Q: How do I slow diarrhea with my case of Ulcerative Colitis? At this point I am having a hard time and there are sudden urges and bloating that I can often barely make it to the bathroom most of the time. What do you recommend I do with my diet, are their any drugs or dietary or herbal supplements that can help too? Also how can I retain a fecal transplant enema long enough for it to work when I’m having all of this diarrhea?

A: There are several question here, however the first thing is to slow the diarrhea that is such a problem with Crohn’s Disease, Ulcerative Colitis and Irritable Bowel Syndrome (IBS). Slowing diarrhea can help good bacteria from pro-biotic supplements or fecal enemas become established faster and more effectively. Here are several different options grouped by category.

1) Anti-spasmodic drugs

These drugs calm the muscles in the bowels which slows urgency and the frequency of diarrhea that you have.

Immodium (generic: Loperamide) an over the counter drug which calms muscle spasms. It is effective, however it only lasts 4 hours and make interact with certain medications.  This can also be used before you may have diarrhea, for example an hour before you eat or before the Fecal Transplant enemas.

Anti-depressants or anti-anxiety drugs – Many anti-depressants, especially tri-cyclic anti-depressants are anti-spasmodics, that is they also slow muscle spasms and responses in muscles in the intestines which slow the rate of bowel movements. In patients without digestive disease many drugs considered to be anti-spasmodic can cause constipation. However if diarrhea is a problem, this can be a good way to treat it.

I had good results with the drug Silenor (Generic: Doxepin 6 mg tablets) which is prescribed for sleep maintenance. However Silenor is just a lower dose of Doxepin an off-patent tri-cyclic anti-depressant which might be even more effective for slowing diarrhea for an extended period of time at higher dosage levels. Side effects can include drowsiness.

Gas-X (Generic: Simethicone)

This is not an anti-diarrhea drug itself, however Simethicone helps ease bloating caused by gas which often happens along with diarrhea and can contribute to urgency. Immodium Advanced is a drug that contains both Loperamide, an anti-spasmodic and Simethicone.

2) Supplements

Peppermint Oil – I found this to be pretty effective with the added advantage of fresh breath. Peppermint oil is a natural anti-spasmodic. You can get this from Peppermint candy that has actual peppermint oil in it like Altoids, or Peppermint tea. However enterically coated peppermint oil capsules like Pepogest and Peppermint Plus are more effective because the oils are not digested until they reach the intestines.

Soluable fiber (Benefiber) – This is very helpful as a stool thickener, it helps soak up excess water and also is a good pre-biotic which can help “good” bacteria from fermented foods, yogurt and pro-biotic supplements become established.

Digestive enzymes and pro-biotics – Health food stores like WholeFoods has the best selection, however you can also find effective ones at drug stores and grocery stores. Basically enzymes like lactase that help break down the lactose in dairy foods and others like Beano that includes enzymes to break down the sugars in certain beans, fruits and vegetables. However it might be more helpful to just avoid some foods like dairy and other foods which have a higher chance of causing digestive problems.

3) Foods and dietary changes

A basic rule of thumb is to eat foods that thicken stool and avoid foods that are high in fiber or stimulate the muscles of the digestive track.

Low residue diet – This basically includes avoiding food and drinks that are irritating to the digestive track including those containing caffeine. Other irritants to avoid include foods with high amounts of insoluble fiber including nuts and many fruits and vegetables.

Eat foods that thicken stool –

This comes from the old stand-by of the BRAT or bland diets that have been used for many years to combat active diarrhea.

Applesauce and bananas contain soluble fiber, a form of fiber that may thicken your stool by absorbing water from digestive wastes. Apples and bananas also provide potassium, a mineral that you may lose if you have watery stool.

Banana bread – In the midst of persistent diarrhea I have sometimes basically lived off of banana bread which helps thicken stool. I used the recipe from the aforementioned link, although I later substituted rice flour for wheat flour while attempting a gluten-free diet.

Bread, pasta and rice also contain starches and fiber that can help bind watery stools. Eat refined white breads, cereals, pastas and skinless potatoes rather than whole-grain breads and cereals to prevent diarrhea. I tried substituting gluten-free breads, however they did not always offer the same amount of stool-thickening help. I think this may be because they had more insoluable fiber.

So there are a few ways to deal with diarrhea and urgency, often before it happens, and also to enhance your ability to retain a fecal enema.