Medications to Reduce Diarrhoea
Also known as:
Loperamide (this is an over-the counter medication), codeine, diphenoxylate, tincture of opium, paregoric – a dilute solution of opium – (these are prescription drugs, as some are narcotic).
Used between acute flare-ups to control abdominal discomfort and diarrhoea.
Many people with IBD, especially those with Crohn’s disease, suffer from cramps and urgent diarrhoea. Anti-diarrheal drugs alter muscle activity of the intestine and slow down the movement of the contents, which firms up the stool.
Possible side effects: These drugs can work too well, causing constipation, resulting in increased abdominal pain and bloating. Also, with the narcotic prescription drugs, there is a small risk of becoming addicted.
Note: These drugs are generally not used during acute flare-ups of inflammatory bowel disease because of evidence that they may encourage complications of IBD. In small-bowel Crohn’s disease, they may increase the risk of bowel obstruction. In ulcerative colitis and Crohn’s colitis, there’s an increased risk of toxic megacolon (massive dilation of the colon), which may require surgery.
Available as: Tablets, capsules, drops and syrups.
Bulk Formers
Also known as: Natural fibre source; bran, psyllium seed; also available in several over-the counter medications.
Used to treat constipation and relatively mild diarrhoea. Bulk-formers are not true drugs, but are a type of fibre that “soaks up” or “binds” water, making stool less loose. Bowel movements may be more frequent.
Possible side effects: They’re not common, but include bloating and gas. It’s rare, but some people experience allergic reactions when they inhale the fine dust produced by these materials.
Available as: Powders, granules or natural fibre sources.
Bile Salt Binders (for Crohns Disease Only)
Also known as: Cholestyramine
Bile salt binders are drugs that form a chemical complex with bile salts. Bile salts are produced by the liver and help the intestine to digest fat; then they are re-absorbed by the ileum. When the ileum is extensively diseased, or when a portion is surgically removed, there is less absorptive tissue to “take up” the bile salts. The excess passes into the colon, where it builds up and irritates the lining. That causes water to collect in, rather than be absorbed by, the colon. The result is diarrhoea.
Bile salt binders help prevent the irritation. Cholestyramine is used specifically for this type of watery diarrhoea.
Possible side effects:
It may be difficult to digest and absorb fat, especially for people who have had more than 90 centimetres of ileum removed. It may be difficult to absorb vitamins A, D, E, and K (all fats), so vitamin supplements may be recommended. Lesser side effects: nausea, vomiting, constipation, diarrhoea, abdominal pain and bloating.
Available as: Powder, usually cholestyramine. It’s metallic tasting and is difficult to dissolve. The alternatives are the Anti-diarrheal drugs described earlier (loperamide, diphenoxylate, codeine).
Nicotine and Ulcerative Colitis
Although not currently considered standard therapy, nicotine appears to control ulcerative colitis in some people. It’s available as nicotine gum or as a “patch” worn on the skin. Studies suggest that after the disease is under control, nicotine does not prevent future flare-ups. Side effects include nausea, light-headedness, headache, sleep disturbance or vivid dreams, dizziness, skin irritation due to the patch, sweating and shaking of the hands.
Medications for Other Symptoms and Problems
Haemorrhoids and Anal Fissures:
To reduce the inflammation of a haemorrhoid, most people use ointments and suppositories containing hydrocortisone or another steroid, which shrinks the tissue around the haemorrhoid, reducing the swelling. Regulating the stool also helps.
It is important to reduce inflammation surrounding a fissure. If the anus becomes inflamed, this causes spasm of the anal sphincter muscle and leads to constipation. The treatment is the same as for haemorrhoids: apply a steroid-containing ointment, and regulate the stool. As well, a daily sitz bath ÷ sitting in a warm bath for a few minutes, after a bowel movement or before bedtime relaxes the anal sphincter (muscle that controls the anus).
Anal Itching: The skin of the anal canal can easily become irritated by frequent wiping, and stool can become caught on the roughened irritated skin, causing an itch. The solution: control diarrhoea, use sitz baths then apply ointment, such as zinc oxide or baby ointment.
Vitamins and Minerals:
People with IBD can have trouble getting all the vitamins and minerals they need. This is partly because the disease, or medications taken to control it, make it difficult for the intestines to absorb nutrients, and partly because people with IBD may avoid eating to avoid pain.
Painkillers (Analgesics):
Some people can develop stomach and duodenal ulcers as a result of using acetyl-salicylic acid (ASA) for headaches. For people with Crohn’s disease, the risk may be even greater. Because of the chemical properties of ASA, people with ulcerative colitis who use ASA will bleed more, when the colon is inflamed.
The least harmful non-prescription analgesic for people with Crohn’s disease and colitis is acetaminophen. It too can have side effects: overdose can damage the liver, and large doses taken over many years could lead to kidney failure. However, these risks are far less likely than those posed by ASA.
Updated July 2003