How does Imodium actually work?

PluotMember

I'm a little over two weeks out from j-pouch construction and have been dealing with slightly high output from my loop ileo. With just lifestyle changes (eating thickeners only, no sugar, no beverages with meals) my output was averaging about 1200 cc/day, so I added half a tablet of Imodium in the morning (my surgeon wanted me to start with THREE Imodium per day, but I am super sensitive to the stuff and knew I couldn't tolerate it)

Anyway, with 1/2 an Imodium on board I got to an average of 1000 cc/day, but I still felt a little dehydrated and quite frankly I hate having a bag full of liquid all the time (I'm used to my very well behaved end ileo). Today I tried my usual 1/2 Imodium before breakfast and another 1/2 before lunch. My output decreased a LOT (the day is almost over and I'm at 600 cc) and the consistency has been pretty nice, but after dinner I started to have a very bloated blocked feeling. I'm not blocked, as I'm still having good output, but it was enough discomfort that I had to lay down, massage my abdomen, drink hot tea, etc.

Anyway, getting to my real questions:
- For how long after surgery does the small intestine continue adapting and increasing absorption? Until the post-dinner bloating I was really happy with my 1 Imodium experiment, but if I still have hope of getting less output with less Imodium I will cut back. Again, it's only been 15 days.

- Does taking Imodium interfere with the process of small intestine adaptation? I've read here often that many surgeons don't want people to take Imodium soon after surgery. Mine doesn't feel that way and prescribed it while I was still in the hospital. I don't want to shoot myself in the foot here and become dependent on the Imodium/get in the way of my body learning to function without it.

- Does the timing of the Imodium matter? ie does it make sense to take 1/2 at breakfast and 1/2 at lunch vs. just taking a full pill at breakfast? My output naturally slows to a crawl at night while I'm sleeping so I don't want to take any in the afternoon or evening.

I know it sounds silly to obsess over such a small amount when there are people taking 8 pills every day, but my body is VERY sensitive to it so this feels like a big dose to me.

Thanks in advance!!

5/16/138:10 PM

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Jan DollarModerator, RN, retired

Imodium works exactly the same as morphine and other opiates, without the analgesia. It works through the opiate receptor in the gut.

Everything I have read about it indicates that tolerance and dependence do not occur with Imodium. As you have noticed, we each have our own sensitivity to it, so you are right to adjust according to your own needs.

There is nothing to indicate that it interferes with adaptation in any way. The doctors who prefer you not take bowel slowers at first probably just want to see if things will be OK without it before you take them. Like your surgeon, mine had me on it prior to discharge.

Typically, adaptation occurs mostly within the first year, with there tending to be incremental improvements after the first 6-12 weeks. For me, I needed maximum dosing of Imodium for around 4 years, but I think that was mainly due to undiagnosed cuffitis.

I do still take it, but half as much as I used to.

Jan