On Flagyl, is this normal?

[Midnight]

Hi everyone,

I was in the hospital for cellulitis for a week in February this year. Once I got out, I started having a little blood in my stool. Took an incomplete course of flagyl after results came back negative for c diff (was already on flagyl when tested). So I finished antibiotics, cellulitis healed, but I had blood in my stool intermittently. Over the next few months, I started having more blood but no other uncomfortable symptoms. I thought it was just hemmorhoids. Then, after my bowel habits started changing (developed urgency, started going many more times in a day, cramping, pain, etc.), I realized that this is probably more than hemorrhoids.

I got a second stool test testing for c diff, but that came back negative as well. My lab doesn't test right away, and I turned my specimen in right before they closed, so I don't know if that led to a degradation of the sample in any way.

Anyhow, my doctor who is treating me put me on a course of flagyl just in case to see how I would do. The urgency went away. A lot of the pain went away. I was able to urinate more freely and frequently again (in the midst of the infection, I didn't really ever urinate, and when I did the amounts were so small. I got really dehydrated without realizing it to the point of waking up with calf cramps in the middle of the night).

I was out of town a few days ago and my stools had no blood in them. Because of the nausea, I had most of my calories in the form of liquids, but the blood was pretty much gone and my bowel movements were nice, and there was no urgency, and my ability to urinate properly and fully had returned. No more calf cramps from dehydration. I also felt better mentally.

Since I got back home, I was able to eat solid foods more regularly and found that some of the blood in my stool is returning, despite the overall improvements. Today is my last day of the course, and I'm a little frightened. Is it normal to still have a bit of bleeding after going through an entire course? My stools are still formed really well, and while there is blood, there is much much less blood than there was before. Is this a normal sign of having a little blood here and there?

[Midnight]

It seems to just be on the surface. For a few days there was no blood at all. It seems like it is getting slightly worse. All other symptoms have continued to be better.

[beth22]

I was told by my GI that when the blood is on the outside, it could be a fissure or hemmorhoids. When was the last time you had a colonoscopy or sigmoidoscopy? Polyps can also bleed.

[Midnight]

Last year (May 2013), I had infectious colitis (different bacteria) which they thought was ulcerative since I was 20 years old at the time and young people generally don't get the type of infection I had. A round of vanco got rid of it. I had a colonoscopy before and a colonoscopy a month after I got out of the hospital to check for UC. Everything was all clear, no inflammation and the biopsy revealed no sign of ulcerative colitis.

So the last time I had a colonoscopy was last year. Between that bout of colitis and my exit from the hospital for cellulitis last year, I had absolutely no bowel troubles. Everything was fine. The first bout occurred because I had been throwing up multiple times every day while trying to eat normal foods. After 2-3 weeks of doing that, my stomach acid was not killing the bacteria in my food and then I ended up with colitis. So that wasn't like a secret UC flare, especially since they did a biopsy a month later and found no sign of UC whatsoever.

Now I start having blood in my stool the day I am discharged from the hospital in February of this year, and it got slowly and slowly worse until now. Since I was in the hospital for cellultis for a week, and they gave me clindamycin for a few days (antibiotic which increases the risk for C diff colitis), the most likely explanation is that it is C diff.

A doctor put me on flagyl after I left the hospital and then tested me for c diff back in March 2014. The test was negative, so I thought I was good and stopped taking it. I stopped in the middle of my course, and I was tested while I was already on flagyl. Then over the next few months, I had no other symptoms of anything being wrong, so I thought the blood was just hemorrhoids, but then the blood started being mixed in with the stool, and my symptoms got slowly worse and started to include the traditional colitis symptoms. So I told my doctor, and he tested me again, and it came out negative. On flagyl, the symptoms were going away and it was great, until yesterday. Now the symptoms seem to be slowly coming back, minus the improved urination.

[beth22]

If you had the colonoscopy and no polyps were found, then I would not worry about that. I do know someone who had c diff and got UC as a result. Somehow it triggered it according to his doctors. Was the last negative test that you had for c diff also when you were on Flagyl or was it done before you started this course you are on now? I understand your concern because Clindamycin is about the worst antibiotic to cause c difficile. However, if you are having bleeding even while on Flagyl, that is unusual because generally the bleeding that comes with c diff subsides after a person has been on the meds for a few days. I never took Flagyl, but this is what happened when I took vanco each time. After 4 - 5 days I could no longer see any bleeding.

[Midnight]

Well it did subside for a few days. It has become less and less, and was even gone for a few days. My doctor extended my course of flagyl through the weekend until I can see him in his office on Monday, otherwise today was supposed to be my last day.

I called him and apparently he is not worried about it being autoimmune, so there is that. Hopefully he is right.

My first test for c diff in March 2014 came back negative, but I was on flagyl for a few days at that point, so I don't know how reliable that is. The second time I was tested for it 2-3 weeks ago, they could not culture it so it came back negative, but I guess there were white blood cells in my stool. I took another test today, but I've been on flagyl for about 2 weeks now, so I really doubt they would be able to culture it or find a toxin. So 2 out of 3 of the times I've been tested for it are probably unreliable, at least.

[beth22]

The test is not usually reliable when you are on medication. They are finding that some strains of c difficile seem to be getting resistant to Flagyl, but if your only symptom is the bleeding and the bms are better, then that is probably not the case. It is good that you have the Flagyl through the weekend and your doctor can figure it out on Monday. Maybe it is just a fissure or a hemmorhoid. They have creams and suppositories for those.

[Midnight]

Well the BMs are variable. This morning they were well formed, yet bloody, but as they day went on...they were beginning to look more similar to before I started the course. Could it be a resistant strain?

I suppose we can't know until we have more info. My doc is scheduling another colonoscopy, and assured me not to worry about the worst-case scenario.

[beth22]

If Flagyl does not work after two courses, usually doctors will prescribe another medication such as vancomycin or Dificid. It is good that the doctor is doing the colonoscopy to check it out. If it turns out to be c difficile, then you can treat it, but no point in taking extra antibiotics if it is not c difficile.

[Midnight]

Thanks everyone. I'll wait for the colonoscopy to see what's going on.

[Bobbie]

Agree- probably hemms but best to make sure. Ley us know outcome. Best to you.

[Midnight]

Hi everyone,

So for the most part, the bleeding of my stools stopped. My stools form normally and they smell normal again, sorry for TMI. I still get occasional bleeding but I've also decided not to sit on the toilet playing on my phone for 15 minutes at a time, so my one minute visits to the bathroom have resulted in a lot less blood. Additionally, I was absolutely convinced I had UC, so the anxiety was really doing a number on my bowels. I felt like I had to go all the time and there were all sorts of pains, but as the anxiety died down, my bowels feel absolutely fine and there is hardly any blood. So I think flagyl worked and despite the initial negative test for c diff, a two week course treated all my symptoms and things are basically normal again. Crossing my fingers that I don't relapse! Thank you for your help everyone!

[beth22]

Good to hear! Good luck and hopefully c diff will just be a distant memory soon.