PD ... diarrhea, constipation

Discussions for Patients, Family, and Friends PD For Patients
1

Hi Guys,

We get occasional opportunities to log in here and read some stuff. In the past we have found this very useful. Also in the past have left messages where the replies have been also very helpful. So Far we wish to say thank you one and all …

So now - more things happening. I should explain - my Wife has Kidney disease, 37 , awaiting for transplant - she is less than a year on the list ( here in Ireland ), seems it may take at least two years before a transplant on average here. She is on Home Dialysis using a machine the size of a video recorder and also this glucose type fluid which comes in bags of 3 or 4 different colours indicating strengths.

In the last few months - since before christmas - she has suffered from very acidic diarrhea. Why I say acidic is I am assuming this as it apparently burns when going to the toilet ( pardon the description ). She needs to use creams. She also suffers from constipation. Both can occur in cycles.

We met the consultant recently, on this amongst other things. He seemed to think it was unrelated to dialysis. I shall expand. If we go out for a meal ( always ) OR when eating at home (alwaysish) - give it about 15 minutes or less and she HAS to go to the toilet. Also that night she may be up a few times to visit the toilet.

The consultant said she has a FAST TRANSIT. His thoughts were in and around possibly - celiac disease? and the like. He is refering her to a Gastro Consultant - just for your information - http://www.webmd.com/digestive-disorders/bowel-transit-time AND http://www.greenbarley.com/ccdetail1.html

She has had trouble with her stomach way before Kidney Disease - possible intolerance to fats. I have found now when she eats out or at home she will not finish the meal by a long shot and visit within minutes to the toilet is necessary, even at work when she comes back from lunch OR after breakfast in the morning.

In the last week we decided to try a wheat free diet just to see - only for a few days so no news their yet. Obviously all this is a little bit uncomfortable and inconvenient.~

I should say that when she got her first Tenckhoff inserted below the stomach it unfortunately was not the best. It resulted in very painful dialysis and irritaion of the bowel. As I said she has had a long history in this area - before the kidney disease. They took the first Tenckhoff out ( this took about two hours, it apparently got ‘stuck’ after the fisrt op ) and added a new one on the other side!

All her stats are fine, very good actually. EXCEPT she is having trouble with the PARA THYROID. They popped her on a new drug for this before christmas called MIMPARA by Amgen. Some interesting side effects are listed for this. The consultant mentioned that if this drug does not work over time they may have to operate and remove the parathyroids altogether [ one implanted in the arm apparently ].

I realise that on HD, one can have constipation alot potentially. Not sure about diarrhea. I said I would throw up this loose ramble with the possibility that others may have been down this road and if so can give us some on the ground info.

their may be other details - at the moment I cannot think of them but will add to this if they come to mind,

Cheers and thanks,
Aidan

2

Hi Aidan,
I am not on dialysis and I have the same problem when we eat out. Major diarrhea !!! I have found that it is the preservative on the lettuce. In the U.S., they use Sodium dioxide as a preservative. When I eat at home I wash the lettuce, very well and it has no preservative --no problem. You might try avoiding any lettuce and see if that
helps. I never have a salad at a restaurant any more only at home
Alice

3

Hi Alice,

Thanks for that - I will pass this on. Interestingly my brother in law mentioned the same recently about lettuce - that if he eats any amount of same - as you said - Major diarrhea !!!

I wonder would Coleslaw cause the same? I noticed that at lunch she may have a side of coleslaw with a sandwich / pannini. BUT as I said she is now trying to stay off wheat and trying a chicken and veg lunch. Here in Ireland you get coleslaw and lettuce and onion with all sandwiches whether you ask for it or not - annoying, particularly onion - causes me indigestion and burping all day,

I should also say that last night she went out with a friend and may have sinned a little - she had a chicken fajita, not too spicy and didnt eat the peppers, also had a glass or two of wine, poor kid, shes very good usually, just wants the very occasional break out. Of course felt sick when I collected her later.

