Left Lower Abdominal Discomfort and Bowel Issues - Gastroenterology and Hepatology

Left lower abdominal discomfort and bowel movement issues?

Hello Doctor: About a month ago, I started feeling a sensation of fullness in my lower left abdomen.
Most of the time, it is not painful, but occasionally I experience slight bloating and discomfort.
After visiting the doctor, I had an X-ray, which showed that my lower left intestine was filled with stool.
The doctor prescribed Laxative and Lactulose.
After taking them for a week, I feel slightly better, and I have also been doing some massage and exercise, but I still feel a foreign body sensation in my lower left abdomen.
Over the past month, I have been having bowel movements almost every day, usually quickly, with formed stools that are at least 10 cm long and two fingers wide.
Occasionally, I have two bowel movements or pass small, pellet-like stools.
My diet mainly consists of more vegetables and less meat, and I drink over 2000 cc of water daily.
I would like to ask: 1.
Why is there still so much stool accumulated in my intestines despite daily bowel movements? How can I improve this? Would fasting help clear it out? 2.
With so much stool in my intestines, why do I not feel the urge to defecate? 3.
The fecal occult blood test was negative; what could be the issue? Thank you for your response!

yi wen, 30~39 year old female. Ask Date: 2020/07/11

Dr. Chen Shidian reply Gastroenterology and Hepatology

Normal individuals naturally have the ability to temporarily store feces, so there is no need to worry about the presence of fecal matter on X-ray images.
As long as bowel movements occur every 1 to 3 days and the fecal occult blood test is negative, there is no cause for concern.

Reply Date: 2020/07/11

More Info

Understanding left lower abdominal discomfort and bowel issues can be quite complex, especially when symptoms persist despite regular bowel movements. Based on your description, it seems you are experiencing a combination of discomfort, changes in bowel habits, and a feeling of incomplete evacuation. Let's break down your concerns and explore potential explanations and recommendations.

1. Accumulation of Stool Despite Daily Bowel Movements: It is indeed possible to have a sensation of stool accumulation even when you are having daily bowel movements. This could be due to several factors:
- Irritable Bowel Syndrome (IBS): This condition can cause changes in bowel habits and sensations of incomplete evacuation. It is characterized by abdominal discomfort, bloating, and altered bowel habits (diarrhea, constipation, or alternating between both).

- Functional Constipation: Even if you are having regular bowel movements, the stool may be harder or more difficult to pass, leading to a sensation of fullness or blockage.

- Dietary Factors: While you mentioned a diet rich in vegetables and adequate hydration, it's essential to ensure that you are also consuming enough fiber. Sometimes, the type of fiber (soluble vs. insoluble) can affect bowel function differently.
To improve your situation, consider gradually increasing your fiber intake, ensuring you are consuming both soluble (found in oats, beans, and fruits) and insoluble fiber (found in whole grains and vegetables). Additionally, regular physical activity can help stimulate bowel function.

2. Lack of Urgency Despite Stool Presence: The sensation of not having the urge to defecate despite the presence of stool can be perplexing. This could be attributed to:
- Neuromuscular Dysfunction: The nerves and muscles that control bowel movements may not be functioning optimally, leading to a lack of urgency.

- Rectal Sensitivity: If the rectum is not sensitive enough to detect the presence of stool, it may not trigger the urge to defecate. This can occur in conditions like rectal hyposensitivity.

- Psychological Factors: Stress and anxiety can also impact bowel habits and sensations.
If this continues to be a concern, it may be beneficial to consult with a gastroenterologist who can evaluate your bowel function more thoroughly.

3. Negative Fecal Occult Blood Test: A negative result on a fecal occult blood test is reassuring as it indicates that there is no visible blood in the stool, which can be a sign of serious conditions like colorectal cancer or significant gastrointestinal bleeding. However, it does not rule out other issues such as:
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can sometimes present without blood in the stool but still cause significant discomfort and changes in bowel habits.

- Functional Disorders: As mentioned earlier, conditions like IBS can cause symptoms without any structural abnormalities or blood.

In summary, your symptoms suggest a possible functional gastrointestinal disorder, such as IBS or functional constipation. It is essential to continue working with your healthcare provider to monitor your symptoms and possibly explore further diagnostic tests if necessary.
As for your questions about fasting, while it may provide temporary relief by allowing the bowel to rest, it is not a long-term solution and could lead to other issues if not done correctly. Instead, focus on a balanced diet, adequate hydration, and regular exercise. If symptoms persist or worsen, consider seeking a second opinion or further evaluation from a specialist in gastroenterology. Your health is paramount, and addressing these concerns with a professional can lead to better management and relief from discomfort.

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