Abdominal Noises and Bloating: Causes and Concerns - Gastroenterology and Hepatology

Borborygmi and bloating?

During middle school, I was diagnosed with irritable bowel syndrome due to family stress, but the symptoms disappeared in college.
Two years ago, around eleven at night, I started experiencing intermittent abdominal rumbling.
Previously, I also had episodes of diarrhea with a significant amount of fresh blood in my stool.
I went to a teaching hospital for an examination, and the doctor performed a rectal examination, diagnosing me with an anal fissure.
Both symptoms disappeared until last year when I underwent surgery for a sebaceous cyst and took amoxicillin for two weeks.
After that, I began experiencing abdominal rumbling again, which occurred at night before sleep.
The symptoms disappeared after two to three months but then returned with diarrhea and the sensation of blood in my stool, along with the feeling of an anal fissure.
After two days, my bowel movements returned to normal, but the abdominal rumbling persisted intermittently, accompanied by bloating and gas.
Additionally, I have no other discomfort, and my stool is generally normal and somewhat bulky.
I would like to ask the doctor if cancer could present with such fluctuating symptoms.
Furthermore, I have noticed that the anal fissure occurs during times of significant emotional distress, while it does not occur when my mood is stable.
Could this be indicative of another underlying condition?

Niming, 30~39 year old female. Ask Date: 2020/11/01

Dr. Chen Shidian reply Gastroenterology and Hepatology

Anal fissures are not significantly related to emotions.
If you frequently experience bloody stools, you should return for a follow-up examination.

Reply Date: 2020/11/01

More Info

Understanding abdominal noises and bloating can be quite complex, especially when there are multiple symptoms involved. Based on your description, it seems that you have a history of irritable bowel syndrome (IBS), which can often be exacerbated by stress and emotional factors. IBS is a functional gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, and changes in bowel habits, including diarrhea and constipation.

The abdominal noises you are experiencing, known as borborygmi, are typically caused by the movement of gas and fluids in the intestines. This can be more pronounced during times of stress or anxiety, which may explain why you notice these sounds more at night when you are winding down for bed. Stress can significantly impact gut motility and sensitivity, leading to increased intestinal activity and, consequently, more audible sounds.

Your previous experiences with rectal bleeding and the diagnosis of anal fissures are also noteworthy. Anal fissures can occur due to passing hard stools or straining during bowel movements, which can be influenced by diet, hydration, and emotional stress. The fact that you have experienced these fissures during periods of emotional distress suggests a connection between your mental state and gastrointestinal symptoms. Stress can lead to muscle tension, which may exacerbate issues like fissures and contribute to the sensation of bloating and discomfort.

Regarding your concerns about cancer, it is important to note that while certain gastrointestinal symptoms can be alarming, the intermittent nature of your symptoms, along with the normal appearance of your stool, is less suggestive of a malignancy. Cancer symptoms typically do not fluctuate in such a manner; they tend to be more persistent and progressive. However, any new or concerning symptoms, especially those involving blood in the stool, should be evaluated by a healthcare professional. It is crucial to rule out any serious conditions through appropriate diagnostic testing, such as colonoscopy, especially given your history of rectal bleeding.

In terms of managing your symptoms, consider the following strategies:
1. Dietary Adjustments: Focus on a high-fiber diet to promote regular bowel movements and prevent constipation, which can contribute to anal fissures. Incorporate plenty of fruits, vegetables, and whole grains while staying well-hydrated.

2. Stress Management: Since you have identified a link between your emotional state and gastrointestinal symptoms, implementing stress-reduction techniques such as mindfulness, yoga, or cognitive-behavioral therapy may help alleviate some of your symptoms.

3. Regular Check-ups: Continue to follow up with your healthcare provider, especially if you notice any changes in your symptoms or if they worsen. Regular monitoring can help catch any potential issues early.

4. Medication Review: If you are taking any medications, including antibiotics like amoxicillin, discuss with your doctor whether they could be contributing to your gastrointestinal symptoms. Antibiotics can disrupt the gut microbiome, leading to issues like bloating and diarrhea.

5. Probiotics: Consider discussing the use of probiotics with your healthcare provider. Probiotics can help restore the balance of gut bacteria, which may be beneficial, especially after a course of antibiotics.

In conclusion, while your symptoms may be distressing, they are likely related to your history of IBS and the impact of stress on your gastrointestinal system. It is essential to maintain open communication with your healthcare provider and to seek further evaluation if your symptoms change or worsen. Remember, managing stress and maintaining a healthy diet can significantly improve your overall gastrointestinal health.

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