Nighttime Diarrhea and Skin Issues in Older Adults - Gastroenterology and Hepatology

My mother has been experiencing diarrhea at night recently, which has left her feeling hungry. Additionally, she has small red spots on her thighs and calves?

Hello Doctor: My mother is 55 years old and has recently been experiencing diarrhea almost every night for unknown reasons.
Sometimes she feels hungry after having diarrhea, and after eating, she may stop having diarrhea, but other times it continues.
She is reluctant to get checked out.
She has a history of left ventricular hypertrophy, liver issues, Meniere's disease with dizziness, hypertension, and diabetes.
For the past three years, she has also been experiencing persistent burning sensations in her legs, for which she has been taking anti-inflammatory medication.
This issue of frequent bathroom visits started a few years ago but did not cause her to feel hungry.
After retiring, her diarrhea improved slightly, but recently, the nighttime diarrhea has become more frequent, often leading her to feel hungry.
Additionally, we have noticed small red spots on her thighs, about the size of a pinhead, some slightly smaller and some larger.
When pressed, the color does not fade, but applying pressure causes her significant pain in some spots, while others are not sensitive.
There are also small, thin blue veins scattered around her thighs, and she is unwilling to undergo any examinations.
I am reaching out to seek your advice and sincerely request your insights.
I will also do my best to persuade my mother to visit a hospital for a check-up.
Thank you very much for your help.

Xiao Yu, 50~59 year old female. Ask Date: 2020/04/27

Dr. Chen Shidian reply Gastroenterology and Hepatology

The situation is more complicated; it is advisable to go to the hospital for an examination.

Reply Date: 2020/04/27

More Info

Understanding nighttime diarrhea and skin issues in older adults can be quite complex, especially when considering the underlying health conditions that may be present. Your mother’s situation, as you described, involves several concerning symptoms: frequent nighttime diarrhea, abdominal discomfort, and the appearance of red spots on her legs. Given her medical history, including heart issues, liver problems, hypertension, diabetes, and the use of anti-inflammatory medications, it is crucial to approach this situation with care.

Nighttime Diarrhea: Potential Causes
Nighttime diarrhea can be caused by various factors, including dietary choices, gastrointestinal disorders, infections, or medication side effects. In older adults, the gastrointestinal system may become more sensitive, and changes in diet or lifestyle can lead to digestive issues. Some potential causes include:
1. Dietary Factors: Certain foods can irritate the gastrointestinal tract, leading to diarrhea. Spicy foods, dairy products, or high-fiber foods may trigger symptoms, especially if consumed close to bedtime.

2. Medications: Anti-inflammatory medications, particularly non-steroidal anti-inflammatory drugs (NSAIDs), can cause gastrointestinal side effects, including diarrhea. If your mother has been taking these medications regularly, they could be contributing to her symptoms.

3. Infections: Gastrointestinal infections, whether viral or bacterial, can lead to diarrhea. If your mother has been exposed to contaminated food or water, this could be a factor.

4. Underlying Conditions: Given her history of liver issues and diabetes, it is essential to consider that these conditions can affect digestion and absorption, potentially leading to diarrhea.

5. Stress and Anxiety: Emotional factors can also play a role in gastrointestinal health. If your mother is experiencing stress or anxiety, it may exacerbate her symptoms.

Skin Issues: Understanding the Red Spots
The appearance of red spots on the skin, particularly if they are painful and do not blanch when pressed, can indicate several conditions. Some possibilities include:
1. Petechiae: These are small red or purple spots caused by bleeding under the skin. They can be a sign of various conditions, including clotting disorders or infections.

2. Allergic Reactions: If your mother has recently changed her diet or started new medications, she may be experiencing an allergic reaction that manifests as skin rashes or spots.

3. Vascular Issues: The presence of blue, thin blood vessels and red spots could indicate vascular changes, which may be related to her underlying health conditions.

4. Dermatological Conditions: Conditions such as eczema or psoriasis can also cause red spots and may be exacerbated by stress or changes in the environment.

Recommendations
Given the complexity of your mother’s symptoms and her reluctance to seek medical attention, it is crucial to encourage her to visit a healthcare provider. Here are some steps you can take:
1. Open Communication: Discuss your concerns with her in a supportive manner. Emphasize the importance of understanding her symptoms and how they can be managed effectively.

2. Document Symptoms: Keep a record of her symptoms, including the frequency of diarrhea, any dietary changes, and the appearance of her skin. This information can be invaluable for healthcare providers.

3. Encourage a Check-Up: Suggest a comprehensive check-up that includes blood tests and possibly imaging studies to assess her liver function and rule out any serious conditions.

4. Dietary Modifications: Encourage her to maintain a food diary to identify any potential triggers for her diarrhea and skin issues. A balanced diet rich in fiber, hydration, and avoidance of irritants may help.

5. Medication Review: If she is taking multiple medications, a review by a healthcare professional can help identify any that may be contributing to her symptoms.

In conclusion, while it is understandable that your mother may be hesitant to seek medical help, her symptoms warrant a thorough evaluation. Early intervention can lead to better management of her conditions and improve her quality of life. Your support and encouragement will be vital in helping her take the necessary steps toward better health.

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