Managing Bloating, Constipation, and Unformed Stool: A Guide for Health Professionals

Despite having a good diet, experiencing bloating, constipation, and unformed stools?

Hello, Doctor.
I am currently 25 years old and started my master's degree abroad last September.
I am here to inquire about my health due to concerns about high medical costs.
I am a nutritionist and have been following a nutritionally complete vegan diet for about two years, including vegetables, fruits, nuts, seeds, legumes, whole grains, mushrooms, and appropriate supplements (D, B12), ensuring that I meet all nutrient RDA requirements.
I keep detailed records of my daily diet, and my annual health check-ups have always been healthy with no medical history or symptoms of discomfort.
I maintain good lifestyle habits, going to bed early and waking up early, exercising for an hour daily, and I do not smoke or drink alcohol.
However, about two months ago, I began experiencing issues such as lower abdominal bloating, constipation, unformed stools, gastroesophageal reflux, and mild abdominal pain.
Additionally, I have developed a small number of mild rashes around my navel and on the back of my hands, and I am unsure if they are related.
The same amount of food that I used to consume now causes abdominal bloating, making it difficult to eat.
I feel as if food is stuck and there is a sensation of fullness with food refluxing into my throat.
Even after a 16-hour overnight fast, my upper abdomen is flat and my abdominal muscles are visible, but my lower abdomen remains bloated, with a noticeable protrusion at the iliac crest, which is significantly different from my previously lean physique.
It feels as if there is a foreign object lodged in my intestines.

My bowel habits have changed drastically; I used to have bowel movements 1-2 times a day with healthy stools, but now I only have a bowel movement every three days, and my stools are all muddy and unformed.
The only significant dietary change was switching to a different brand of mixed cereal 1-2 months ago, and I experienced abdominal pain the first time I consumed this brand's bran.
Therefore, I suspect that the different types of cereals abroad may have caused me to develop celiac disease, wheat allergy, or non-celiac gluten sensitivity (NCGS).
However, I have been on a gluten-free diet for a week without improvement.
Based on my personal learning experience, it could also be issues like inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO), or colorectal tumors, but I am uncertain how to further improve my diet or which direction to take for medical consultation.
Currently, I have reduced my food intake and eliminated hard-to-digest whole grains and legumes, focusing on easily digestible vegetables and fruits, along with a moderate amount of nuts and seeds.
This has improved my bloating somewhat, but I am still experiencing constipation.
Additionally, after consuming a baked bean can yesterday, I experienced bloating again.
In terms of medication, I have used 10 mg of bisacodyl, but it had limited effects, only producing a small amount of stool.
I found 60 ml of lactulose to be very effective for bowel movements, but constipation returned after discontinuation.
Psyllium husk powder (10-20 g) showed no significant effects.
A few days ago, I tested consuming flaxseeds with lactulose after fasting, and about 12-16 hours later, I observed flaxseed fragments in my stool, indicating that food is being expelled rather than blocked.
I am uncertain about the source of my bloating.
Additionally, I have lost a small amount of weight, around 1 kg (from 70 kg to 68-69 kg), possibly due to reduced food intake.
My main symptoms are bloating, constipation, and unformed stools, with no other symptoms (no fatigue, anxiety, insomnia, or signs of anemia or weakness).

Doctor, how can I manage this on my own? What dietary changes and over-the-counter medications would be beneficial (should I continue using lactulose)? How should I proceed with medical diagnosis (colonoscopy, endoscopy, or X-ray)? Thank you.

Wang, 20~29 year old female. Ask Date: 2022/01/13

Dr. Chen Shidian reply Gastroenterology and Hepatology

Fecal occult blood testing can be performed; if the results are normal, dietary adjustments should be made based on the FODMAP food list, and weight should be monitored.

Reply Date: 2022/01/13

More Info

Managing gastrointestinal issues such as bloating, constipation, and unformed stool can be complex, especially for someone with a background in nutrition like yourself. Given your detailed account of symptoms and dietary habits, let's break down the potential causes and management strategies.

Understanding Your Symptoms
1. Bloating: This can be caused by various factors, including dietary changes, food intolerances, or gastrointestinal disorders. Since you mentioned a recent change in your cereal brand, it's plausible that the new product contains ingredients that your body may not tolerate well, such as gluten or certain fibers.

2. Constipation and Unformed Stool: The shift from regular bowel movements to infrequent and unformed stools can indicate a change in gut motility or the composition of your diet. High fiber intake, especially from whole grains and legumes, can sometimes lead to bloating and constipation if not balanced with adequate hydration and other digestive aids.

3. Gastroesophageal Reflux Disease (GERD): The sensation of food backing up into your throat can be exacerbated by bloating and delayed gastric emptying, which may be linked to your dietary changes or stress.

4. Skin Rashes: The appearance of mild rashes could suggest an allergic reaction or sensitivity, possibly related to the new cereal or other dietary components.

Dietary Management Strategies
1. Elimination Diet: Since you suspect gluten or wheat sensitivity, continuing a gluten-free diet for a longer period (at least 4-6 weeks) may help clarify if these are contributing factors. Monitor your symptoms closely during this time.

2. Fiber Intake: While fiber is essential for digestive health, the type and amount are crucial. Soluble fiber (found in fruits, vegetables, and oats) can help with stool formation, while insoluble fiber (found in whole grains and legumes) may exacerbate bloating in some individuals. Gradually reintroducing fiber sources while monitoring your body's response can be beneficial.

3. Hydration: Ensure you are drinking enough fluids, especially when increasing fiber intake. This can help alleviate constipation and improve overall digestive function.

4. Probiotics: Consider incorporating probiotics into your diet, either through fermented foods (like yogurt, kefir, or sauerkraut) or supplements. Probiotics can help restore gut flora balance, which may be disrupted.

5. Digestive Aids: Continue using lactulose as it has been effective for you. However, be cautious with overuse, as it can lead to dependency. You might also explore other options like magnesium citrate or psyllium husk, which can aid in bowel regularity.

When to Seek Medical Attention
Given your symptoms and the duration of your issues, it may be wise to consult a healthcare professional for further evaluation. Here are some diagnostic approaches:
1. Gastroenterology Consultation: A specialist can provide insights into your symptoms and recommend appropriate tests.

2. Endoscopy or Colonoscopy: These procedures can help visualize the gastrointestinal tract and rule out conditions such as inflammatory bowel disease (IBD) or malignancies.

3. Imaging Studies: An abdominal ultrasound or X-ray may help assess for any structural issues or obstructions.

4. Allergy Testing: If food allergies or intolerances are suspected, testing can help identify specific triggers.

Conclusion
Managing your gastrointestinal symptoms requires a multifaceted approach, focusing on dietary adjustments, hydration, and possibly medical evaluation. Given your background in nutrition, you are well-equipped to monitor your dietary intake and make necessary changes. However, do not hesitate to seek professional help if symptoms persist or worsen. Your health is paramount, and addressing these issues early can prevent further complications.

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