Medicines & You
A Guide for Patients with a Total Colectomy, Ileostomy or J-pouch

One Size Does Not Fit All
When it comes to medicines, one size does not fit all. A person, who has had to have his colon removed, digests food more rapidly and, therefore, must take special precautions when taking some forms of medicines.

Because you look well, it is easy for doctors and pharmacists to forget you no longer have a colon. Before you have a prescription filled or purchase over-the-counter medicines, make sure that the medicine is appropriate for you. Remind your doctors and pharmacist of your condition and give them a copy of these guidelines.

By working together, you can help to better maximize benefits and minimize risks of drugs you take.

Enemas and Laxatives

• Never take large volume enemas! The small intestine is not designed to allow for large volume distention (expansion). These kinds of enemas could harm your small intestine.

• Very gentle laxative only for exam preps of the bowel—When your colon has been removed, it takes very little time for food to be digested and waste eliminated. It can be as short as one hour with an average of three to four hours. That's why clear liquid diets the day before an exam are usually adequate preparation.

Delayed-Release Drugs/Time-Release Drugs

• Any medications should be absorbed easily in the upper intestine. Medicines come in various forms: liquid, tablets, caplets, capsules, and ghost carriers. The formula design determines where the drug is dissolved and absorbed. Delayed-release medicines/ time-release medicines will not be effective, since the time it takes food to pass from the mouth to the pouch is short, usually 4 hours.

Remember Your Vitamins

• Multi-Vitamins are best taken in a liquid form or chewable tablet.

Do Not Crush

• Never crush medicines without checking with the pharmacist that it is safe. Many drugs come in different forms. Some medicines when crushed can cause too rapid absorption and overdosage. Other times, crushing can cause gastrointestinal upset and/or destroy a medication's effectiveness.

Diarrhea

• Antibiotics—Some antibiotics can change the normal bacteria in the intestinal tract and contribute to diarrhea. Notify your doctor if you develop diarrhea while on antibiotics or if diarrhea occurs after finishing a course of antibiotics.

• Antacids—Antacids that contain magnesium (i.e., Riopan, Maalox, Gelusil, and Mylanta) can cause an increase in bowel movements. Those containing aluminum hydroxide (i.e., Amphojel and Alternagel) should not cause diarrhea.

Diuretics

• Diuretics (water pills) should be used cautiously. Diuretics are sometimes used to control other medical conditions, but be sure your doctor is aware of your surgery. You may need to add more potassium and/or sodium to your diet. For instance, adding bananas, tomatoes, sports drinks (i.e., Gatorade), or orange juice may help. But be sure to read the labels of sports or nutrition drinks and to check with your doctor before using them. Some sports and nutrition drinks contain higher amounts of caffeine, vitamins, or herbal supplements than the recommended daily allowance (RDA) and may potentially cause complications.

Do Not Insert

• No medication or anything else should be inserted into the stoma (if you have one). Most of the time it will just be expelled. Other times, foreign objects can migrate into the small intestine and cause an obstruction (blockage).

If you have any questions about these or other types of medicines, consult your personal physician, pharmacist, and other qualified healthcare professionals involved in your care.

For more information about ileostomy, total colectomy, or J-pouch surgery, visit the United Ostomy Association.