exclude chronic infection and imaging of the small and large bowel (which has been done).

Selective testing for secretagogues, such as gastrin or vasoactive intestinal polypeptide (VIP) can evaluate for endocrine tumors that can cause diarrhea.

Testing for bile-acid malabsorption or empiric treatment with a bile-acid binding resin may also be helpful in secretory diarrhea.

Fatty diarrhea (steatorrhea) should be suspected in patients who report greasy, floating, and malodorous stools.  A quantitative estimation of stool fat can be done to evaluate for malabsorption.  

If every single test continues to be negative, you then may want to consider the diagnosis of irritable bowel - as this is one of the more common causes for chronic diarrhea.  There are many options for treatment, but the patient response is variable.  You may want to discuss these options with your personal physician.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[PAJ]

You might consider a yeast infection , I must say your not a text book case but with Flagel not having much effect it’s worth considering. You wont get this information from the docs BTW they are [mostly] in denial over the condition . Doctors today are crippled by the politics of medicine , they practice what has been termed “Defensive Medicine” that roughly translates,  if it’s not in the book you don’t get treated.  
I speak from experience , yeast infections are endemic ,& and are believed to be the main missing link in many of our modern day diseases and sub health conditions.
I find it extraordinary that doctors especially on a gastro forum totally ignore the condition , Still Forums could have been invented for situations such as this .
Read this article , http://drcranton.com/CFIDS.htm#CFIDS%20Paper it turned out to be my personal “Rosetta Stone” it detailed most of the symptoms that had puzzled both myself and my doctors. As you see  he favours a trial on drugs for a diagnosis , from your symptoms if you have the condition you should react fairly dramatically to Nystatin .It’s a very safe drug ,but you must take doses  that are up to the job ,that is five million units per day [10 tablets ] try it for a couple of weeks. If you [or anyone] take this advise please report back so we may know how the theory is working out. Good luck

"WITH THERAPEUTIC USE 1. Toxicity from orally administered nystatin is extremely low. Dermal application or ingestion of even large quantities should produce only minor GI symptoms. Treatment is usually unnecessary.".........."Laboratory: Nystatin is not well absorbed orally. Unless GI inflammation is present, blood levels should not be detectable. Therapeutic or toxic blood levels have not been established."........"Toxicity due to nystatin is negligible. Even when large amounts have been ingested, ensuing symptoms have been minor. Charcoal, emesis and cathartic should not be necessary."......."ABSORPTION...FROM GI TRACT IS NEGLIGIBLE, & DRUG APPEARS IN FECES. WHEN DOSES OF 8 MILLION UNITS OR MORE ARE GIVEN, INDIVIDUALS WITH NORMAL RENAL FUNCTION MAY HAVE PLASMA CONCN OF ONLY 1-2.5 UG/ML. ... NYSTATIN IS NOT ABSORBED FROM SKIN OR MUCOUS MEMBRANES. [Goodman, L.S., and A. Gilman. (eds.) The Pharmacological Basis of Therapeutics. 5th ed. New York: Macmillan Publishing Co., Inc., 1975. 1236]**QC REVIEWED**"
http://toxnet.nlm.nih.gov/cgi-bin/sis/search/f?./temp/~AAAnTaaFg:1

[concernedmck]

Thanks Paj for you advice. I'll look into that.  I used to suffer alot from sinus problems which were attributed by an "alternative" doctor to candida type symptoms, so I somewhat understand the background to yeast infections.  Thanks again - I'll look into it and let you know.

[karrie2020]

SPEAKING FROM EXPERIENCE:

     Make sure your doctor rules out..HEPATITIS A !!!!!
     ALSO make sure he rules out...H. PYLORI with the proper
     tests.

[PAJ]

A couple years ago Mayo clinic released a research proceedings claiming they had research indicating that almost all chronic sinusitus is ultimately caused by inflamation (inflammation) induced by a fungal infection. This research has now been independently reproduced by a lab in Europe.
http://www.mayo.edu:80/sinusinfo/index.html
Mayo clinic now has attracted  a massive grant to study the possibility that fungal infections are involved in more health problems. They are currently pursuing one such clinical trial investigating asthma... they believe that the same mechanism found in sinusitus is causing lung inflamation (inflammation) in asthmatics.
http://www.mayo.edu:80/research/crpad/trial_126.html
  Try this forum for more information

http://www.healthyawareness.com/_pages/forums.htm

[concernedmck]

I've read quite a bit into the subject of yeast infections because I also have a condition called endometriosis which again is often related to Candida.  When I saw you're suggestion about checking yeast infections, I kicked myself for not having thought of that before - I just didn't realise one could have an isolated disgestive problem.  I've started a non yeast, non sugar diet to see if any improvement starts, and will be seeing my doctor in two weeks when I can talk to him about possible medication.  Thanks again for your advice Paj.

