My 10 year old j-pouch works great and I have good control. Unfortunately, I have a recto-vaginal fistula that isn't so nice. I try to keep my stool somewhat firm by taking 1 Imodium each morning. A gynecologist is suggesting that I switch to Pepto Bismol due to it's binding properties. I am testing it out but was wondering if anyone has any experience with these two over the counter medicines? Thank you
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If Imodium is working for you, why change? Imodium is safe long term. There isn't much data for Pepto Bismol (bismuth subsalicylate) for long term use. In high doses long term there are some reports of encephalopathy (reversible) due to heavy metal poisoning from bismuth accumulation. It is extremely rare, so if you want to try Pepto Bismol, it might be worth a try. It will turn your stools black, so don't be alarmed by that.
You can take up to 8 (16 mg) Imodium daily, so you are on a very low dose.
Some people with R/V fistulas get good results by using soluble fiber supplements to bulk the stool and reduce leakage through the fistula.
Jan 
Thank you Jan!
Another side effect of the Pepto is that your tongue can turn black too. Happened to my husband and it scared us to pieces!! �� For my pouch, I've been on Metamucil since the day I got it... 18 years ago. Won't miss a day. I also will throw in an immodium if needed. Personally, I'd stay away from Pepto.
If you take the caplets instead of the liquid or chewable Pepto, black tongue is not much of an issue.
Jan
