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Dr.Saleem
Dr.Saleem, Doctor
Category: Medical
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Experience:  MBBS
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I HAVE DIARRHOEA EVERY NIGHT, WHILE I AM ASLEEP. IT OFTENCONTINUES

Customer Question

I HAVE DIARRHOEA EVERY NIGHT, WHILE I AM ASLEEP. IT OFTENCONTINUES DURING THE DAY, LOPERAMIDE HAS BEEN GIVEN REGULARLY, WITH LITTLE EFFECT FOR LONG,.ALTOGETHER60 TABLETS OVER TIMEHAVE RESULTED IN SEVERE ANAL AND ABDOMINAL PAIN. I AM IN AN EXCELLENT NURSING HOME. PLESE CAN YOU HELP ME?
Submitted: 3 years ago.
Category: Medical
Expert:  Dr.Saleem replied 3 years ago.

Hi

 

Welcome to JA!

Thanks for the question.

 

How long do you have these symptoms?

How frequent are the diarrheal episodes?

Previous history of any surgery in the pelvic area?

Have you been investigated for the cause of diarrhea?

Do you have any other medical or surgical condition diagnosed?

 

regards

Expert:  Dr.Saleem replied 3 years ago.
Hi Fiona!

Firstly, It is important to determine the cause of incontinence which can be done by examination by an experienced surgeon and necessary tests. Fecal incontinence can result from dysfunction of the anal sphincters, abnormal rectal compliance, decreased rectal sensation, or a combination of any of these abnormalities.
Some of the more common causes of incontinence include:
1. Dysfunction of the anal sphincters due to vaginal delivery or surgical trauma
2. Diabetes mellitus (autonomic neuropathy)
3. Decreased rectal compliance or impaired rectal sensations
4. Fecal impaction
5. Idiopathic — Idiopathic fecal incontinence occurs most commonly in middle aged or elderly women. Although by definition, the cause cannot be identified, it is probably due to denervation of pelvic floor muscles resulting from stretch injury to pudendal and sacral nerves as might occur following a prolonged vaginal delivery, defecatory straining, or anismus.

For diagnosis examination by an experienced surgeon and tests like Anorectal manometry, Pudendal nerve terminal latency, Endorectal ultrasound, Defecography or Electromyography are required. In addition finding the cause of diarrhea is also important.

Treatment options include Medical therapy, biofeedback and surgical treatments

Medical treatment includes:
Specific treatment should be sought for the underlying cause in all patients who have diarrhea.
Stool frequency can be reduced with antidiarrheal drugs. Loperamide was more effective than diphenoxylate for reducing urgency associated with incontinence
Anticholinergic agents (such as hyoscyamine) taken before meals may be helpful in patients who tend to have leakage of stools after eating
Patients who have stool impaction should be disimpacted and treated with a bowel regimen to prevent recurrent impaction
Patients who have incontinence related to mental dysfunction or physical debility may benefit from assistance with a regular defecation program.
low doses of the tricyclic antidepressant amitriptyline can improve symptoms in patients with idiopathic fecal incontinence


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regards

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