Copyright 2024 IBD Clinic.
There are a number of drugs available, often ‘over the counter’ (without a prescription), which can be very effective at treating symptoms such as diarrhoea, constipation and pain. These are known as symptomatic drugs. However, they do not reduce the inflammation causing these symptoms.
Codeine phosphate, loperamide (Imodium©), and diphenoxylate (Lomotil©) are all drugs which reduce diarrhoea by slowing down the contractions (muscle activity) of the gut, so food takes longer to pass through your system. This allows more time for the water produced by the digestive processes to be reabsorbed by the colon, and for the stools to become firmer and less urgent.
This means that abdominal cramps and constipation can be a side effect of these antidiarrhoeals. Sometimes they can cause hard stools that are difficult or painful to pass.
Codeine can also cause nausea and drowsiness, and may encourage dependence if taken in relatively large doses for a prolonged period. If codeine is suddenly withdrawn it may cause a general feeling of being unwell or of anxiety.
Loperamide is generally considered the safest antidiarrhoeal – but should not be taken by anyone having a significant UC flare-up.
Bile salts are naturally released from the liver to help with digestion, and are then reabsorbed in the ileum (the lower part of the small intestine). If you have Crohn’s Disease and have had surgery to remove the ileum, higher levels of bile salts can drain into the colon and cause watery diarrhoea.
Bile salt binders such as cholestyramine (Questran©) and colestipol (Colestid©) combine with the bile salts and prevent them from reaching the colon. This helps reduce the diarrhoea. Cholestryramine and colestipol are in powder form and can be mixed with water, juice or soft food.
Possible side effects include indigestion, abdominal bloating and discomfort, nausea and constipation. Bile salt binders can also affect how well other drugs are absorbed so should not be taken within four hours of other medication.
Bulking agents or ‘bulk formers’ contain a water absorbent plant fibre – usually ispaghula or stercula. Popular brands include Fybogel© and Normacol©. These come as granules which, when taken with plenty of water, swell up inside the bowel and thicken liquid or soften hard stools. The fibre also provides enough bulk for the bowel to work normally.
Bulking agents can be particularly helpful in treating diarrhoea if you have had surgery to remove your colon in which your small intestine is joined to your rectum (colectomy with ileo-rectal anastomosis). They can also be useful to soften the hard motions you can get with UC of the lower colon or of the rectum. However, you should not take bulking agents if you have a stricture (narrowing) of the bowel, as sometimes happens with CD.
Constipation can also be a symptom of IBD, especially of proctitis (inflammation in the rectum). Laxatives help to relieve constipation. Osmotic laxatives, such as Movicol, which contain a compound known as macrogol, are usually considered the best type of laxative for people with IBD. These increase the amount of water in the large bowel and make the stools softer and easier to pass. However, laxatives can also cause wind and stomach cramps, especially at the start of treatment.
Anti-spasmodics such as hyoscine butylbromide (Buscopan©) reduce painful gut cramps or spasms by relaxing the intestinal muscles. These medicines are most likely to be recommended for people with Irritable Bowel Syndrome (IBS), but they may also be helpful for the IBS-like symptoms sometimes experienced by people with IBD.
If you need to take over the counter painkillers it is probably best to avoid ibuprofen and diclofenac. These are what are known as non-steroidal anti-inflammatory drugs (NSAIDs). While they can be very effective for pain in the joints and spine, which may affect some people with IBD, there is some evidence that they may make other IBD symptoms worse or possibly trigger a flare up. Some people may also be affected by aspirin, so for simple pain relief paracetamol is probably the safest option for people with IBD.
If you find you have ongoing problems with pain and need to keep taking painkillers, talk to your doctor about your symptoms as other treatment may be more appropriate.
Copyright 2024 IBD Clinic.