Pale Stools and Strictures - Is There A Connection?

I have been having real pale stools recently (never had them before). I have strictures in small bowel. Could there be a connection between the two? I take Entocort.

Thanks.
jac521

Pale stools probably just indicate an absorbtion problem. I don't think there would be a connection to stricturing

The only thing to look out for with stool is to see if it gets very narrow or bloody or inability to pass stool at all because that would most likely be related to the stricture.

nogutsnoglory - thanks

Would Small Bowel Overgrowth cause absorption problems?

Hmm I'm not sure if it would cause absorption problems but it would definitely exacerbate symptoms of diarrhea, gas and bloating.

Bacteria does play a role in absorption of food but its not well known how much of a role they play. Someone else might know better if that can be part of the issue.

Have you considered antibiotics or a fecal transplant? They work very well on SIBO.

Hi Jac521, my GI always asks about the colour of my stools and i thought I remembered him commenting about malabsorption problems when i had pale stools so I looked this up for you:

Pale Stool

Stool that is pale or grey may be caused by insufficient bile output due to conditions such as cholecystitis, gallstones, giardia parasitic infection, hepatitis, chronic pancreatitis, or cirrhosis. Bile salts from the liver give stool its brownish color. If there is decreased bile output, stool is much lighter in color.

Other causes of pale stool is the use of antacids that contain aluminum hydroxide. Stool may also temporarily become pale after a barium enema test.

Pale stool may also be shiny or greasy, float, and be foul smelling, due to undigested fat in the stool (see soft and smelly stool).

If it continues mention it to your doctor just in case there is something else going on.
Hope it pass (no pun intended ) soon,

NGNG, do you have a paper or other source that shows a fecal transplant works well on SIBO?

jac, is your GI aware of your pale stools? If so, what did they say?

David - Yes, I told the Dr. He said it was malabsorption. I told him also that I have malodorous stools, bad taste in my mouth, get real bad heartburn after eating fatty foods and not relieved by antacids and Nexium. After I eat something fatty besides the real bad heartburn I get very nauseaous. I have pain in my upper-middle left side that gets worse after bowel movements. Also very weak and fatigued. I do not have a gallbladder.

I asked the Dr. If I could take some Flagyl as I have had small bowel overgrowth in the past and asked him if that could be my problem. He didn't say, but he did prescribe Flagyl 250 mgs. x's 4. I do feel better since I have been taking the Flagyl for the last 2 days.

Dr. Wants to do pill cam since MRE did not show active inflammation, but did show strictures.

No one has done liver or pancreatic enzyme tests. I did have an Endoscopy Ultrasound last week that showed some pancreatic changes, but negative for Chronic Pancreatitis.

Your thoughts are appreciated.

Jac

If you have pale stool I think some enzyme tests might be worth discussing with your doctor to see what they say, especially with visible pancreatic changes.

David said:

NGNG, do you have a paper or other source that shows a fecal transplant works well on SIBO?

jac, is your GI aware of your pale stools? If so, what did they say?

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My GI told me but now I'm wondering if he said C-Dif and not SIBO. Ill google.

It has definitely been shown to help C.diff. SIBO is small intestine so I don't think it would help much there. But I'm certainly open to reading a paper that says otherwise

David- Can Crohn's disease in the small intestine cause pale stools? The Dr. Thinks I have active disease in the small intestine and wants to do a pill cam. Will a pill cam show active inflammation?

Here is a link showing that Flagyl is indicated for SIBO:

Merckmanuals.com/.../gastrointestinal.../bacterial_overgrowth_...

Thanks.
Jac

jac521 said:

David- Can Crohn's disease in the small intestine cause pale stools? The Dr. Thinks I have active disease in the small intestine and wants to do a pill cam. Will a pill cam show active inflammation?

Here is a link showing that Flagyl is indicated for SIBO:

Merckmanuals.com/.../gastrointestinal.../bacterial_overgrowth_...

Thanks.
Jac

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I always get very nervous when I hear active disease and pill cam in the same sentence. If you are inflamed, narrow or god forbid partially obstructed a pill can cause so much damage and possibly emergency surgery. I get how the pill cam is ideal for someone otherwise healthy but it should not be used in people flaring.

I guess the reason I thought I felt better on the Flagyl was because I didn't have a bowel movement yesterday so the pain in my left side was better.

However, I just had a bowel movement and I got very bad pain in my upper left side, followed by nausea. Nausea usually follows eating, but I didn't eat anything only drank Gatorade.

Your thoughts are appreciated.

Jac

jac521 said:

David- Can Crohn's disease in the small intestine cause pale stools? The Dr. Thinks I have active disease in the small intestine and wants to do a pill cam. Will a pill cam show active inflammation?

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It can lead to it, yes. Crohn's disease can also lead to complications with the pancreas, liver, gallbaldder, etc. For example, pale colored stools can be the result of complications with the biliary system. I assume your GI will look into all of this but I don't feel pale colored stools should be passed off as, "malabsorption" without some testing. But hey, I'm no doctor.

A pill cam can show active inflammation, yes. If the inflammation is only microscopic in nature (I don't believe yours is) then it wouldn't pick up on that. You can read more about the pillcam here.

nogutsnoglory said:

I always get very nervous when I hear active disease and pill cam in the same sentence. If you are inflamed, narrow or god forbid partially obstructed a pill can cause so much damage and possibly emergency surgery. I get how the pill cam is ideal for someone otherwise healthy but it should not be used in people flaring.

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I disagree. The data shows that the pill cam is a good tool for evaluation of potential IBD. If strictures are suspected, then the "dummy pill" can be utilized to make sure the real cam isn't going to get stuck. If obstruction is suspected, then other tests would likely be utilized first.

David - I swallowed the fake camera in October and it was ok. However, I am much much worse than I was then. The MRE that showed strictures was done in October as well.

Do you think I should do another fake pill cam since I am much worse than I was in October? Can strictures get worse that quickly??

Thanks.
Jac

They can certainly get worse but I'm in no position to quantify how much or how fast. That would be a conversation to have with your doctor (and let us know their answer so we can learn ). Sorry I'm not more help on that.

I've never had nausea following bowel movements before. Is that another symptom of the Crohn's?

I have very little appetite and lost 20 lbs. in one month. Is a weight loss that quick another symptom of CD?

Thanks.
Jac

David - I asked my Dr. as you stated in your post above about the strictures getting worse since my MRE and swallowing the fake capsule in October. He said as long as I am able to keep food down and I'm not vomiting he is not worried about me doing the pill cam.

I told the Dr. that I am nervous about doing the pill cam because of the strictures and asked about doing the Fecal Calprotectin test instead. He said he needs to see that I have active disease going on and that the Fecal Calprotectin test is "worthless" in that regard.

My pain on the left side and nausea just keep getting worse. So I am going to do the pill cam next week. I just keep getting worse daily. Tramadol doesn't help with the pain and I am so weak I can hardly do anything.

Thanks.
Jac

I can see his desire for the pill cam. I don't understand why he wouldn't do the fecal calprotectin as well.

jac521 said:

I've never had nausea following bowel movements before. Is that another symptom of the Crohn's?

I have very little appetite and lost 20 lbs. in one month. Is a weight loss that quick another symptom of CD?

Thanks.
Jac

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I have also had both those problems before with my CD Jac.