Dear Dr. Gott: I am writing to find how my friend might be helped. At age 77, she underwent surgery to remove pre-cancerous tissue in the upper intestine. Her father died of colon cancer, and a brother also has the same diagnosis. The second day after the surgery, she was rushed into the operating room to remove more of the intestine because she was becoming very ill and was near death.

Now, 18 months after surgery, she gets diarrhoea immediately after starting eating. It can happen at any time so she cannot leave the house. Her doctors have tested for cancer, but this was negative. She had recent surgery to explore the diarrhoea problem and to determine if she needed a colostomy. Nothing was discovered, and the colostomy was found to be unnecessary.

Her HMO referred her to an MD who is now starting her on yoghurt that contains probiotics, which I think is great. In my opinion, her system no longer has the necessary components to process food appropriately. I'm not a doctor and believe in using natural methods of healing, but I know there is a limit. If you get hit by a truck, you don't take herbs for it.

Is there anything we can do to stop her uncontrollable diarrhoea? She is now very depressed because she is normally a very active person.

Reply: Diarrhoea following bowel surgery can be difficult to treat; it depends on what part of your friend's intestine was removed. If approximately half of her small intestine was removed, she may be suffering from Short Bowel Syndrome. This condition is a group of intestinal problems caused by poor absorption of nutrients in people who have had a major portion of the small intestine removed.

The primary symptom is diarrhoea, which may be accompanied by cramping, bloating, weakness, fatigue and heartburn. The diarrhoea may be severe enough to lead to weight loss, malnutrition and dehydration if not properly treated.

Treatment of mild cases includes eating small, frequent meals, increasing fluid intake, adding nutritional supplements and using antidiarrheal medications. Moderate to severe cases may require IV fluids and feeding tubes. Normal eating is often continued in order to stimulate the remaining intestine to function better. If this is not your friend's problem, she may have to undergo testing to determine the cause and best course of action. Bacterial or viral infections, food allergies or sensitivities, parasite infections, adverse reactions to medication and several bowel disorders are possible culprits, and each has a different treatment plan.

While yoghurt with probiotics may help, it is not the only treatment available. Your friend should be under the care of a gastroenterologist. She also needs to be careful with her diet. Fatty, greasy and very sweet foods, as well as those high in fibre, caffeine or dairy, may worsen the situation. Taking in plenty of fluids, such as water and electrolyte solutions, is vital to avoid dehydration. Soft, bland foods such as bananas, cooked carrots, toast, crackers, boiled potatoes and plain rice can be eaten once symptoms improve.

To provide related information, I am sending you a copy of my Health Report 'Constipation and Diarrhoea'. Other readers who would like a copy should send a self-addressed stamped number 10 envelope and a cheque or money order for $2 to Newsletter, PO Box 167, Wickliffe, OH 44092.