Best medications for treating diarrhea in Crohn's disease
People with Crohn's disease can find diarrhea a particularly troubling symptom. It can come on unexpectedly and interfere with daily activities significantly. If left untreated, diarrhea can also lead to serious health complications, such as severe dehydration.
In this article, we look at different anti-diarrheal drug treatments for people with Crohn's disease along with some general tips for managing diarrhea.
Over-the-counter medications for diarrhea
People can buy several treatments for diarrhea over-the-counter (OTC) at pharmacies. Below are some examples:
Loperamide slows down bowel movements.
Image credit: Kristoferb, 2010
Loperamide is a common OTC treatment for short-term diarrhea. The drug works by reducing water in the intestines and slowing down bowel movements. Loperamide can be used to control ongoing diarrhea or reduce the amount of fluid in people with ileostomies.
Loperamide is an oral medication that comes in tablet, capsule, and liquid form. A doctor can also prescribe loperamide.
Doctors generally do not recommend taking loperamide long-term, as it can increase a person's risk of developing megacolon, where the colon swells or an intestinal obstruction develops.
The U.S. Food and Drug Administration (FDA) also warn that taking more than the recommended dose of loperamide can cause dangerous heart problems or even death.
People should speak to their doctor before taking loperamide if they have a history of a slow or irregular heartbeat.
The FDA state that loperamide is safe when taken correctly.
Psyllium husk, also known as ispaghula husk, is a bulk-forming laxative that can help treat mild diarrhea.
Psyllium husk is widely available and is a type of fiber that works by absorbing water in the intestines, which thickens the stool and slows its passage through the bowels.
Psyllium husk often comes as a powder that a person mixes with water and then drinks. People can also use this medication to treat constipation.
When using psyllium to treat diarrhea, it is important to avoid products that also contain laxatives.
Psyllium husk is available to purchase in pharmacies, health stores, and online.
Bismuth subsalicylate (Pepto-Bismol)
Bismuth subsalicylate, more commonly known by it's brand name Pepto-Bismol, is a common OTC remedy for people with diarrhea and is available as chewable tablets, capsules, or as a liquid.
This medication works by reducing how much fluid the intestines absorb and reducing inflammation. Bismuth subsalicylate also has antacid properties that may help with nausea, heartburn, and upset stomach.
Using this medication can temporality cause a person's stools or tongue to become dark. These side effects are harmless and usually go away a few days after stopping bismuth subsalicylate.
Bismuth subsalicylate is available to buy in pharmacies, health stores, and online.
Prescription drugs for diarrhea
When a person with Crohn's disease visits their doctor about diarrhea, they may be given a prescription medication to treat the symptoms.
A doctor may prescribe anti-diarrheal treatment when a person has Crohn's disease and diarrhea.
Colesevelam is a type of drug known as a bile acid sequestrant. These drugs treat diarrhea by regulating the amount of bile acid in the digestive system.
Bile acids help the body to digest food. However, in some people with Crohn's disease, particularly those who have had part of the small bowel removed, bile acids can build up in the bowel and cause diarrhea.
A small 2014 study investigated the effectiveness of colesevelam for treating diarrhea in people with Crohn's disease. Participants who took colesevelam saw a significant improvement in symptoms after 4 weeks compared to those who received a placebo.
Colesevelam is a prescription medication that comes in tablet form.
Diphenoxylate is a synthetic opioid that treats diarrhea by slowing down the passage of stool through the intestines.
Doctors usually prescribe diphenoxylate in combination with fluid and electrolyte replacement measures to treat people with severe diarrhea.
Diphenoxylate comes in tablet and liquid forms and is available on prescription only.
Because diphenoxylate can become addictive, manufacturers combine it with atropine to cause unpleasant side effects if a person takes too much of the medication. It is, therefore, essential to carefully follow the doctor's instructions when taking diphenoxylate.
Codeine is a prescription drug that doctors usually prescribe to treat people with pain or coughing. They also sometimes prescribe it for treating short-term diarrhea.
Codeine is an opioid and can help treat diarrhea because it slows down the passage of stool through the intestines.
As with other opioids, codeine can become addictive, so it is essential for people to follow their doctor's instructions when taking this drug.
Side effects of codeine can include dry mouth, nausea, and sleepiness.
General tips for managing diarrhea
Keeping a food diary helps people identify foods that trigger diarrhea.
Talk to a doctor before starting OTC treatments for diarrhea, as the primary use of these medications is usually not meant for people with Crohn's disease.
Also, people may wish to check that these OTC medicines do not have any negative interactions with others they are taking for their condition.
During bouts of diarrhea, it is essential to stay well-hydrated and drink plenty of water. Dehydration, when not treated appropriately, can become serious and even lead to hospitalization.
Drinking plenty of water is necessary to ensure adequate hydration. It is also important to replace electrolytes by drinking broths or low-sugar juices and sports drinks. People should avoid caffeine and alcohol, as these can stimulate the intestines, making diarrhea worse.
Dietary changes can help reduce or prevent diarrhea for people with Crohn's disease. These adjustments may include:
- avoiding high-fiber foods
- avoiding fizzy drinks, such as soda and cola
- keeping a diary to identify and avoid foods that trigger or worsen diarrhea
- eating more frequently but with smaller portion sizes
A doctor or dietitian may also be able to recommend and provide support for specific diets that may help with a person's symptoms.
Diarrhea is a common yet troublesome symptom of Crohn's disease. There are a range of OTC and prescription drug treatments a person can take to treat short-term diarrhea. However, it is important for people with Crohn's disease to speak to a doctor before starting any OTC medications.
During bouts of diarrhea, it is also critical to drink plenty of fluids and replace lost electrolytes. For some people, dietary changes may help reduce or prevent diarrhea or other symptoms of Crohn's disease.
When a person with Crohn's disease experiences diarrhea, what is the best treatment option, and when should they see their doctor?
The best treatment is one that you and your doctor determine works for you individually. It may mean trying different approaches, and it can also depend on the severity of your disease.
It is important to control the symptom of diarrhea to prevent dehydration, electrolyte imbalance, and weight loss. Start by discussing with your doctor what you should, or should not, try. Ask your doctor about interactions between prescribed medication and OTC or homeopathic remedies.
The takeaway is that you should see your doctor for ongoing diarrhea that does not respond to OTC medication, or that causes blood in your stool, unexplained fever, or weight loss.Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.