[Schmoopie]

I too experienced diarrhea for many months.  I was keeping track of everyting I put in my mouth, EXCEPT I wasn't taking into account some of the vitamins I was taking.  I, too, had every test under the sun and no diagnosis.  I stopped taking Vitamin C on the suggestion of a friend and the diarrhea stopped.  I'm not saying that's the source of your problem but it's good to hear of others' experiences.
Good luck

[Concerned lady]

I agree 100% with the the others' very good advice, to you.

Maybe it IS relevant, that this problem began 3 months after you gave birth to your baby:

--Were you drinking a lot of cow's milk, eating yogurt, eating cheese & other milk products, in order to produce more breast milk to nurse the baby? If yes, might you have a lactose (milk-sugar) intolerance? This can cause diarrhea, cramps, bloating, etc. If this is possible, have you tried using some Lactase enzymes, along with the milk products?

--Could you have eaten something that had some kind of bacterial contamination (food poisoning)?

--Did you have any vaccinations?

--Did you have a natural birth, or a C-section? Maybe you got some kind of infection, in the hospital? or, by bacterial contamination during an operation?

--Also, look up "endometriosis" in holistic books, to get ideas of how that might relate to your problem, if it does.

Some types of watery diarrheas can be caused by intestinal infections that result from using antibiotics. Had you taken any antibiotics, around the time of your onset of the diarrhea?

If this is possible, try eating a milk-free probiotic preparation, such as "Dairy-free MAXI BIFIDUS" by Ethical Nutrients.  

The reason to try a milk-free preparation, is that milk can cause digestive upsets, due to either a milk-sugar (lactOse intolerance), &/or, a milk protein allergy.

Probiotics can help to normalize watery diarrhea that is often caused by the bad side effects of antibiotics, such as yeast infections as was already mentioned, or, diarrhea from other intestinal infections. Acidophilus & Bifidus are 2 types of probiotics, found in health food stores, in the refrigerated section.

You also might want to read the very good book called "Sinus Survival" by Dr. Robert Ivker, D.O., and this book also includes advice about fighting Candida albicans (yeast infections).

Also, you may want to check into possible FOOD SENSITIVITIES. There's a great laboratory called "EnteroLab", run by a great MD named Kenneth Fine, MD. The link to Dr. Fine's website, is http://www.finerhealth.com

At "EnteroLab", they do special STOOL SAMPLE ANALYSES, to see if you might be allergic to, sensitive to, intolerant of, various foods, such as MILK, GLUTEN, etc. Food sensitivities can cause diarrhea. The stool sample analyses can be more accurate than intestinal biopsies & blood tests:

The forum doc, here, mentioned greasy, frothy, floating, foul smelling stools, that are symptoms of mal-absorption, due to conditions like gluten intolerances, such as Celiac Disease.

Gluten is found in wheat, rye, oats, barley & buckwheat. Brown rice is gluten-free.

And as was already mentioned, don't overdo on Vitamin C.

Good luck to you!

Sincerely, Concerned lady
http://cantbreathesuspectvcd.com

[Hyena of Ice]

Despite what these people say, Candida infection of the intestines is highly unlikely unless you fit the bill of one of the following:

*prolongued use of antacids (stomach acid would normally kill the candida, but with it neutralized, the fungi can reach the intestines still alive.  Of course, you have to keep in mind that Candida albicans is normal in bowel flora as well as the flora of the mouth and nose.  Normally, it is kept under control by various bacteria that like to either eat it or secrete compounds that the candida doesn't like.)
*Immunocompromised
*Took antibiotics over a prolongued period of time, usually months.

Be wary of any holistic documentation for ANY condition that lists a whole host of very common and often vague symptoms, in a compiled list where it is unlikey anyone will not find at least two symptoms they suffer.  This is a common tactic used by holistic practitioners to get you to buy their nutritional supplements and cleansing formulas.  A good example of such a list would be:

*fatigue
*weight gain
*ADD or ADHD
*mind fog or trouble concentrating
*craving for sweets
*itching of the ears or anus
*gas
*indigestion
*arthritis
*headaches
*depression
*irritability
*bloated abdomen
*rashes, exzema (eczema), psoriasis
*allergies
*athsma
*fibromyalgia
*dyspepsia
*infertility/impotence
*urinary tract infections
*catch colds easily
*tingling in extremities (or cold extremities)

Symptoms that general Candida infection DOES cause: chills, fever, low blood-pressure, prostration (flu-like fatigue), and occasional rash.  Other symptoms may vary depending on the part of the body that is infected (can involve mouth, bowels, esophagus, vagina, skin, and rarely, the foreskin of the penis of a man who has had intercourse with an infected woman.)

Risk factors: rise in sugar level caused by diabetes, use of broad-spectrum antibiotics, being immunocompromised (includes the body being severely weakened by some other illness, such as cancer)

Treatment: Treatment generally involves treating the cause of the creation of the enviorment that allows Candida to thrive, such as treating the diabetes or discontinuing antibiotic therapy.  For the immunocompromised, antifungal medications are given.