I have been very aware - kidney disease aside - that one does not know what goes into sauces in restuarants - even eateries where you pay top dollar. If a meal repeats on me ( and my wife is the same ) - this to me is a good indication that they are cutting corners and using packet sauces. Of course we are super critical as we both prefer to cook for our selves.

Cheers
Aidan

4

Hi Aidan,

Since your wife cycles between diarrhea and constipation, I wonder if she might have irritable bowel disease (IBD)? IBD usually starts in the late teens and early 20s, and is much more common in women than men. Various things can trigger it, and it can get better or worse at various times. IBS is a functional disease–there is nothing physically wrong that can be found with tests, but yet there are still problems with how the gut functions. Other things need to be ruled out before making an IBS diagnosis.

An IBS website that has a ton of helpful info is: http://www.helpforibs.com/. Of course, with kidney problems too, check with the doctor before taking any type of remedy, herbal product, tea, or whatever. Reading the descriptions here might help your wife to see if this might be her problem.

If she thinks it is, Amazon has the book written by the woman who does the website (used for as low as $3): http://www.amazon.com/First-Year-Irritable-Essential-Diagnosed/dp/1569245479/ref=pd_bbs_sr_3?ie=UTF8&s=books&qid=1203206664&sr=8-3

Here is a book written by a gastroenterologist who makes the case that the real problem in IBS is bacteria in the wrong part of the gut. Eating NO sugar or foods that turn into sugar (which starves the little suckers–and helps reduce diabetes risk at the same time!) can help a LOT. He also recommends an antibiotic that isn’t absorbed (so it may be safe even with kidney disease) http://www.amazon.com/New-IBS-Solution-Mark-Pimentel/dp/0977435601/ref=pd_bbs_sr_4?ie=UTF8&s=books&qid=1203206701&sr=8-4

5

A blood test could be a first step in determining if your wife has celiac disease.

I have a friend with celiac disease. She has to eat a gluten-free diet and is not supposed to eat something prepared on a cutting board, in a pan, or with any kitchen utensil that was used to prepare food containing gluten. Even small amounts of gluten can cause symptoms. It’s important when eating out to ask the server to ask the chef if gluten is in anything that you’re having. I hope a chef would know this since more and more people seem to have celiac disease and restaurants don’t want to lose them as customers.

Here’s a U.S. government website with all kinds of info about digestive diseases:

Here’s a U.S. government publication on celiac disease. One thing I hadn’t considered before reading this is that drugs may be gluten-free or contain gluten. The pharmacist or company could tell you if the drugs your wife takes are gluten free or have gluten. If your wife turns out to have celiac disease and any of her drugs have gluten in them, ask the doctor what to substitute for that drug.
http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/

You may want to keep this link if your wife is diagnosed with celiac disease because it discusses managing the diet for someone with celiac disease on dialysis. It also lists common dialysis drugs (U.S.) that are gluten free.
http://www.healthsystem.virginia.edu/internet/digestive-health/nutrition/ObreroArticle.pdf

6

Hi Guys,

Thanks for all this - much appreciated.

Dori - “irritable bowel disease (IBD)”

Yes - I think I made a mistake in my original message - this is what the consultant mentioned, not celiac disease. Sorry for any misleading info.

BETH - I thank you too for this, one never knows what the cause is, interesting info also. I apologise to you that I may have said celiac disease instead of IBD. None the less all apreciated.

Cheers and much thanks
Aidan

7

Hi Aidan,

Celiac and IBD can be related. In some people, dairy or wheat are triggers for IBD. Sometimes going off of them can help the symptoms, and it’s possible to add them back in later without causing problems. There’s not a lot of rhyme or reason to it…

8

I’ve never heard about this from any other patients that I socialize with. Constipation is common side effect that HD brings, but I don’t know if it can cause diarrhea. I’ll try to dig it up in the web and ask my doctors. I’ll get back to you when I find a conclusive answer. For the meantime, hold on and stay tough.