Diarrhea tips?

I just had a colonoscopy about a week ago. I met with a PA and told her about symptoms I’ve been having since the summer of 2025, which are severe diarrhea sometimes a few times a week. I’ve been taking bismuth ( pepto ) and Imodium. I told the PA to check for micro colitis since it requires a biopsy. Anyway I got my results and the doctor did not do a biopsy because he said my colon did not look like I had it. I believe he did not look at the PAs notes. He said I should take Metamucil and see if I see improvements. After my colonoscopy a few days later the symptoms of diarrhea were quite severe. Can someone here give me advice of how to proceed? Obviously my insurance will not pay for another procedure

Typical of some doctors today....

@kmc123
I am having off and on bouts of this with Xeloda. I choose not to take drug remedies because I don’t want things to go “the other way”. Instead, I eat small portions of food and include more fiber with some cheese. Also soft foods .

I made some energy bites with peanut butter, oats, seeds, cacao powder, etc and eat those sporadically. My stomach pain has relaxed!

@kmc123 I have had serious diarrhea for over a year- and lost weight; the Gasto drs have not really hclped much (had a bypass due to ULCER) 45 yrs ago) but I finally tried some NATURAL- not pasteurized or filtered Apple cider Vinegar and this has definitely helped me (cant process DAIRY ). I had lower stomach and some nerves cut so MAYBE the extra acid plus the GUT bacteria in the vinegar is helping to digest my food BEFORE it gets to the intestines? Get it at ALdis!

@kmc123 Hi and welcome to Mayo Connect. I can feel your frustration. What did the doctor say when you told him that you asked for the biopsy?

@tomrennie he basically said my colon did not look like it had micro colitis and told me to take psyllium husk, and if I have symptoms still after 3 months to reach out

@kmc123 There are many pathologies of the GI tract that can manifest causing diarrhea. When a physician is not taking an approach to making a diagnosis that will then lead to treatment for resolution, this is the time to switch providers and find a specialist.

One of the first tests that should be done is a fecal elastase test. This measures the production and secretion of digestive enzymes. If there is impairment as indicated by a value below 200 micrograms elastase/gram stool, that indicates a pancrealipase such as Creon or Zenpep is required.

In patients that have pancreatic cancer and/or HD. Whipple resection, it can be the cause of Exocrine Pancreas Insufficiency (EPI). Maintaining a sufficient level of enzymes with meals will resolve the diarrhea. With respect to Imodium, I never had the desired effect when taking that OTC product. What did provide relief before I was prescribed a pancrealipase was an Rx anti-diarrheal medication. The one’s I found efective were Loperimide, Lomax, Lomotil and the inexpensive generic diphenoxylate atropine.

Other GI pathologies that can be present complicating a diagnosis are Small Intestine Bacterial Overgrowth (SIBO), Lactose Intolerance, Gluten sensitivity, Crohn’s disease, ulcerative colitis, diverticulitis, INS/IBD and a few other conditions. If this has been going on for a long time, you need to advocate for yourself and escalate this up to being seen at a comprehensive cancer center in the GI department. These large centers have a higher level of expertise and diagnostic tools to evaluate.

I learned how to strongly advocate for myself when I initially worked as a medical technologist in a hospital clinical diagnostic laboratory. From my contact with patients, the term I heard over and over is to know when to cut your losses and move on. I learned this lesson well and why I survived stage IV pancreatic cancer and achieved clinical cure. I learned for anything serious or ongoing, you need to find an a specialist at/a major center.

That reply was very helpful, thanks