Bowel Sounds and Bloating: When to Seek Further Evaluation

Borborygmi, bloating

Hello, doctor.
I have been suffering from chronic indigestion for many years.
I tend to experience diarrhea when I am stressed, along with occasional bloating and frequently unformed stools.
The doctor has mostly diagnosed it as irritable bowel syndrome.
However, I did not have significant bowel sounds in the past, but in the last month, I have noticed bowel sounds and a sensation of peristalsis after eating, when at rest, and while lying down before sleep (not loud, mostly only I can hear it), with varying locations, which has caused me considerable anxiety.
The bloating has also become more pronounced, and I find myself passing gas multiple times every morning, which was less common in the past.
I feel some relief from discomfort when I pass gas.
The clinic doctor has prescribed medications for bloating, acid reduction, and anxiety, but there has been no significant improvement.
Should I consider getting a colonoscopy for further evaluation? (I had an upper endoscopy six months ago, which showed gastroesophageal reflux and mild gastritis.
Two years ago, my stool occult blood test was negative, but my last colonoscopy was ten years ago.) Thank you, doctor.

Mr. Lin, 40~49 year old female. Ask Date: 2021/02/08

Dr. Chen Shidian reply Gastroenterology and Hepatology

Further examination may not be necessary; monitoring, dietary adjustments, and medication management should suffice.

Reply Date: 2021/02/08

More Info

Understanding bowel sounds and bloating can be quite complex, especially for individuals with a history of gastrointestinal issues such as irritable bowel syndrome (IBS). Your symptoms, including increased bowel sounds after eating, bloating, and irregular bowel movements, can indeed be associated with IBS, which is characterized by a combination of abdominal pain and altered bowel habits.
Bowel sounds, or "borborygmi," are the noises produced by the movement of the intestines as they process food. These sounds can become more pronounced due to various factors, including the type of food consumed, anxiety, or gastrointestinal disorders. In your case, the increase in bowel sounds after meals and during quiet times may suggest heightened intestinal activity, which can be a common symptom in IBS. The sensation of bloating and the need to pass gas can also be indicative of increased gas production or altered motility in the intestines.

Given your history of digestive issues and the recent changes in your symptoms, it is understandable that you feel anxious. While anxiety can exacerbate gastrointestinal symptoms, it is essential to rule out any underlying conditions that may require further evaluation.
You mentioned that you had a gastroscopy six months ago, which revealed gastroesophageal reflux disease (GERD) and mild gastritis, and a negative fecal occult blood test two years ago. However, since it has been ten years since your last colonoscopy, it may be prudent to consider scheduling another one. Colonoscopies are essential for screening for colorectal cancer and other significant bowel conditions, especially if there is a family history of gastrointestinal diseases or if you experience new or worsening symptoms.

In your case, the following factors may warrant further evaluation through a colonoscopy:
1. Change in Symptoms: The recent onset of pronounced bowel sounds and bloating, along with irregular bowel habits, could indicate a change in your gastrointestinal health that needs to be assessed.

2. Family History: If there is a family history of colorectal cancer or other gastrointestinal disorders, this increases the importance of regular screenings.

3. Duration of Symptoms: If your symptoms persist or worsen despite treatment with medications for bloating, acid reduction, and anxiety, this could indicate the need for further investigation.

4. Age: As individuals age, the risk of developing colorectal issues increases, making regular screenings more critical.

5. Unexplained Weight Loss or Changes in Appetite: If you experience any unexplained weight loss or significant changes in appetite, these are red flags that should prompt further evaluation.

In conclusion, while your symptoms may be related to IBS and anxiety, the changes you are experiencing warrant a thorough evaluation to rule out any serious conditions. It is advisable to discuss your concerns with your healthcare provider, who can guide you on whether a colonoscopy or other diagnostic tests are appropriate based on your current symptoms and medical history. Taking proactive steps in monitoring your gastrointestinal health is crucial, especially given your history and the changes you have observed.

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