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Bowel problems -- I'm really jonsen for some of that doxycycline, man.
September 29, 2010 8:02 AM   Subscribe

SFW but probably TMI question about a change in bowel movements. Is there something wrong with my diet or is it something else?

For the past couple of years, I've had bowel movements that I wasn't particularly happy with. They'd have a frequency of two or three times a day, and would often be soft (quite a bit of wiping) and foul-smelling. They didn't seem to change much with fiber intake or changes to the quality of my diet. Several months ago I had a case of non-STD epididymitis and was given doxycycline in case E. coli was the culprit. Within a couple of days, my bowel movements had gone from their previous quality to being once a day, firm, and without odor.

All was good for about five months. Then, suddenly, I had cramping and pain and my bowel movements had regressed to their previous quality. Now the cramping and pain are gone, but I can't get back to normal otherwise. To give you an idea of my diet, I typically eat:

Breakfast:
Carb: Steel cut oats, whole wheat toast, or corn tortillas
Protein/Fat: Two eggs, occasionally bacon
Seasonal fruit and tea.

Lunch:
If I bring it, some sort of sandwich (pastrami, tuna, ham/turkey with avocado and lettuce) on whole wheat or rye. Fruit, if I'm at home or I've remembered to bring it.
If I'm eating out, it'll be Korean take-out, a burrito sans-cheese from Qdoba, or a chicken sandwich from Wendy's or Chic-Fil-A.

Dinner:
Some variation of meat/veg/starch. Chicken marbella with pasta and grilled zucchini; Salmon, potatoes, and asparagus; steak with cornbread and salad.

Snack: Cereal or soup I've made (usually lentil or chili)

I usually drink water with every meal. It occasionally gets swapped out with tea or beer. I don't consume dairy products as I'm pretty severely lactose intolerant.

My mother has been dealing with moderate IBS for a while now, if that's of any concern. Demographically, I'm a mid-twenties male who's otherwise healthy.

I'm beginning to think it may be bacterial overgrowth in the small intestine, mostly because of the way it suddenly disappeared after the course of antibiotics I had. I'm looking for possible things to research so I can have an intelligent conversation with my doctor next time I talk to him about this or for someone to point out if I'm missing something obvious here. Are there other chronic gastroenterological conditions that are suddenly but not permanently rendered better by antibiotics? Or maybe I should just get a script for an antibiotic every couple of months?
posted by anonymous to Health & Fitness (15 answers total) 3 users marked this as a favorite
 
NAD, naturally, but makes me think it might be Giardia. A quick google suggests it does respond to doxycycline, but isn't cured by it.
posted by Ahab at 8:06 AM on September 29, 2010


Two things come to mind: if you're concerned about your gut flora, pick up some Florastor from the drugstore. Very unlikely to hurt, might help. Shit, my kid's pediatrician recommended it.

Two: HOWEVER, there doesn't seem to be a huge amount of fiber in your diet. I'm not saying there's NO fiber... there's just not, like, a metric ton of it. Try replacing your snack with a bowl of All-Bran for a week or so and see if that, uh, firms things up.
posted by julthumbscrew at 8:10 AM on September 29, 2010


soft (quite a bit of wiping) and foul-smelling -

This can be a sign of a malabsorption problem. Two hard-to-diagnose, but increasingly common, malabsorption issues are gluten intolerance/celiac disease, and fructose intolerance.

The diet you posted shows a pretty large quantity of both fructose and gluten. I'm wondering if you changed your eating habits during the time you took the doxycycline? Perhaps you ate less of one or both of these things.

(IANAD, but I'm both gluten- and fructose-intolerant.)
posted by chez shoes at 8:19 AM on September 29, 2010


The first thing I thought of was gluten. While you're waiting to go to the doctor, try a hardline gluten-avoiding diet and see if that helps at all.
posted by hermitosis at 9:00 AM on September 29, 2010


I wonder if a daily dose of a probiotic wouldn't do the trick - Florastor appears to be probiotics, but you can get them from food sources too: sauerkraut, kefir (there are vegan versions since you are lactose intolerant), soy-yogurt, and some fermented soy products like miso and tempeh.

I have a mild case of IBS, which is helped greatly by the tonnes of probiotics that I take- I drink kefir or eat yogurt every day, plus I take a enteric coated multi-strain probiotic pill every evening before bed. It greatly helps the cramping, gas and other discomfort I have.

