Bloating and Abdominal Pain: Is It IBS or Something Else?

Gastrointestinal bloating

Recently, I have been experiencing bloating and cramping in my abdomen, and I have difficulty passing gas.
Although I have a bowel movement every day, I feel a sense of heaviness followed by lightness.
I underwent a colonoscopy in April of last year (the bowel was clean, and the examination showed no polyps).
At the end of March this year, I had blood tests to check for inflammation markers, and the stool test for occult blood was negative with no signs of inflammation.
I would like to ask (without diarrhea): 1.
Could this be ulcerative colitis? 2.
Should I undergo another colonoscopy? 3.
The symptoms appeared only in September of last year; I had a colonoscopy previously due to blood in my stool.
4.
The doctor diagnosed me with irritable bowel syndrome, but shouldn't a colonoscopy be performed to confirm the diagnosis after symptoms arise?

Xiao Yang, 30~39 year old female. Ask Date: 2022/04/18

Dr. Zhang Kebin reply Gastroenterology and Hepatology

If the examination results are normal, there is no need for excessive concern; you can continue to monitor the situation.
If you have any doubts, it is recommended to return for a consultation with your primary physician.
Thank you.

Reply Date: 2022/04/18

More Info

Based on your description, it seems you are experiencing a combination of bloating, abdominal pain, and changes in bowel habits, which can be quite distressing. Given your history of constipation, the presence of mucus in your stool, and the recent diagnosis of irritable bowel syndrome (IBS), it is essential to explore these symptoms further.

1. Understanding IBS: IBS is a functional gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, and altered bowel habits (diarrhea, constipation, or a mix of both). It is important to note that IBS does not cause structural changes in the intestines, which is why tests like colonoscopy may come back normal, as they did in your case. The symptoms can often be triggered by stress, dietary choices, or hormonal changes.

2. Bloating and Abdominal Pain: The bloating and cramping you are experiencing could be due to gas buildup in the intestines, which is common in IBS. This can lead to a sensation of fullness or pressure in the abdomen. The fact that you feel "heavy" in your abdomen but still have bowel movements suggests that there may be some functional issues with how your intestines are processing food and gas.

3. Mucus in Stool: The presence of mucus in your stool can be a common symptom associated with IBS. It is not necessarily indicative of inflammatory bowel diseases (IBD) like ulcerative colitis or Crohn's disease, especially since your previous colonoscopy showed no abnormalities. However, if you notice blood in your stool or significant changes in your bowel habits, it is crucial to consult a healthcare provider.

4. Ulcerative Colitis Concerns: Your concern about ulcerative colitis is understandable, especially given your previous symptoms of blood in your stool. However, since your colonoscopy was clear and your inflammatory markers were normal, it is less likely that you have this condition. Ulcerative colitis typically presents with more severe symptoms, including persistent diarrhea with blood, abdominal pain, and weight loss.

5. Further Testing: Given that your symptoms have persisted and you have a history of gastrointestinal issues, it may be worth discussing with your doctor whether a repeat colonoscopy is necessary. However, if your symptoms are consistent with IBS and there are no alarming signs (like significant weight loss, persistent vomiting, or blood in the stool), your doctor may recommend managing your symptoms through dietary changes, stress management, and possibly medication.

6. Dietary Considerations: Many individuals with IBS find relief by adjusting their diet. Keeping a food diary can help identify any triggers. Common recommendations include a low FODMAP diet, which reduces certain fermentable carbohydrates that can cause gas and bloating. Additionally, increasing fiber intake gradually can help regulate bowel movements.

7. Lifestyle Modifications: Regular physical activity, adequate hydration, and stress-reduction techniques (such as yoga or mindfulness) can also be beneficial in managing IBS symptoms.
In conclusion, while your symptoms may be indicative of IBS, it is essential to maintain open communication with your healthcare provider. They can help you navigate your symptoms, determine if further testing is necessary, and develop a comprehensive management plan tailored to your needs. If your symptoms worsen or new symptoms arise, do not hesitate to seek medical attention.

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