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Crohn's Disease Forum » Treatment » Enteral Nutrition & TPN » Is it normal to have green/grey stools whilst on Modulen?


01-25-2017, 10:35 AM   #1
CYY
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Is it normal to have green/grey stools whilst on Modulen?

Hello everyone! I'd like to clarify my doubts about something today.

So, I've been on Modulen for 6 weeks now, and I've got about 4 more weeks to go. Before Modulen, I've been suffering from frequent bouts of diarrhoea, averaging about 3-4 times a day. A few days after being on Modulen, I've noticed that my BMs have become less frequent, and that I don't have to go to the loo every single day anymore. However, my stools are still as watery as before, coupled with a weird shade of lime green.

I've discussed this with both my dietitian and my gastroenterologist, and they told me that they would not be too concerned about this. However, taking into consideration that I'm still having flare ups every now and then (just not as frequent as before) they decided to add another 2 weeks of Modulen for me, just to be sure to induce remission. This is why I'm on ten weeks of EEN instead of the usual eight, and I can't wait for it to be over.

Fast forward to 6 weeks later, and I've noticed that my BMs have become smaller and even less frequent, with 3-4 days as the average wait time between BMs. My stools have become hard as a rock, and they are now grey in colour. I have not seen any blood (yet) in my stools, but it takes a lot of forcing for them to come out at all. This is the complete opposite of what I've been experiencing for a good decade of my life, and I'm starting to wonder if this is normal.

In addition, my urine has a little tinge of green in it, and I'm wondering if that's a cause for concern as well. My next appointment with my GI doc and my dietitian will be in about a week's time, and I hope I can go to the hospital knowing roughly what to ask and what to expect.

Thank you to everyone for taking the time to read through this, and any help at all would be greatly appreciated.
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Hi, I'm CYY! (✿◠‿◠)/
Age: 17
Diagnosed with: Crohn's Disease, Supraventricular Tachycardia, Chronic Asthma
Currently on: Methotrexate 20mg/week, Folic Acid 5mg, Atenolol 50mg, Modulen IBD (10 scoops), Ondansetron (PRN), Debridat 100mg (PRN), Anarex (PRN), Ventolin (PRN)
Previously on: Azathioprine 50mg, Propanolol 25mg, Seretide

Last edited by CYY; 01-26-2017 at 04:07 AM. Reason: Poor grammar
01-25-2017, 01:50 PM   #2
ronroush7
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I would consider going to the doctor about your urine . I would talk to him also about the stools. Best to you.
01-25-2017, 07:25 PM   #3
my little penguin
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Formula only can cause too things
One liquid in=liquid out and green is very common

Second in some it can cause constipation since you have very little waste
Formula is used very effectively by the body with very little left over
When ds is formula only he needs more miralax (osmotic) to help keep things soft firmed and moving

Urine ...
Definitely talk to your GP/GI
As well as the grey color
They could prescribe an osmotic like miralax to help keep things moving good luck
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01-26-2017, 10:28 PM   #4
CYY
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Alright, will do. Thanks for the help!
01-30-2017, 10:34 PM   #5
CYY
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Hey guys! Here's an update from me:
4 days ago, my stools have started turning brown again, and they're back to the watery state that they were before constipation kicked in. Having said that, however, I had 10 BMs yesterday, 4 of which were within 2.5 hours of me waking up. I've been in a terrible flare for the past 3 days.

I'm pretty sure that the 10 BMs yesterday was probably due to that one little pineapple tart and that one tiny peanut cookie that I sneakily ate during the Lunar New Year (3 days ago), when I'm supposed to be on EEN (I've been a bad girl, I know). At the same time, I'm just wondering what caused the sudden change from diarrhoea to constipation and now back to diarrhoea in the first place. This is because the sudden change from constipation back to diarrhoea took place A DAY BEFORE I stole the goodies, but my flare symptoms have only started AFTER I ate the goodies.

Anyways, I've got an appointment with both my dietitian and my GI doc today, so I'll be sure to clarify this with them. In the meantime, has anyone experienced this sudden change from diarrhoea to constipation and then back to diarrhoea whilst on Modulen?

(On a side note, my urine is also back to normal.)
01-31-2017, 06:41 AM   #6
CYY
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Hi all, I'm back from my visit to the dietitian and the gastroenterologist. Although I did ask them about the colour of my stools, I was not satisfied by both their replies, so hopefully someone could help me out here. ._.

My dietitian said that green stools were totally normal, but she had no idea why my stools turned grey. She added that as this was her first time seeing a patient with such bad inflammation due to Crohn's Disease (clearly, the doctors don't have much experience in dealing with Crohn's patients in this part of the world), much of the stuff I'm experiencing is new to her. For example, all the other CD patients that she has seen do not complain about abdominal pains one or two weeks after they've been on Modulen, but I'm still experiencing some cramping in my gut every now and then (even without me eating anything that I'm not supposed to eat). All the other CD patients that she has seen have fully formed brown stools (neither diarrhoea nor constipation) by the time they've been on Modulen about a month or so, but I'm still getting diarrhoea and constipation and weird coloured stools 6 weeks into Modulen. To cut a long story short, she had no idea what was going on, and told me to consult my GI doc.

