Is It IBS or a More Serious Gastrointestinal Issue?

Q: Is It IBS or a More Serious Gastrointestinal Issue?

Hello： This symptom seems more like constipation. <br>I can prescribe some stool softeners and probiotics for you. <br>I also recommend increasing your fluid intake and consuming more fruits and vegetables to see if your symptoms improve. <br>Regarding the presence of blood strea

Is it irritable bowel syndrome or a more serious gastrointestinal issue?

Hello Dr.
Tsai,
I have always had digestive issues and often experience bloating.
Recently, in the past month, I have had about three episodes of cramping pain in my lower left abdomen.
Yesterday afternoon, the abdominal cramping became unbearable, but I felt the urge to use the restroom without being able to pass anything.
I experienced some urgency and heaviness, and while trying to use the restroom, I passed gas and expelled a mucus-like substance similar to snot, which contained a bit of blood.
I suspect it might be related to intestinal issues.

After that, for the next four hours, I went to the restroom once every hour, managing to pass a small amount of hard, round stool.
Later that evening, I continued to have hourly bowel movements, but the stool had changed shape to long, thin strands, and it had a foul odor with a color that was a mix of earthy yellow and black.
This continued for three hours, with hourly trips to the restroom until bedtime.

This morning, I again felt the urge to have a bowel movement, but once more, I only passed gas and expelled a thick, mucus-like substance resembling a snot toy.
Since I am currently abroad, my general practitioner may not easily refer me to a specialist.
I plan to see my family doctor tomorrow, and I am unsure whether I should insist on getting a prescription for a referral to a specialist for further examination.

Xiao Qi, 20~29 year old female. Ask Date: 2021/03/01

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: This symptom seems more like constipation.
I can prescribe some stool softeners and probiotics for you.
I also recommend increasing your fluid intake and consuming more fruits and vegetables to see if your symptoms improve.
Regarding the presence of blood streaks, please monitor if they continue to appear.
If they do, I suggest consulting a gastroenterologist to differentiate between hemorrhoids and intestinal tumors.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun

Reply Date: 2021/03/01

More Info

Based on the symptoms you've described, it is essential to consider both Irritable Bowel Syndrome (IBS) and other potential gastrointestinal issues. Your experience of left lower abdominal cramping, difficulty in passing stool, and the presence of mucus with blood streaks are concerning and warrant further investigation.

IBS is a functional gastrointestinal disorder characterized by a combination of symptoms, including abdominal pain, bloating, and changes in bowel habits (diarrhea, constipation, or alternating between both). It is typically diagnosed based on symptom patterns rather than specific tests, as there are no definitive laboratory or imaging studies that can confirm IBS. The symptoms you mentioned, such as the urgency to defecate, the presence of mucus, and changes in stool consistency, could indeed align with IBS. However, the presence of blood in your stool is a significant red flag that should not be overlooked.

The blood-streaked mucus you described could indicate several conditions, including but not limited to:
1. Inflammatory Bowel Disease (IBD): This includes conditions like Crohn's disease and ulcerative colitis, which can cause inflammation in the gastrointestinal tract and lead to symptoms similar to what you're experiencing.

2. Infections: Gastrointestinal infections, whether viral, bacterial, or parasitic, can lead to symptoms of cramping, diarrhea, and mucus in the stool.

3. Diverticulitis: This condition occurs when small pouches (diverticula) in the colon become inflamed or infected, leading to abdominal pain and changes in bowel habits.

4. Colorectal Cancer: Although less common, especially in younger individuals, any presence of blood in the stool should raise suspicion for potential malignancies.

Given your symptoms, it is crucial to communicate clearly with your primary care physician. You should express your concerns about the blood in your stool and the significant changes in your bowel habits. It is reasonable to request a referral to a gastroenterologist for further evaluation, which may include a colonoscopy or other diagnostic tests to rule out serious conditions.

In terms of managing your symptoms in the meantime, consider the following:
- Dietary Adjustments: Keeping a food diary can help identify any potential triggers for your symptoms. Some individuals with IBS find relief by following a low-FODMAP diet, which reduces certain fermentable carbohydrates that can cause bloating and discomfort.

- Hydration: Ensure you are drinking plenty of fluids, especially if you are experiencing diarrhea.

- Stress Management: Stress can exacerbate IBS symptoms. Techniques such as mindfulness, yoga, or cognitive behavioral therapy may be beneficial.

- Medications: Depending on the diagnosis, your doctor may prescribe medications to help manage your symptoms, whether they are related to IBS or another gastrointestinal condition.

In summary, while your symptoms may suggest IBS, the presence of blood and mucus in your stool is concerning and warrants further investigation. It is crucial to advocate for your health by seeking a referral to a specialist who can provide a thorough evaluation and appropriate management. Your health and well-being are paramount, and addressing these symptoms promptly is essential.

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