Long-term Bloating and Changes in Bowel Habits - Gastroenterology and Hepatology

Q: Long-term Bloating and Changes in Bowel Habits

Hello： It is recommended to follow up with the gastroenterology outpatient clinic for treatment. <br>After the colonoscopy, please review the report. <br>Symptoms of ulcerative colitis may include abdominal pain, diarrhea, blood in the stool, malnutrition, weight loss, and fever.

Chronic bloating and changes in bowel habits?

Hello Doctor, thank you for answering my questions.
I am a 19-year-old student.
Since early December 2019, I have been experiencing upper abdominal bloating.
After undergoing ultrasound, blood tests, and an endoscopy, I was diagnosed with gastric bleeding that had formed a clot (with no Helicobacter pylori infection).
After taking the medication prescribed by the doctor, my upper abdominal bloating improved slightly, but now I have a bloating sensation in my lower abdomen, which is sometimes tender.

Previously, I would shower after school and have a bowel movement, which was smooth.
Now, I may only eat one meal a day and have bowel movements in the afternoon or evening, producing hard, dry stools that are either in pieces or have cracks (1-2 bowel movements a day).
In early February, I suddenly had a large amount of brick-red stool, and there was dark red mucus on the toilet paper.
Could this be related to the food I ate the night before? I had red bean paste bread the night before the stool change.

I underwent a colonoscopy and stool tests (I haven't seen the colonoscopy report, but the doctor said everything looked normal, and the stool occult blood was negative, showing no other issues).
As of now, at the end of March, I still experience daily bloating, and my weight has dropped from 61 kg in December to 55 kg now.

Could you please help me understand what might be wrong? I took probiotics prescribed by the hospital for two weeks, but my bloating remains significant.
Today, I saw a doctor who reviewed an X-ray and suggested it might be ulcerative colitis, prescribing mesalamine.
What could my symptoms indicate? Many doctors have suggested different diagnoses, so I would like to know what my symptoms might resemble.
Is there a possibility that this is a serious illness? Thank you, Doctor.

Da J, 10~19 year old female. Ask Date: 2020/03/26

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello: It is recommended to follow up with the gastroenterology outpatient clinic for treatment.
After the colonoscopy, please review the report.
Symptoms of ulcerative colitis may include abdominal pain, diarrhea, blood in the stool, malnutrition, weight loss, and fever.
A colonoscopy can assess the severity of inflammation in the colon.
Due to weight loss, and having used mesalamine medication, it is advised to continue follow-up treatment with the gastroenterology outpatient clinic.
The exact cause of inflammatory bowel disease (ulcerative colitis or Crohn's disease) is still unclear, but it is currently believed to be related to gut microbiota, environmental factors, immune response, and genetics.
An imbalance of these factors can lead to chronic inflammation of the intestines.
Wishing you peace and health! Sincerely, Dr.
Ming-Hui Lin, Attending Physician, Department of Gastroenterology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2020/03/26

More Info

Thank you for your detailed question regarding your gastrointestinal symptoms. It sounds like you've been through a lot with your health, and I appreciate your willingness to seek clarity on your condition. Based on the information you've provided, let's break down your symptoms and potential underlying issues.

First, you mentioned experiencing abdominal bloating, changes in bowel habits, and the presence of blood in your stool. These symptoms can be concerning and warrant thorough investigation, which it seems you've already begun with various tests, including ultrasound, blood tests, and endoscopy.

Understanding Your Symptoms
1. Abdominal Bloating: This can be caused by a variety of factors, including dietary choices, gastrointestinal disorders, or even stress. Since you noted that your bloating has shifted from the upper abdomen to the lower abdomen, it may suggest a change in your digestive process or the way your intestines are functioning.

2. Changes in Bowel Habits: You mentioned that your bowel movements have become less frequent and that you are experiencing hard, dry stools. This could indicate constipation, which can be exacerbated by dietary changes, dehydration, or even certain medications. It's important to ensure you are consuming enough fiber and fluids.

3. Blood in Stool: The presence of red blood in your stool, especially if accompanied by mucus, can be alarming. It can be associated with several conditions, including hemorrhoids, anal fissures, or more serious conditions like inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease. The fact that your colonoscopy was reported as normal is reassuring, but it does not completely rule out IBD, especially if the symptoms persist.

4. Weight Loss: A significant drop in weight, such as from 61 kg to 55 kg, is concerning and may indicate that your body is not absorbing nutrients properly or that you are not eating enough due to discomfort. Weight loss can also be a sign of underlying disease processes.

Possible Conditions
Given your symptoms and the tests you've undergone, several conditions could be considered:
- Irritable Bowel Syndrome (IBS): This functional gastrointestinal disorder can cause bloating, changes in bowel habits, and abdominal discomfort. It is often triggered by stress or certain foods.

- Inflammatory Bowel Disease (IBD): As mentioned, conditions like ulcerative colitis or Crohn's disease could explain your symptoms, especially if there is inflammation in the intestines. The treatment you received (e.g., mesalamine) suggests that your doctor is considering this possibility.

- Gastritis or Peptic Ulcer Disease: Given your history of upper gastrointestinal bleeding, it's essential to consider that gastritis or ulcers could still be contributing to your symptoms, even if they are not currently active.

Recommendations
1. Follow-Up with Your Doctor: It's crucial to maintain open communication with your healthcare provider. If your symptoms persist or worsen, further evaluation may be necessary, including repeat imaging or additional tests.

2. Dietary Adjustments: Keeping a food diary may help identify any triggers that exacerbate your symptoms. Increasing fiber intake and staying hydrated can also help with bowel regularity.

3. Stress Management: Since stress can significantly impact gastrointestinal health, consider incorporating stress-reducing techniques such as mindfulness, yoga, or counseling.

4. Monitor Symptoms: Keep track of any new symptoms, changes in your condition, or responses to medications. This information will be valuable for your healthcare provider.

In conclusion, while your symptoms are concerning, they can often be managed effectively with the right approach and treatment. It's essential to continue working closely with your healthcare team to determine the best course of action for your specific situation. Thank you for sharing your experience, and I wish you the best in your journey toward better health.

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