Another thing that helped me was going vegetarian. Meat was a big issue for me - my body just can't handle it. (I suspect that if I cut out dairy too, I would do even better... but I just can't kick the cheese - you are a step ahead here). I have heard great things about a raw diet, but that is pretty extreme.
posted by LyndsayMW at 9:09 AM on September 29, 2010 [1 favorite]


Regarding your lactose intolerance: when you eat restaurant food, it's possibly that you're getting dairy even when it's not obvious. There might be some in the bread at Wendy's, for instance. Or some dairy derivative in a sauce on your dinner, or injected into the salmon/chicken/whatever as a flavor enhancer. You could try eating only things you've prepared yourself for a week or so and see if that helps.
posted by MexicanYenta at 9:15 AM on September 29, 2010


Oh and - for years my food intolerances were written off as "lactose intolerance" but that turned out to be the least of my problems. While I am lactose intolerant, the only dairy I eat is aged cheese and butter - and the cheese-making and butter-making processes already eliminate most of the lactose.

In my case, it was the fructose that was the primary culprit. And fructose, I probably don't need to say, is in everything processed - chances are your whole wheat toast, cereal, Korean takeout, and chain fast food meals are full of it.
posted by chez shoes at 9:52 AM on September 29, 2010


Have you been tested for H Pylori?
posted by meepmeow at 10:05 AM on September 29, 2010


I had giardia. Nasty, horrible cramping; so bad I dreaded eating. It lasted over a month (two, maybe?) and was continual - once infected, you don't have "good days" until it's gone.

And there's almost no suitable treatment; it's mostly "wait it out".

Just FYI.
posted by IAmBroom at 11:05 AM on September 29, 2010


Don't stop eating gluten until you've had all testing done; otherwise you are wasting your time and money.
posted by egk at 11:10 AM on September 29, 2010


Don't stop eating gluten until you've had all testing done; otherwise you are wasting your time and money.

Yeah, seconding this. If you stop eating gluten and you have celiac, you'll show up as negative because your gut will begin to heal itself.

I'd get to a gastro. They'd be most likely to be able to help.
posted by PhoBWanKenobi at 11:24 AM on September 29, 2010 [1 favorite]


And there's almost no suitable treatment; it's mostly "wait it out".

Definitely not true in the case of Giardia, a simple course of antibiotics like Flagyll will set your straight. It may not be giardia, it may not be gluten. A gastro + breath, blood and faecal tests + maybe eventually endo/colonoscopy (human fingercuffs! And you get to be the cuffs!) could be the best answer.

Doctor Internet is especially guilty of malpractice when it comes to digestive issues.
posted by smoke at 4:53 PM on September 29, 2010


If you have reason to think it may be gluten, the forum at celiac.com has info on tests and Gastro docs.

Who should test?

Dr Green, researcher at Celiac Disease Center, Columbia University
_Celiac Disease: A Hidden Epidemic_

Section 1 Symptoms

Experienced at least once a week during the past 3 months
bloating
gas and/or stomach cramping
diarrhea or runny stools
constipation
joint pain
numbness or tingling in your extremities
itchy skin lesions
constant unexplained fatigue
frequent headaches or migraines

Section II Diagnoses
Have been diagnosed with any of the following:
irritable bowel syndrome
eczema or unexplained contact dermatitis
fibromyalgia
chronic fatigue syndrome
nervous stomach (non-ulcer dyspepsia)

Section III Associated Illnesses
Do you have any of the following:
Lactose intolerance
ostopeia and/or osteoporosis
autoimmune disorders (thyroid disease, hypo or hyper, Type I diabetes, Sjogrens syndrome, chronic liver disease)
an immediate family member with an autoimmune condition
peripheral neuropathy
non-Hodgkins lymphona
psychiatric disorders or depression
small intestinal cancer
anemia
infertility

If you checked one or more lines in either Section I or II and have ANY of the illnesses in section III, test for celiac disease, especially males or women under 45 with osteopenia/osteoporosis.
If you have checks in all 3 sections, you and your doctors should definitely explore a celiac diagnosis.
posted by egk at 7:35 AM on October 2, 2010


And there's almost no suitable treatment; it's mostly "wait it out".

Definitely not true in the case of Giardia, a simple course of antibiotics like Flagyll will set your straight.

smoke, thank you! Wish I'd known that then... Hmmm, incompetent doctor, or newer knowledge?
posted by IAmBroom at 1:48 PM on October 3, 2010


IAmBroom (and also OP fwiw), one of the things that giardia can do is come on all strong at first with the stinky flatulence and loose stools, then over weeks or months settle down to a pattern of regular bowel movements with firm stools but occasional or very occasional days where you're back to the start.

It's just my NAD understanding, but I believe in that sort of situation you've still got it, it's doing you long term damage, and you're still carrying and potentially spreading it.

If your doctor never treated you with either Flagyl or Fasigyn it's probably worth going to a different doctor, explaining the previous diagnosis and lack of treatment, and getting yourself treated.

My doctors here have always tended to treat on the basis of presumptive diagnosis because testing can often be inconclusive and the drugs involved are relatively safe, cheap, short course, and effective.
posted by Ahab at 5:02 PM on October 3, 2010


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