LAR Syndrome: Best $7 I ever spent...

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chrisca
Posts: 244
Joined: Wed Dec 07, 2011 10:35 pm
Location: Portland, Oregon

LAR Syndrome: Best $7 I ever spent...

Postby chrisca » Thu Nov 11, 2021 10:48 pm

It's been over ten years dealing with LAR Syndrome, I've been to multiple specialists, with very little improvement to show for it. Finally, something that's helped a bit. A couple of months back, I had a bad episode of explosive diarrhea lasting over a week. The symptoms were different from what I've experienced before. I thought it could indicate I had an ongoing giardia infection that I had adapted to, but for some reason had it flare up. My new primary care doctor is much more willing to listen than my previous one and agreed to try one dose of tinidizaole, which is a newer drug used to treat it. It has definitely done something. The diarrhea stopped and there was a gradual but noticeable improvement in the LARS symptoms. It's not a miracle, but perhaps a 10-20% improvement. Less time sitting on the toilet, fewer visits to the bathroom with reduced urgency after meals, also much more normalized stool formation with less fragmentation. After two months, the improvement is still there.

Before cancer, I used to backpack, camp, and do international travel a lot. I got traveler's diarrhea many times but always recovered quickly. One of those times could have been a giardia infection. It's estimated that between 3 and 7 percent of the US population has an ongoing infection they've adapted to. It's worth discussing a course of this drug with your doctor if your LARS includes bouts of diarrhea, bad stool fragmentation, and lots of cramping that requires spending a long time in the bathroom. It cost me only $7 on my insurance and I am very glad I tried it.
Male, false negative colonoscopy age 48
DX: 12/2010 rectal cancer age 51
Stage T3N0M0 2 cm from anal verge
neoadjuvant rad/chemo Xeloda
Rectal resection (open surgery) straight anastomosis
Xeloda round 2
ileostomy reversal 11/2011
Successful adhesion X-lap 8/2013
Ongoing LAR syndrome but NED 10 years

JJH
Posts: 324
Joined: Mon Apr 24, 2017 7:26 am

Re: LAR Syndrome: Best $7 I ever spent...

Postby JJH » Sat Nov 13, 2021 12:05 am

Thank you for the information on Tindamax (tinidazole). It's good to see that you found some relief, even if it might not be permanent. Do you have any further information on tinidazole vis-à-vis the LAR syndrome? For example, how does it compare to Pentasa and other solutions that you have tried in the past?

I think that LARS is generally linked to neuro-vascular problems with the muscles in the pelvic area and to anatomical changes such as a narrower and less flexible neo-rectum, but it is not generally linked to infectious diseases. Do you know why tinidazole was recommended in your case? Maybe due to an amebic dysentary infection or prior giardia infection that flares up periodically? Did they do a stool examination to check for an infestation of malevalent bacteria? If so, what kind of infection did they find?

I think that it's best to do an appropriate stool test prior to prescribing this medication:

Drug Resistance
Prescribing Tinidazole Tablets in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.
https://www.drugs.com/pro/tinidazole-ta ... #s-34070-3
"The darkest hour is just before the dawn" - Thomas Fuller (1650)

User avatar
chrisca
Posts: 244
Joined: Wed Dec 07, 2011 10:35 pm
Location: Portland, Oregon

Re: LAR Syndrome: Best $7 I ever spent...

Postby chrisca » Tue Nov 16, 2021 3:49 am

We did not do a stool test as the cost was far more than the drug, plus the stool tests have a high false negative rate. Pentasa has been helpful for short term relief if I have a flare-up, but I can’t use it long-term due to gallbladder pain. There’s been no negative effects from the tinidazole. We chose it over Flagyl because it’s a single dose and is better tolerated. As always, discuss with your doctor and check your insurance before making a decision.
Male, false negative colonoscopy age 48
DX: 12/2010 rectal cancer age 51
Stage T3N0M0 2 cm from anal verge
neoadjuvant rad/chemo Xeloda
Rectal resection (open surgery) straight anastomosis
Xeloda round 2
ileostomy reversal 11/2011
Successful adhesion X-lap 8/2013
Ongoing LAR syndrome but NED 10 years


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