IBS: Symptoms, Diagnosis, and Treatment Options - Gastroenterology and Hepatology

Is it simply irritable bowel syndrome?

Hello Doctor,
For nearly two years now, I have been experiencing diarrhea every morning upon waking up.
I usually have dinner around 7 or 8 PM and do not have a habit of eating late-night snacks.
I go to bed around 11 or 12 PM.
Typically, I have diarrhea on an empty stomach every morning, but it only occurs once in the morning.
Throughout the day, I sometimes experience constipation and sometimes diarrhea.
I often feel the urge to have a bowel movement but cannot, and consuming fruits, pears, or fried foods tends to trigger diarrhea.
A gastroenterologist I consulted suggested that I might have irritable bowel syndrome (IBS).

Additionally, I have another issue: I am insensitive to hunger and satiety cues, and I often experience unexplained dizziness during my high school years.
I initially thought it was due to anemia combined with my slim physique, so I didn't pay much attention to it.
However, in recent years, I have experienced dizziness several times, but it resolves completely after eating.
This made me realize that my dizziness might be caused by low blood sugar.
Consequently, regardless of whether I feel hungry or not, I have been eating three meals at regular intervals, which has significantly improved the dizziness issue.
However, my gastrointestinal discomfort has started, initially presenting as a lack of appetite, feeling nauseous after only a few bites, bloating, and seeing undigested food in my stool, indicating clear indigestion.
This has now evolved into the situation described above, and I have also developed anal fissures.
I would like to ask the doctor:
1.
Is it simply irritable bowel syndrome? How can IBS be effectively treated, as it has been a persistent issue for a long time?
2.
Regarding my lack of hunger sensation, are there any tests I should undergo? I often feel no sense of fullness after eating (I don't feel hungry before eating either).
However, if I continue to eat, I end up feeling bloated and uncomfortable.
In short, I do not experience hunger or fullness before and after eating.
If I do not eat at regular intervals, I either feel faint from hunger or overly full to the point of nausea.
I eat at a slow pace, often being one of the last to finish when dining with others.
Additionally, I often choke on water, particularly at the moment of swallowing, and I am aware that I might choke.
I also find it easy to skip lines or miss words when reading, or I mix up letters (for example, writing "津" instead of "法律" or "悶" instead of "開心"), but my vision check shows no worsening of my myopia or strabismus.
3.
Regarding the anal fissure issue, I noticed a small bump while applying medication, which does not bleed and only hurts when pressed with a cotton swab.
It usually does not hurt otherwise.
Could this be hemorrhoids or something else?
Thank you, Doctor, for your advice.

Fei, 20~29 year old female. Ask Date: 2019/02/17

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Symptoms are related to gastrointestinal dysfunction; it is recommended to follow a low-fat, low-dairy, and low-irritant diet.
Hemorrhoids may be present.

Reply Date: 2019/02/17

More Info

Understanding Irritable Bowel Syndrome (IBS) is crucial for managing the symptoms and improving the quality of life for those affected. IBS is a common gastrointestinal disorder characterized by a combination of symptoms, including abdominal pain, bloating, and alterations in bowel habits, such as diarrhea and constipation. The diagnosis of IBS is primarily based on clinical symptoms and the exclusion of other gastrointestinal diseases.

Symptoms of IBS
The symptoms of IBS can vary widely among individuals, but they typically include:
1. Abdominal Pain: Often relieved by bowel movements.

2. Altered Bowel Habits: This can manifest as diarrhea, constipation, or alternating between both.

3. Bloating and Gas: Many patients report a sensation of fullness or swelling in the abdomen.

4. Mucus in Stool: Some individuals may notice mucus in their bowel movements.

5. Urgency: A sudden, strong need to have a bowel movement.

In your case, the daily occurrence of diarrhea in the morning, coupled with episodes of constipation and sensitivity to certain foods, aligns with the typical presentation of IBS. The fact that you experience relief after bowel movements is also a common symptom of this condition.

Diagnosis of IBS
The diagnosis of IBS is often made using the Rome IV criteria, which require that symptoms be present for at least one day per week in the last three months, with symptom onset at least six months prior to diagnosis. It is essential to rule out other conditions, such as inflammatory bowel disease (IBD), celiac disease, and infections, through appropriate testing, including blood tests, stool tests, and possibly imaging studies or endoscopy if indicated.

Treatment Options
While there is no cure for IBS, various treatment strategies can help manage symptoms:
1. Dietary Modifications: Many patients find relief by adjusting their diet. This may include:
- Low FODMAP Diet: Reducing fermentable carbohydrates that can cause gas and bloating.

- Avoiding Trigger Foods: Identifying and avoiding foods that exacerbate symptoms, such as high-fat foods, dairy, and certain fruits.

- Regular Meal Patterns: Eating at regular intervals can help regulate bowel function.

2. Medications: Depending on the predominant symptoms, different medications may be prescribed:
- Antispasmodics: To relieve abdominal cramping.

- Laxatives: For constipation-predominant IBS.

- Antidiarrheal medications: For diarrhea-predominant IBS.

- Probiotics: May help in some cases to restore gut flora.

3. Psychological Therapies: Since stress and anxiety can exacerbate IBS symptoms, therapies such as cognitive-behavioral therapy (CBT) or mindfulness may be beneficial.

4. Lifestyle Changes: Regular exercise, adequate hydration, and stress management techniques can also contribute to symptom relief.

Addressing Other Concerns
Regarding your lack of hunger and fullness sensations, this could be related to gastrointestinal motility issues or even psychological factors. It might be worthwhile to consult with a gastroenterologist or a nutritionist who can provide tailored advice and possibly recommend further testing, such as gastric emptying studies or assessments for functional dyspepsia.

As for the anal fissure and the small painful area you mentioned, it could indeed be related to hemorrhoids or a fissure. Maintaining a high-fiber diet and ensuring adequate hydration can help prevent constipation and reduce the risk of fissures. If the pain persists or worsens, a consultation with a colorectal specialist may be warranted.

Conclusion
In summary, while your symptoms are consistent with IBS, a thorough evaluation is essential to rule out other conditions. Treatment is multifaceted, focusing on dietary changes, medications, and lifestyle adjustments. Addressing your additional concerns about hunger and anal discomfort will require further investigation and possibly a multidisciplinary approach. Regular follow-ups with your healthcare provider will be crucial in managing your symptoms effectively.

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