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

Is it irritable bowel syndrome (IBS)?

I have been experiencing diarrhea since around April of last year.
In the first few days, I had an episode of vomiting and diarrhea after eating a hot pot with fresh beef.
At that time, I didn't think much of it, but by October, I was still having diarrhea, so I underwent a painless colonoscopy.
The doctor said there was nothing wrong with my intestines and suggested that I was under too much stress, advising me to go out and relax more.
After that, I started taking probiotics, which slightly improved my symptoms, but if I stop taking them, the diarrhea worsens.
I experience alternating constipation and diarrhea, and regardless of whether I take probiotics, my stools are very foul-smelling.
The end of my stools is often mushy, which is quite unpleasant, and I've noticed some white spots on my stools.
I then consulted a traditional Chinese medicine practitioner, who prescribed me medication for irritable bowel syndrome.
Initially, I felt better and my energy improved significantly.
After taking the medication for a month, I experienced less diarrhea, but if I stop taking it, the diarrhea returns.
This leads me to wonder if the beef I ate back then could have had parasites...
Is that a likely possibility? What tests should I undergo? Can I be prescribed medication to eliminate parasites directly?

Hao Dai, 20~29 year old female. Ask Date: 2019/03/10

Dr. Chen Qifeng reply Gastroenterology and Hepatology

You can first go to the infectious disease department to check for parasites.
Otherwise, it could be irritable bowel syndrome triggered by a previous gastroenteritis.

Reply Date: 2019/03/10

More Info

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder characterized by a combination of symptoms, including abdominal pain, bloating, and altered bowel habits, which can manifest as diarrhea, constipation, or alternating episodes of both. Your symptoms, which began with diarrhea and included episodes of vomiting after consuming potentially contaminated food, suggest a complex interplay of factors that may have triggered your IBS.

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

2. Altered Bowel Habits: This can include diarrhea, constipation, or alternating between the two.

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

4. Mucus in Stool: Some patients notice mucus in their stool, which can be concerning but is often benign in the context of IBS.

Your experience of alternating constipation and diarrhea, along with the foul-smelling stools and the presence of mucus, aligns with the typical presentation of IBS. The fact that your symptoms improved with probiotics and traditional Chinese medicine suggests that dietary and lifestyle modifications can play a significant role in managing IBS.

Diagnosis of IBS
The diagnosis of IBS is primarily clinical, based on symptom patterns and the exclusion of other gastrointestinal disorders. The Rome IV criteria are often used, which require the presence of abdominal pain at least one day per week in the last three months, associated with two or more of the following:
- Related to defecation
- Associated with a change in frequency of stool
- Associated with a change in form (appearance) of stool
Since your colonoscopy showed no significant abnormalities, it is likely that IBS is the correct diagnosis. However, if you are concerned about the possibility of parasitic infections due to your initial symptoms after eating the contaminated food, it may be prudent to discuss this with your healthcare provider. They may recommend stool tests to check for parasites or other pathogens.

Treatment Options
1. Dietary Modifications: Many individuals with IBS find relief by adjusting their diet. This can include:
- Low FODMAP Diet: Reducing fermentable carbohydrates that can exacerbate symptoms.

- Increased Fiber: Soluble fiber can help regulate bowel movements.

- Avoiding Trigger Foods: Identifying and avoiding foods that trigger your symptoms.

2. Probiotics: As you noted, probiotics can help restore gut flora balance and may alleviate symptoms.

3. Medications: Depending on your predominant symptoms, your doctor may prescribe:
- Antispasmodics: To relieve abdominal pain.

- Laxatives: For constipation-predominant IBS.

- Antidiarrheal medications: For diarrhea-predominant IBS.

- Antidepressants: Low-dose antidepressants can help manage pain and improve gut motility.

4. Stress Management: Since stress can exacerbate IBS symptoms, techniques such as mindfulness, yoga, or cognitive behavioral therapy may be beneficial.

5. Regular Follow-ups: Continuous communication with your healthcare provider is essential to monitor your symptoms and adjust treatment as necessary.

Conclusion
In summary, your symptoms are consistent with IBS, and while the initial gastrointestinal upset may have been triggered by food, the ongoing issues suggest a chronic condition that can be managed with lifestyle changes, dietary adjustments, and possibly medication. If you are concerned about parasitic infections, it is advisable to consult your healthcare provider for appropriate testing and treatment options. Remember, IBS is a manageable condition, and with the right strategies, you can significantly improve your quality of life.

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