I felt that my GI doc was trying his best to come up with a possible explanation as to why I'm having grey coloured stools whilst I'm on Modulen, but I can tell that he didn't know the answer as well. True, grey coloured stools are definitely not normal, but as to what causes it he narrowed it down to either an infection (which I thought was highly unlikely), or some innate undiscovered function that my gut has when digesting Modulen (which seemed equally unlikely). He was also very quick (maybe a little too quick), to add that so long as it is not bothering me too much, I should not be too concerned about it.

All in all, neither the dietitian nor the gastroenterologist could explain why I was experiencing grey stools whilst on Modulen, and both of them have decided not to persue this matter further, instead concentrating on getting me through EEN into remission, and start Azathioprine as soon as possible. Don't get me wrong, it's good that my doctors have my welfare at heart, but maybe they are overlooking some things?

Some enlightenment would be greatly appreciated.
01-31-2017, 04:35 PM   #7
GirlwiththeCurl
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Have you ever had bloodwork to test liver function? Gray-colored stool can result from bile not making it into your digestive tract. There are some liver diseases that can co-occur with IBD that will produce gray or white stool if the is a blockage of the bile ducts. Primary sclerosing cholangitis is the one I'm familiar with (my daughter has it).

I'm not saying that's what you've got. It's just something to consider. It's more common with UC than Crohn's, but I think about 0.5% of people with Crohn's develop PSC.
01-31-2017, 06:12 PM   #8
Maya142
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Green is pretty normal with Crohn's, but grey definitely is not. I agree that blood work to check liver function is a good idea.

Some people do not go into complete remission with EEN. Occasional symptoms while on EEN aren't that uncommon. It sounds like you need a maintenance medication (like azathioprine) to "help" so to speak (and to keep you in remission once you get there). It also does take time for the gut to heal - it took time for it to get into the state it's in, so it will also take time to heal.

If you're not completely comfortable with the explanations your GI is giving you, have you considered a second opinion? Is there another GI who is experienced with IBD near you?
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Mom of S (23)
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02-01-2017, 06:30 AM   #9
CYY
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Have you ever had bloodwork to test liver function? Gray-colored stool can result from bile not making it into your digestive tract. There are some liver diseases that can co-occur with IBD that will produce gray or white stool if the is a blockage of the bile ducts. Primary sclerosing cholangitis is the one I'm familiar with (my daughter has it).

I'm not saying that's what you've got. It's just something to consider. It's more common with UC than Crohn's, but I think about 0.5% of people with Crohn's develop PSC.
Green is pretty normal with Crohn's, but grey definitely is not. I agree that blood work to check liver function is a good idea.

Some people do not go into complete remission with EEN. Occasional symptoms while on EEN aren't that uncommon. It sounds like you need a maintenance medication (like azathioprine) to "help" so to speak (and to keep you in remission once you get there). It also does take time for the gut to heal - it took time for it to get into the state it's in, so it will also take time to heal.

If you're not completely comfortable with the explanations your GI is giving you, have you considered a second opinion? Is there another GI who is experienced with IBD near you?
Thanks for both your replies. It seems weird that my stools have suddenly changed from green (too much bile) to grey (too little bile) all of a sudden. I thought a blockage sounds more likely than an infection. I'll be sure to suggest to my GI doc to do some blood work to check my liver function during my next appointment with him.

Maya142, I agree with you that having symptoms while on EEN is definitely not uncommon. In this part of the world, Crohn's is considered a rare disease, and my dietitian looks like someone in her late 20s or early 30s, so I'm not entirely surprised if she hasn't seen many CD patients before.

Funny you should mention taking Azathioprine, because my GI doc just prescribed some to me yesterday, and I'm supposed to start taking it together with Modulen next week (reintroducing food in another 2 weeks). I'll be going for a blood test to check my reaction to Azathioprine in about 2 weeks' time, so might as well request for the liver function test then. XD

Second opinions are out for me because:

1) My current gastroenterologist is the only paediatric GI who has any experience with IBD near me. When I get transferred into the adult portion of the hospital in about 2 years' time, there'll be 3 other GIs specialising in IBD available for me to choose from. If not, the second nearest hospital with a GI who specialises in IBD is a 40 minute drive away, which is considered a long way in this small island nation.

2) A second opinion would cost money, and financial independence is not something I have now. As I was referred to a specialist by a government-subsidised clinic, I qualify for a 50% student subsidy for all my consultations and medications (even Modulen). If I were to seek a second opinion, I would not enjoy the 50% subsidy and I'll only become a greater financial burden to my parents, who are already struggling with my current medical expenses.

GirlwiththeCurl, I'll be sure to do more research on primary sclerosing cholangitis. Hope your daughter gets well soon!
02-01-2017, 12:12 PM   #10
my little penguin
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Normally they would check liver function as part of standard aza blood work
Good luck
02-01-2017, 04:13 PM   #11
CYY
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Normally they would check liver function as part of standard aza blood work
Good luck
Ah, that would makes things much simpler. Thanks for the heads up!
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