IBS: Symptoms, Causes, and Treatment Options

Irritable Bowel Syndrome (IBS) with a sense of urgency and incomplete evacuation?

Hello doctor, three days ago I suddenly experienced severe abdominal cramping.
After squatting for a long time, I had diarrhea, and since then, I've felt a constant urge to have a bowel movement, but when I go to the bathroom, I can only pass a small amount or none at all (and it requires a lot of effort).
After eating dragon fruit, I had diarrhea again.
It seems like I'm alternating between diarrhea and constipation.
Could this be irritable bowel syndrome? Additionally, I'm not sure if the alternating diarrhea and constipation have caused some anal discomfort; when I looked inside, the surface appeared a bit red (but there was no bleeding).
Could this be hemorrhoids, or is it more likely an anal fissure due to excessive straining? Thank you!

Niming, 10~19 year old female. Ask Date: 2021/06/30

Dr. Ke Fangxu reply Surgery

Based on your description, it seems more like the typical symptoms of an anal fissure, which include pain during bowel movements accompanied by slight bleeding.
The common causes are often constipation or diarrhea.
The fundamental treatment is to address the bowel movement issues, along with warm sitz baths.
Warm sitz baths can help alleviate pain, maintain cleanliness, and promote blood circulation.
It is rare for a 17-year-old to experience irritable bowel syndrome; this phenomenon is usually a temporary gastrointestinal discomfort.
It is recommended to start with a light diet and maintain a good daily routine.
Spicy, irritating, and greasy foods should be avoided, and increasing dietary fiber from plant sources can also be beneficial.
If symptoms persist without improvement, it is advisable to consult a physician for further evaluation.

Reply Date: 2021/06/30

More Info

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder characterized by a combination of symptoms that can include abdominal pain, bloating, gas, diarrhea, and constipation. Your symptoms of alternating diarrhea and constipation, along with abdominal pain and the feeling of incomplete evacuation, are indeed suggestive of IBS.

Symptoms of IBS
The symptoms of IBS can vary widely among individuals, but they typically include:
- Abdominal Pain: Often relieved by bowel movements.

- Altered Bowel Habits: This can manifest as diarrhea, constipation, or alternating between the two.

- Bloating and Gas: Many patients report a feeling of fullness or swelling in the abdomen.

- Mucus in Stool: Some individuals may notice mucus in their bowel movements.

- Urgency: A sudden, strong need to have a bowel movement.

Causes of IBS
The exact cause of IBS is not well understood, but several factors may contribute:
- Gut Motility Issues: Abnormal contractions of the intestinal muscles can lead to symptoms.

- Nerve Sensitivity: Increased sensitivity of the nerves in the gut can cause pain and discomfort.

- Psychological Factors: Stress, anxiety, and depression can exacerbate symptoms.

- Dietary Triggers: Certain foods, such as dairy, gluten, and high-fat foods, can trigger symptoms in some individuals.

Diagnosis
Diagnosing IBS typically involves ruling out other conditions. There are no specific tests for IBS, but doctors may perform blood tests, stool tests, or imaging studies to exclude other gastrointestinal disorders. The diagnosis is often based on the presence of symptoms and the exclusion of other diseases.

Treatment Options
Treatment for IBS is usually tailored to the individual and may include:
- Dietary Changes: Keeping a food diary to identify and avoid trigger foods can be beneficial. A high-fiber diet may help with constipation, while a low-FODMAP diet can reduce symptoms for some patients.

- Medications: Depending on the predominant symptoms, treatments may include:
- Antispasmodics: To relieve abdominal cramps.

- Laxatives: For constipation-predominant IBS.

- Antidiarrheal medications: For diarrhea-predominant IBS.

- Probiotics: Some patients find relief with probiotics, which can help restore gut flora.

- Psychological Therapies: Cognitive-behavioral therapy (CBT) or other forms of therapy can help manage stress and anxiety, which may alleviate symptoms.

- Lifestyle Modifications: Regular exercise, adequate hydration, and stress management techniques can also be beneficial.

Regarding Your Symptoms
The alternating diarrhea and constipation you are experiencing, along with the abdominal pain and the sensation of incomplete evacuation, are consistent with IBS. The discomfort and redness you noted around the anus could be due to several factors:
- Hemorrhoids (痔瘡): Swollen veins in the rectal area can cause pain and discomfort, especially after straining during bowel movements.

- Anal Fissures (肛裂): These are small tears in the lining of the anus, often caused by passing hard stools or straining. They can cause sharp pain and may appear red or inflamed.

Recommendations
1. Monitor Your Diet: Keep track of what you eat and how it affects your symptoms. Consider reducing high-fat and spicy foods, as well as caffeine and alcohol.

2. Stay Hydrated: Drink plenty of water, especially if you are experiencing diarrhea.

3. Avoid Straining: Try to relax during bowel movements to prevent further irritation of the anal area.

4. Consult a Healthcare Provider: If your symptoms persist or worsen, or if you notice any bleeding, it’s important to seek medical advice for a thorough evaluation and appropriate treatment.

In summary, your symptoms are indicative of IBS, and while they can be uncomfortable, they are manageable with lifestyle and dietary changes, along with appropriate medical treatment. If you have concerns about hemorrhoids or anal fissures, a healthcare provider can provide a proper examination and treatment options.

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