Gastrointestinal Discomfort: Causes and Solutions - Gastroenterology and Hepatology

Gastrointestinal discomfort?

Hello Doctor: I have been experiencing a persistent issue.
I usually wake up in the morning and have a normal bowel movement.
However, after I eat breakfast or drink water, I experience abdominal pain and the urge to use the bathroom again, sometimes resulting in a second bowel movement (which can be formed or unformed), and occasionally a third time.
I continue to feel the urge to go, and my stomach feels uncomfortable.
It usually improves after 3 PM.
This has been happening almost daily for the past two years, including on weekends.
I have annual screenings, including colonoscopy and gastroscopy.
Two years ago, I had a small colon polyp that was removed, and the last two years have been normal.
I also have a 0.7 cm gallbladder polyp, and I am a carrier of Hepatitis B (monitored every six months), along with internal hemorrhoids.
I experience excessive flatulence (odorless) and significant bowel sounds, regardless of whether I am fasting or have eaten.
Do I need to undergo any further tests? Thanks a lot.

Xiao Xie, 50~59 year old female. Ask Date: 2017/04/25

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Based on the symptoms, this appears to be a gastrointestinal functional disorder.
The current follow-up examinations seem sufficient.
It is advisable to adjust the diet by reducing oil, dairy, and irritants, and to adopt a mild diet.
If there is no improvement, consideration can be given to digestive enzymes for gut health.

Reply Date: 2017/04/25

More Info

Gastrointestinal discomfort can be a complex issue, often involving a variety of symptoms such as abdominal pain, changes in bowel habits, and feelings of urgency. Based on your description, it seems that you experience recurrent abdominal pain and a frequent need to use the restroom after meals, which can be quite distressing. Let's break down the potential causes and management strategies for your symptoms.

Possible Causes
1. Irritable Bowel Syndrome (IBS): Your symptoms may align with IBS, a common functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits. IBS can manifest as diarrhea, constipation, or a mix of both. Stress, diet, and lifestyle factors often exacerbate the condition.

2. Gastroesophageal Reflux Disease (GERD): Given your history of gastrointestinal issues, GERD could also be a contributing factor. This condition can cause discomfort after eating, as stomach acid flows back into the esophagus, leading to pain and a sense of urgency to relieve discomfort.

3. Food Intolerances: Certain foods may trigger your symptoms. Common culprits include lactose, gluten, and high-FODMAP foods. Keeping a food diary can help identify any correlations between what you eat and your symptoms.

4. Post-Cholecystectomy Syndrome: If you have had your gallbladder removed, you might experience symptoms related to bile acid malabsorption or changes in digestion, leading to diarrhea or abdominal pain after meals.

5. Psychological Factors: Stress and anxiety can significantly affect gastrointestinal function, leading to symptoms like abdominal pain and increased bowel movements.

Management Strategies
1. Dietary Modifications: Consider adopting a low-FODMAP diet, which has been shown to help many individuals with IBS. This involves reducing foods that are poorly absorbed in the small intestine, which can lead to gas, bloating, and diarrhea.

2. Regular Exercise: Engaging in regular physical activity can help improve bowel function and reduce stress, which may alleviate some of your symptoms.

3. Stress Management: Techniques such as mindfulness, yoga, or cognitive-behavioral therapy can be beneficial in managing stress and its impact on your gastrointestinal health.

4. Medications: Depending on your specific symptoms, medications such as antispasmodics, laxatives, or anti-diarrheal agents may be prescribed. Probiotics may also help in restoring gut flora balance.

5. Follow-Up with Your Healthcare Provider: Given your history of gastrointestinal issues, it is essential to maintain regular follow-ups with your healthcare provider. Since you have had colonoscopies and endoscopies that returned normal results, it may be worthwhile to discuss the possibility of IBS or other functional disorders with your doctor.

6. Further Testing: If your symptoms persist despite these interventions, additional tests such as breath tests for lactose intolerance or small intestinal bacterial overgrowth (SIBO) may be warranted.

Conclusion
Your symptoms of recurrent abdominal pain and frequent bowel movements after meals can be indicative of a functional gastrointestinal disorder, such as IBS. While your previous tests have ruled out serious conditions, ongoing symptoms warrant a comprehensive approach that includes dietary changes, stress management, and possibly medication. It is crucial to work closely with your healthcare provider to tailor a management plan that suits your needs and improves your quality of life. Remember, gastrointestinal health is closely linked to overall well-being, and addressing these issues can lead to significant improvements in your daily life.

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