Gastrointestinal Issues: From Constipation to Digestive Discomfort

Gastrointestinal and bowel issues?

Hello Doctor: I would like to ask about a sore throat that started on December 20.
I feel discomfort when swallowing saliva, and I begin to have a runny nose when I eat hot foods.
I have a history of urinary tract infections, and my BMI is normal, with only a weight fluctuation of 1-2 kg.

Medical history: In March 2017, I experienced a severe episode of constipation, which I resolved myself, and there was bleeding from the anus.
Later, I drank black fungus juice regularly, which helped with bowel movements.
In June 2018, after walking a bit faster than usual post-lunch, I felt discomfort in my chest in the afternoon, as if something was stuck there.
I couldn't hold it and ended up vomiting, which consisted of undigested food from lunch.
After vomiting, I felt completely relieved and had an appetite.
At that time, I visited a doctor who performed an X-ray and gastroscopy, revealing hard stools in my abdomen and Helicobacter pylori.
I was prescribed medication for H.
pylori and digestive aids.
Recent history: In August 2019, the same chest discomfort reoccurred, but I did not vomit immediately; I felt nauseous but couldn't vomit until I took gastric medication.
Over the past year, my stools have consistently appeared as small, hard pellets.
I usually feel the urge to defecate shortly after my first meal of the day (typically, bowel movements occur quickly).
I often experience bloating, foul-smelling gas, and there is no residual stool when wiping (after severe constipation, I had bright red blood during wiping, but this has not occurred recently).
Sometimes, I hear gurgling sounds from my stomach, and my stools have mucus (clear or white).
There are white substances in my urine that resemble mucus.
Current situation: I eat a bowl of vegetables (green vegetables) and a bowl of fruit (about four types including guava, apple, dragon fruit, and banana) daily, along with vegetable soup (carrots, tomatoes, etc.).
My family eats the same foods.
I often stay up late, but my family has regular bowel movements.
Currently, my bloating is quite severe, I have some pain around my navel, and I am having difficulty passing stools.
What should I do to improve this situation? I initially thought that having daily bowel movements meant I was not constipated, but I realize that my stools are pellet-like (which I learned can also indicate constipation), and I am a bit worried that something might be wrong.
Thank you for taking the time to read this.

Claire, 30~39 year old female. Ask Date: 2019/12/27

Dr. Yang Zhichao reply Gastroenterology and Hepatology

Hello Claire, if you are concerned about any issues, you can discuss with your physician whether further examinations are necessary.
For daily living, it is recommended to exercise more, eat plenty of fruits and vegetables, and drink plenty of water.
Exercise should be done for 20-30 minutes daily (with a heart rate >160 beats per minute), and establishing healthy habits must be consistent and sustained.
Thank you for your question.

Reply Date: 2019/12/27

More Info

It sounds like you're experiencing a complex set of gastrointestinal symptoms that can be quite distressing. Based on your description, you have a history of gastrointestinal issues, including severe constipation, episodes of nausea and vomiting, and recent changes in your bowel habits. Let's break down your concerns and explore potential underlying causes and management strategies.

Understanding Your Symptoms
1. Constipation and Bowel Movements: You mentioned that your stools are often pellet-like (often referred to as "sheep stools"), which is a classic sign of constipation. This type of stool indicates that the bowel is not moving efficiently, leading to dehydration of the stool as it remains in the colon for too long. The fact that you experience daily bowel movements but they are not well-formed suggests that you may have a functional gastrointestinal disorder, such as Irritable Bowel Syndrome (IBS), which can manifest as constipation-predominant (IBS-C).

2. Abdominal Pain and Discomfort: The pain around your navel and the sensation of bloating can be linked to your bowel habits. Bloating often occurs when gas builds up in the intestines, which can be exacerbated by certain foods, stress, or inadequate fiber intake. The discomfort you feel may also be related to the irregularity of your stool consistency.

3. Dietary Factors: You mentioned a diet rich in vegetables and fruits, which is generally beneficial for digestive health. However, if your fiber intake is not balanced with adequate hydration, it can lead to constipation. Additionally, certain foods can cause gas and bloating, such as beans, cruciferous vegetables (like broccoli and cabbage), and high-fructose fruits. It may be worth keeping a food diary to identify any potential triggers.

4. Previous Medical History: Your history of a severe constipation episode with rectal bleeding is concerning and should not be overlooked. While you have not experienced this recently, it highlights the importance of monitoring your bowel health closely. The presence of Helicobacter pylori in the past also indicates a history of gastric issues, which may contribute to your current symptoms.

Recommendations for Management
1. Hydration: Ensure you are drinking plenty of fluids throughout the day. Water is essential for softening stool and promoting regular bowel movements. Aim for at least 8-10 cups of water daily, adjusting based on your activity level and climate.

2. Dietary Adjustments: While you are consuming a variety of fruits and vegetables, consider increasing your intake of soluble fiber (found in oats, beans, and fruits like apples and bananas) and reducing insoluble fiber (found in whole grains and some vegetables) if it seems to exacerbate your symptoms. Gradually increase fiber intake to avoid gas and bloating.

3. Regular Physical Activity: Engaging in regular physical activity can help stimulate bowel function. Aim for at least 30 minutes of moderate exercise most days of the week.

4. Stress Management: Stress can significantly impact gastrointestinal function. Techniques such as mindfulness, yoga, or deep-breathing exercises may help alleviate some of your symptoms.

5. Consultation with a Gastroenterologist: Given your complex history and ongoing symptoms, it may be beneficial to consult with a gastroenterologist. They can perform further evaluations, such as stool tests, imaging studies, or even a colonoscopy if indicated, to rule out any underlying conditions.

6. Probiotics: Consider incorporating probiotics into your routine. They can help balance gut flora and may improve symptoms of IBS and constipation.

Conclusion
Your symptoms suggest a potential functional gastrointestinal disorder, possibly IBS-C, exacerbated by dietary factors and stress. By making dietary adjustments, ensuring adequate hydration, and engaging in regular physical activity, you may find relief from your symptoms. However, given your medical history and the complexity of your symptoms, it is crucial to seek professional medical advice for a thorough evaluation and tailored treatment plan. Remember, you are not alone in this, and many people experience similar gastrointestinal challenges.

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