Recurring Gastrointestinal Issues: a Month of Discomfort

Gastrointestinal issues have been recurring for a month?

Hello Dr.
Chen,
About a month ago (mid-February 2019), one afternoon after playing basketball with friends, I came home and drank a glass of cold milk from the fridge.
That night, I suddenly experienced diarrhea, and I had another episode in the middle of the night.
My gastrointestinal tract was unusually hyperactive.
The next day, I took some Motilum on my own, but instead of improving, my gastrointestinal motility decreased, leading to difficulty in passing stool.
Occasionally, when I did manage to pass stool, it was thinner than usual.
I visited a nearby hospital's gastroenterology department, where the doctor diagnosed me with gastroenteritis and prescribed medication.
After taking the medication for three to four days, my condition improved, but it relapsed afterward.
By that time, school had started, and I consulted the school physician, who also diagnosed me with acute gastroenteritis.
I had two consultations, and each time, I experienced initial improvement with medication, followed by a relapse.

In the meantime, I experienced a sensation of swelling and pressure in a specific spot in my lower abdomen, but it resolved on its own after a few days.
I asked the school physician about it, and he suggested it might be due to fecal accumulation in the intestines causing pressure.
My third visit to the school physician was about two weeks ago, at which point I felt my symptoms had improved, so I did not take any medication.
A week ago, I seemed to have recovered, and my bowel movements returned to normal.
I thought everything was fine, but three days later, the symptoms returned.
Initially, my bowel movements became more frequent, with a feeling of urgency, and while the color was normal (light yellow), the shape was often thin and flat.
Yesterday (March 21), I had a bowel movement that was somewhat loose and mushy.
Later, it returned to normal but remained thin and flat.
Currently, my stool alternates between being thin, flat, or loose.
There are occasional variations between thin, flat, and somewhat thicker stools.
However, I often feel like I cannot fully evacuate.
In the mornings, after just waking up, I tend to have smoother and more substantial bowel movements.
Sometimes, I feel tightness in my intestines.
The school physician mentioned that the gastroenteritis had resolved but then relapsed.

I would like to ask you what this situation might indicate.
It has been a month, and I can't help but worry if there might be something growing in my intestines.
Thank you, doctor!

Ning, 20~29 year old female. Ask Date: 2019/03/22

Dr. Chen Qifeng reply Gastroenterology and Hepatology

In some cases of gastroenteritis, patients may experience symptoms similar to irritable bowel syndrome after the gastroenteritis has resolved.
It is recommended to extend the duration of dietary adjustments that involve low oil, low dairy, and low irritant foods.

Reply Date: 2019/03/22

More Info

It sounds like you've been experiencing a challenging month with recurring gastrointestinal issues, and I understand how concerning this can be. Based on your description, it seems that you may be dealing with a combination of factors that could be contributing to your symptoms, including potential irritable bowel syndrome (IBS), dietary influences, and possibly lingering effects from the initial gastroenteritis.

Understanding Your Symptoms
1. Initial Gastroenteritis: Your symptoms began after consuming cold milk, which could have triggered an episode of gastroenteritis. This condition is often caused by viral or bacterial infections, leading to inflammation of the stomach and intestines, resulting in diarrhea and abdominal discomfort. The fact that you experienced diarrhea followed by constipation suggests that your gastrointestinal tract may have been reacting strongly to the initial infection.

2. Irritable Bowel Syndrome (IBS): Given the recurring nature of your symptoms, it’s possible that you may have developed IBS, a functional gastrointestinal disorder characterized by symptoms like abdominal pain, bloating, and changes in bowel habits (diarrhea and constipation). Stress, dietary changes, and infections can all exacerbate IBS symptoms. The alternating patterns of stool consistency you described (thin, flat, and loose) are common in IBS.

3. Bowel Obstruction or Accumulation: The feeling of incomplete evacuation and the occasional sensation of tightness in your abdomen could indicate that there is some form of stool accumulation or even a mild obstruction. This is particularly plausible if you have experienced episodes of constipation following diarrhea. However, the fact that you have had normal bowel movements intermittently is reassuring.

Recommendations for Management
1. Dietary Adjustments: Since your symptoms seem to fluctuate, keeping a food diary may help identify any specific triggers. Consider a low-FODMAP diet, which has been shown to alleviate symptoms in many IBS patients. This involves reducing certain carbohydrates that can ferment in the gut and cause bloating and discomfort.

2. Hydration and Fiber: Ensure you are drinking plenty of fluids, especially if you have experienced diarrhea. Gradually increase your fiber intake through fruits, vegetables, and whole grains to help regulate your bowel movements. However, be cautious with fiber if you notice it exacerbates your symptoms.

3. Probiotics: Incorporating probiotics into your diet may help restore the balance of gut bacteria, which can be beneficial after an episode of gastroenteritis. Yogurt with live cultures or probiotic supplements can be considered.

4. Stress Management: Since stress can significantly impact gastrointestinal health, consider incorporating stress-reducing techniques such as mindfulness, yoga, or regular physical activity into your routine.

5. Follow-Up with a Healthcare Provider: Given that your symptoms have persisted for a month, it would be prudent to follow up with a gastroenterologist. They may recommend further investigations, such as stool tests, imaging studies, or even a colonoscopy, to rule out any underlying conditions, especially if there are concerns about structural issues in the bowel.

Conclusion
Your symptoms are indeed concerning, but they are not uncommon in the context of post-infectious gastrointestinal disturbances. With appropriate dietary management, stress reduction, and possibly further medical evaluation, you should be able to find relief. It's essential to keep an open line of communication with your healthcare provider to ensure that any serious conditions are ruled out and that you receive the best care possible.

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