Gastrointestinal Issues: When to Seek Further Testing

Gastrointestinal discomfort

For about three to four years, I have been experiencing unformed stools.
They break apart when flushed, and I often have diarrhea or floaty, sticky stools with many bubbles.
Sometimes I feel the urge to have a bowel movement, but I can't pass anything.
Previously, a gastroenterologist mentioned that it seems to be irritable bowel syndrome caused by emotional stress, and also suggested that the long-term alternating diarrhea and constipation might have led to anal fissures, which caused pain during bowel movements for several weeks (like a wound tearing), with blood during wiping.
There was also a small lump at the anal area, but the doctor did not mention any issues with hemorrhoids or polyps at that time.
Since there was no pain, and it was not an ulcerative lesion, just bloating, the doctor suggested it might be gastric bloating but primarily an intestinal issue, and there was no need for an upper endoscopy, as they also advised against a colonoscopy due to the anal fissures.
I took medications for digestion and diarrhea and was advised to maintain a positive emotional state.
However, gastrointestinal issues keep recurring, especially with bowel movements, which often resemble the original shape or color of the food, indicating significant malabsorption.
I have also been experiencing pain when pressing around the navel, especially in the right abdomen.
I would like to ask the doctor if further examinations are necessary.
Can an abdominal ultrasound reveal gastrointestinal issues, or is a colonoscopy required? Thank you.

Ka Fei, 20~29 year old female. Ask Date: 2019/05/05

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Abdominal ultrasound is generally not effective for examining the gastrointestinal tract.
Based on the current symptoms, the likelihood of irritable bowel syndrome is very high; however, performing a colonoscopy to rule out other organic lesions is also advisable.

Reply Date: 2019/05/05

More Info

When it comes to gastrointestinal issues, particularly those involving irregular bowel movements, abdominal pain, and other related symptoms, it is essential to approach the situation with a thorough understanding of the potential underlying causes and the appropriate diagnostic steps to take. Based on your description, it seems you have been experiencing a range of symptoms, including irregular stool consistency, abdominal discomfort, and a history of anal fissures. These symptoms can often be indicative of conditions such as irritable bowel syndrome (IBS), which is characterized by a combination of diarrhea and constipation, as well as abdominal pain.

Understanding Your Symptoms
1. Irregular Bowel Movements: The fact that your stools are often loose, watery, or even floating with bubbles suggests that you may be experiencing malabsorption or an imbalance in your gut flora. This could be due to dietary factors, stress, or an underlying gastrointestinal condition.

2. Abdominal Pain: The localized pain near your belly button, especially on the right side, could indicate issues related to the small intestine or the beginning of the large intestine (cecum). Pain in this area can sometimes be associated with conditions like appendicitis, though your symptoms seem more consistent with IBS or other functional gastrointestinal disorders.

3. Anal Fissures and Hemorrhoids: The presence of blood during bowel movements, especially if associated with pain, raises concerns about anal fissures or hemorrhoids. While these conditions are often benign, they can cause significant discomfort and may require treatment to prevent recurrence.

When to Seek Further Testing
Given the chronic nature of your symptoms and their impact on your quality of life, it would be prudent to consider further diagnostic testing. Here are some recommendations:
1. Colonoscopy: Although your previous doctor advised against it due to the absence of pain, a colonoscopy can provide a comprehensive view of the colon and rectum. It is particularly useful for ruling out conditions such as inflammatory bowel disease (IBD), polyps, or colorectal cancer, especially if there is a family history of gastrointestinal diseases.

2. Abdominal Ultrasound: An abdominal ultrasound can help visualize the organs in your abdomen, including the liver, gallbladder, pancreas, and kidneys. While it may not provide detailed information about the intestines, it can help rule out other potential causes of abdominal pain.

3. Stool Tests: Since you have experienced diarrhea and irregular stools, stool tests can be beneficial in identifying infections, malabsorption issues, or inflammatory markers that could indicate a more serious condition.

4. Dietary Assessment: Keeping a food diary can help identify any potential food intolerances or allergies that may be contributing to your symptoms. Common culprits include lactose, gluten, and certain fermentable carbohydrates (FODMAPs).

5. Psychological Evaluation: Since stress and anxiety can significantly impact gastrointestinal health, it may be beneficial to explore any psychological factors that could be exacerbating your symptoms. Cognitive-behavioral therapy (CBT) has been shown to be effective for managing IBS.

Conclusion
In summary, while your symptoms may be consistent with IBS or another functional gastrointestinal disorder, the persistence and severity of your symptoms warrant further investigation. A combination of colonoscopy, abdominal ultrasound, and stool tests, along with a thorough dietary and psychological assessment, can provide a clearer picture of your gastrointestinal health. It is essential to communicate openly with your healthcare provider about your concerns and the impact these symptoms have on your daily life. Early intervention and appropriate management can lead to significant improvements in your quality of life.

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