Irritable Bowel Syndrome: Symptoms, Diagnosis, and Concerns

Gastrointestinal issues

Hello Dr.
Chen: I have been experiencing abdominal discomfort for half a month.
I visited a gastroenterologist at a large hospital, and the doctor suggested that I might have irritable bowel syndrome (IBS).
He also mentioned that if I was concerned, I could have a blood test and a fecal occult blood test.
After the tests, I forgot to bring the fecal test kit to my follow-up appointment.
The doctor reviewed my blood test results and said there were no significant issues.
He prescribed medication to aid digestion and relieve bloating, reiterating that it was likely IBS and that a colonoscopy was not necessary at this time.
He provided me with a month's supply of medication and suggested we would reassess my condition later.
Initially, my symptoms included diarrhea, and the color of my stool seemed normal, although sometimes I noticed remnants of food from the previous night, like vegetable scraps or carrot bits, which made me feel like I was experiencing indigestion.
My abdomen felt somewhat uncomfortable, but not painful.
Sometimes I felt the urge to have a bowel movement after eating, while other times I did not.
Even when I hadn’t eaten, the urge would come and go.
My stools were generally soft or loose, and I experienced mucus in my stool once or twice, but only in small amounts.
Now, my symptoms have changed; my stools can be soft or loose, but sometimes they are solid.
When I have solid stools, it feels a bit like constipation, requiring some effort, but it doesn’t last long—just a couple of days with stools appearing in pieces or logs, but the quantity has decreased.
The solid stools are not very thin, just average in size.
The color of my stool is mostly yellow-brown, with no other abnormal colors.
After a couple of days, my bowel movements became regular again, but I noticed that solid stools are less frequent, and most of the time, they are loose and break apart easily.
My abdominal discomfort fluctuates; sometimes I feel bloated after eating, while other times I do not.
Recently, I have experienced some bloating and gas, but it is not constant.
I would like to ask if I truly have IBS as the doctor suggested, or is there a possibility of cancer? I have had unformed stools for a while, but I also have solid stools intermittently, though in small amounts.
The solid stools are not thin, about the size of a thumb, and the color is not abnormal.
My symptoms include bloating and unformed stools, but I do not have other symptoms like loss of appetite, weight loss, or anemia.
My appetite is still good, and I have not experienced any anemia or significant weight loss.
I am unsure why I have been experiencing these issues.
The doctor believes it may be IBS, and although my blood tests were normal, I forgot to bring the fecal test kit to my follow-up appointment.
The doctor said it was not a problem and seemed to imply that it ruled out the possibility of colon cancer.
He prescribed a month’s worth of medication and mentioned that it could be caused by IBS, suggesting we would consider a colonoscopy based on my condition after finishing the medication.

Dr.
Chen, could you please tell me if I truly have IBS as the doctor at the large hospital suggested, or are there other possibilities?

Shaen, 30~39 year old female. Ask Date: 2020/06/16

Dr. Chen Shidian reply Gastroenterology and Hepatology

The manifestations of irritable bowel syndrome (IBS) can be further evaluated by performing a stool occult blood test to rule out other possibilities.
Also, please try not to be too anxious!

Reply Date: 2020/06/16

More Info

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder characterized by a combination of symptoms, including abdominal pain, bloating, and changes in bowel habits, such as diarrhea and constipation. Your symptoms, as described, do align with those typically seen in IBS, particularly the alternating patterns of bowel movements and the presence of soft or loose stools.
IBS is classified as a functional gastrointestinal disorder, meaning that it is diagnosed based on symptoms rather than identifiable structural or biochemical abnormalities. The Rome IV criteria, which are commonly used for diagnosing IBS, state that a diagnosis can be made if a patient experiences recurrent abdominal pain, on average, at least one day per week in the last three months, associated with two or more of the following criteria: related to defecation, associated with a change in frequency of stool, or associated with a change in the form (appearance) of stool.

In your case, the presence of abdominal discomfort, changes in stool consistency, and the urgency to defecate after meals are indicative of IBS. The fact that your blood tests and initial stool tests did not reveal any alarming signs, such as blood in the stool or significant abnormalities, further supports this diagnosis.
However, it is crucial to consider other potential causes of your symptoms, especially given your family history of colorectal cancer. While IBS is a likely diagnosis, other conditions such as inflammatory bowel disease (IBD), infections, or even malignancies can present with similar symptoms. The presence of mucus in your stool and the alternating patterns of constipation and diarrhea can sometimes overlap with conditions like IBD, which includes Crohn's disease and ulcerative colitis.
Given your concerns about colorectal cancer, it is understandable to feel anxious. The fact that you have not experienced alarming symptoms such as significant weight loss, persistent vomiting, or blood in your stool is reassuring. Nevertheless, it is essential to follow up on the stool tests you mentioned. A fecal occult blood test (FOBT) is a simple screening tool that can help rule out the presence of blood in the stool, which could indicate more serious conditions.

If your symptoms persist or worsen, or if you develop new symptoms, it may be prudent to discuss further diagnostic options with your healthcare provider. This could include a colonoscopy, especially considering your family history of colorectal cancer. A colonoscopy can provide a direct view of the colon and rectum, allowing for the identification of any abnormalities, and it can also facilitate biopsies if needed.

In the meantime, managing IBS often involves dietary modifications, stress management, and sometimes medications. Many patients find relief by identifying and avoiding trigger foods, which can vary from person to person. Common triggers include high-fat foods, dairy products, caffeine, and certain carbohydrates known as FODMAPs. Keeping a food diary can help you identify patterns and triggers related to your symptoms.

In summary, while your symptoms are consistent with IBS, it is essential to remain vigilant and continue working with your healthcare provider to monitor your condition. If you have any new or concerning symptoms, do not hesitate to seek further evaluation. Your health and peace of mind are paramount, and addressing these concerns proactively is the best approach.

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