Managing Bloating and Diarrhea: Insights from Gastroenterology

Abdominal bloating & diarrhea

Hello Doctor: I have a constitution that easily leads to diarrhea, but in the past six months, in addition to the diarrhea issue, I have also experienced severe bloating.
Sometimes I feel bloated on an empty stomach, but after eating, the situation improves a bit; however, there are times when I feel even more uncomfortable after eating.
After consulting several doctors, I underwent gastroscopy, abdominal ultrasound, and plain X-rays, and the results indicated that my stomach is generally fine, but they mentioned a slight ulcer in the duodenum.
However, the medication has not been very effective, and my bloating issue remains severe.
What should I do???? My bowel habits are usually every 2 to 3 days (without diarrhea); is this normal? What does "stool retention" refer to? Additionally, a doctor mentioned that my liver is slightly enlarged, but after further examination, they said there is no problem with my liver.
Why might there be a situation of liver enlargement? Could you please provide some daily life and dietary advice? Also, would exercise be helpful?

fù zhàng de bù shū fú de rén, 50~59 year old female. Ask Date: 2002/11/10

Dr. Yang Peizhen reply Gastroenterology and Hepatology

Hello! The symptoms you described are collectively referred to as "dyspepsia," which can be divided into two categories: "organic," meaning there is a disease affecting the gastrointestinal organs themselves, and "functional," indicating that there are no significant organic changes in the gastrointestinal tract, which may arise from other causes (such as thyroid dysfunction, diabetes, menopause syndrome, emotional stress, medications, etc.).
Therefore, we must first rule out organic diseases, and you have already undergone gastroscopy, ultrasound, and plain X-ray examinations.
Further evaluations may include colonoscopy or barium enema to exclude lesions in the colon, and even small bowel barium studies to rule out lesions in the small intestine.
Additionally, blood tests should be conducted to assess thyroid function, blood glucose levels, female hormones, electrolytes, and other relevant parameters.
Once a diagnosis of "gastrointestinal functional disorder" is established, improvements should be made in daily routines and dietary habits.
This includes ensuring adequate sleep, minimizing stress, and increasing physical activity.
Dietary recommendations include maintaining regular meal times, avoiding irritants (such as sweet, oily, acidic, and fried foods) and beverages (like alcohol, coffee, and tea), and increasing fiber intake.
If these methods do not yield satisfactory results, medication treatment may be considered.
The term "stool retention" refers to feces that remain in the intestines for too long, becoming hard due to excessive water absorption, making it difficult to pass and potentially causing bloating or abdominal pain.
Improvement strategies include drinking more water, consuming high-fiber foods, and increasing physical activity.

The size of the liver varies among individuals.
Liver enlargement is typically suspected based on 1.
abdominal X-ray findings or 2.
palpation of the liver under the right rib cage during an abdominal examination.
However, the most convenient and reliable tool for confirming liver enlargement is abdominal ultrasound.
The most common causes of hepatomegaly are hepatitis (especially alcoholic hepatitis) and liver tumors, while less common causes include infectious diseases or heart conditions.
A combination of blood tests, abdominal ultrasound, and other necessary examinations can help identify the underlying cause of liver enlargement and guide treatment.

Wishing you and your family peace and happiness,
Dr.
Yang Pei-Chen, Gastroenterology, Taoyuan Hospital, Department of Health, Executive Yuan.

Reply Date: 2002/11/10

More Info

Managing bloating and diarrhea can be quite challenging, especially when underlying gastrointestinal issues are present. Based on your description, it seems you have been experiencing a combination of symptoms, including diarrhea, significant bloating, and a history of duodenal ulcers. Let’s break down your concerns and provide some insights from a gastroenterological perspective.

Understanding Your Symptoms
1. Bloating: Bloating can be caused by various factors, including food intolerances, gastrointestinal motility disorders, or even stress. It is common for individuals with gastrointestinal issues to experience bloating after meals, particularly if they consume foods that are difficult to digest or if they have underlying conditions like irritable bowel syndrome (IBS) or functional dyspepsia.

2. Diarrhea: Your history of frequent diarrhea, particularly if it occurs in conjunction with bloating, may suggest a functional gastrointestinal disorder. Conditions like IBS can lead to alternating symptoms of diarrhea and constipation, along with bloating.
3. Duodenal Ulcer: The presence of a duodenal ulcer can contribute to gastrointestinal discomfort, including bloating and changes in bowel habits. While treatment for ulcers typically involves proton pump inhibitors (PPIs) and antibiotics if H. pylori infection is present, the effectiveness can vary from person to person.

4. Liver Concerns: The mention of a slightly enlarged liver (hepatomegaly) can be concerning, but it is essential to note that liver enlargement can occur for various benign reasons, such as fatty liver disease, which is often associated with diet and lifestyle factors. If further tests indicated that your liver is functioning normally, this is a positive sign.

Dietary and Lifestyle Recommendations
1. Dietary Adjustments:
- Low FODMAP Diet: Consider trying a low FODMAP diet, which can help reduce bloating and gas. This diet involves limiting foods that are high in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.

- Avoid Trigger Foods: Identify and avoid foods that trigger your symptoms. Common culprits include dairy products, gluten, high-fat foods, and certain vegetables like beans and onions.

- Eat Smaller Meals: Instead of three large meals, try eating smaller, more frequent meals to help manage bloating.

2. Hydration: Ensure you are drinking enough water, especially if you experience diarrhea. Staying hydrated is crucial for overall digestive health.

3. Probiotics: Incorporating probiotics into your diet may help balance gut flora and improve digestive health. Foods like yogurt, kefir, and fermented vegetables can be beneficial.

4. Regular Exercise: Engaging in regular physical activity can help stimulate digestion and reduce bloating. Aim for at least 30 minutes of moderate exercise most days of the week.

5. Stress Management: Since stress can exacerbate gastrointestinal symptoms, consider incorporating stress-reducing techniques such as yoga, meditation, or deep-breathing exercises into your routine.

Understanding "宿便" (Stool Retention)
The term "宿便" refers to stool that remains in the intestines for an extended period, which can lead to discomfort and bloating. It is often associated with irregular bowel habits. While having a bowel movement every 2-3 days can be normal for some individuals, it is essential to ensure that the stool is not hard or difficult to pass. If you experience discomfort or a feeling of incomplete evacuation, it may be worth discussing with your healthcare provider.

Conclusion
Given your ongoing symptoms, it may be beneficial to follow up with a gastroenterologist for further evaluation, especially if your current treatment is not providing relief. They may consider additional testing or a referral to a dietitian who specializes in gastrointestinal disorders. Remember, managing gastrointestinal symptoms often requires a multifaceted approach, including dietary changes, lifestyle modifications, and possibly medication adjustments. Stay proactive about your health, and don’t hesitate to seek further medical advice if your symptoms persist or worsen.

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