I’m glad it’s working for you! There’s no particular problem with long-term use of Imodium (loperamide), especially if it’s only routinely taken once a day. Since every medication can have side effects it’s worth seeing if one pill at bedtime does the job for you, but two is fine if that’s what it takes.

JoeJoe- i have been using Imodium and Phazyme (for gas relief )since I was in the hospital for my colonectomy im 1992! I use the minimum I need..usually only a HALF if I think I will need it at bedtime or if I know I have an exercise event or like shopping . It has decreased to this over the years. I don't think I'd ever take it REGULARLY But on an as needed basis.  Let your body do its job and adjust to your NEW NORMAL. It will get easier. I use the Imodium to fine tune my NORMAL. I hope this helps you!!

I have in the past 15 years only used Imodium very judiciously, and only when needed which is very rare. I do not need it to thicken up stool as Metamucil does that job quite well. I have some sense from the many past posts on Imodium that some people use it because they are uncomfortable having 6-8 BMs per day- even if that is the "new norm"- and want 1 or 2 so they can feel "normal." This thinking, where it exists, is in my mind counterproductive and dangerous. I think slowing the transit time in some cases creates conditions that allow things like pouchitis and SIBO to happen over time, or else get worse. You want some degree of "regularity" and if that means 6-8 BMs, so be it. Lowering the number of BMs for the sake of doing so or purely to reduce the number of trips to 1-2 or some artificial "magic number" doesn't, in my opinion, promote overall bowel health. In my early pouch days 1992-2005 or so, I am convinced I overused Imodium and it exacerbated Pouchitis, much to my detriment.

Like the poster above, I am very sensitive to the effect of Imodium and 2 is way too much. 1 will produce a pronounced slowdown and thickening effect, and a half a pill is probably warranted when I get a little watery.  If stools are watery because of bad bacteria overpopulating, you want them flushed out, not staying in. This is the whole idea behind fiber/Metamucil in one's diet and overdoing it with Imodium simply defeats that mechanism of promoting good bowel health.

I am one of the ones who is not particularly sensitive to Imodium. I have taken it regularly since1995. I started with 8 a day and tapered down to 4 per day currently. Periodically I try to reduce it, but have not been able to. This keeps me at 4-8 stools per day.

All very safe long term. I get mine by prescription.

Jan

Jan, thank you. I have no side effects from it and only take two pills at night and now went down to 1 pill. It has really helped. The only thing I noticed is a little dry mouth at night, but I drink a lot of water. Thanks for responding.

Im relatively new to my J pouch , 8 weeks so far since take down.

I take three 2mg loperamide pills a day, I feel like it helps me with less BM's

but again Im very new to this. Im wondering since Iam not having any ill effects from the pills, should I continue using them??

I will be switching to mixture of psyllium husks  and loperamide next week to see if that changes things for me.

Im really glad this forum was started, it is helping me so much.

thanks in advance!!

Yes totally fine!!! I confirmed that with my surgeon

Thanks Lauren. I hope you are doing well.

@JoeJoe posted:

Thanks Lauren. I hope you are doing well.

Your welcome!!! You too! how is the shop???

Lauren, the shop is great. Finally got heat in it. LOL

@CTBarrister I completely agree with you.  Why keep all that in and risk more bacteria or even a possible blockage.  That's why I'm very hesitant in taking immodium, even though I'm exhausted from going to the bathroom.

@SadieM1210 posted:

@CTBarrister I completely agree with you.  Why keep all that in and risk more bacteria or even a possible blockage.  That's why I'm very hesitant in taking immodium, even though I'm exhausted from going to the bathroom.

I hear you girl, sams

@SadieM1210 posted:

@CTBarrister I completely agree with you.  Why keep all that in and risk more bacteria or even a possible blockage.  That's why I'm very hesitant in taking immodium, even though I'm exhausted from going to the bathroom.

Agreed!!!! I wish people would see that the same way as holding it in. I view slowing transit time and holding it in the same way, i know some people see it differently though

It's not at all the same. Holding it in for the first 6 months-1 year is medically advised by surgeons as necessary to expand the pouch to the proper size - so that one doesn't have 20 bowel movements a day. Holding stool only results in stool being retained inside the J Pouch, whose very purpose inside our bodies is what? Fecal storage. It's also a function every normal human being has to do when a bathroom is not available which, unless you never leave the house, will be a not infrequent experience for any person with a J pouch.

Imodium, on the other hand, artificially slows down transit time in a way that can be unhelpful if it's overused. As I mentioned earlier I have significant sensitivity to its effects and overuse would be 2 pills in one day. Which would constipate me.

Constipation can be a very serious medical condition in itself, and can also cause some of the issues none of us really want long term. A friend of mine who combined Imodium and opioid pain meds taken to excess after cervical disc surgery ended up in the emergency room with fecal impaction and had to have the dreaded manual fecal disimpaction. When I was recovering from J Pouch step 1 surgery in Mount Sinai Hospital I had to "witness" my roommate, who was dying of leukemia, have a "disimpaction" procedure (witness meaning I heard his screams on the other side of a drawn curtain). I only heard it and don't think anyone here would want that.

I think the bottom line is to gauge the number of Imodium needed to keep BMs between around 6 and 8 a day.  Taking more than that to reduce it further to some random, "target low number" isn't a good idea.

Yes, CT, that is the perfect way of looking at it. Rather than focusing on any particular dose of Imodium, you need to focus on your specific function and response to Imodium.

Also, the notion of reducing output to resemble the function of a healthy colon and rectum is foolhardy. Serious constipation can happen and the small intestine does not have the musculature and elasticity to handle firm stool.

One other point is to take into account your individual physical differences. If you have a stricture, that can change everything. Motility issues, prolapse, etc. also can play into the equation.

On the other hand, you should not put up with discomfort and being house-bound out of a desire to be medication free or a fear of side effects when there is a safe option available. Just make gradual changes and periodically try to go without to gauge your needs.

Jan

This has been an interesting topic to read as I’ve never used anything but Metamucil.

I’d like to try loperamide, especially for long trips, etc. Is there a specific brand that I should get OTC? Appreciate any input.