Bloating and Constipation: Insights for Relief

Abdominal bloating and constipation?

Hello Doctor, I have been experiencing abdominal bloating for almost six months now, with the bloating sensation primarily located on the right side of my abdomen.
I have undergone a colonoscopy during this period, which was normal.
Currently, I feel a constant sensation of intestinal distension, which becomes more pronounced after eating.
I often feel the urge to have a bowel movement, and I can usually pass stool 2-3 times during the day, although it is not very smooth.
The stools are often small, pellet-like, or in thin, segmented shapes, and the amount is minimal.
After a bowel movement, the urge to go again returns shortly.
I typically cannot have a bowel movement at night, but occasionally I can pass gas after exercising, though it does not provide complete relief.

I have tried various medications to promote gastrointestinal motility, assist with gas relief, digestive enzymes, and antispasmodics.
I have also been taking probiotics, but I feel they have not been very beneficial.
In terms of diet, I have been attempting to follow a low-FODMAP approach to help with my irritable bowel syndrome, but the anxiety surrounding my condition and dietary restrictions has caused me to lose nearly 6 kilograms over the past six months, which raises concerns about other underlying issues, so I have not been able to fully adhere to this diet.

Additionally, I am wondering if I should consider undergoing a chronic food sensitivity test to avoid foods that may cause discomfort, as I have read that individuals with irritable bowel syndrome may be prone to leaky gut syndrome.
I apologize for the lengthy question, but I would appreciate your insights on this matter.
Thank you.

Mr. Chen, 40~49 year old female. Ask Date: 2022/05/27

Dr. Zeng Guosen reply Internal Medicine

Gastrointestinal abnormalities are common clinical issues that can be challenging to manage.
The causes are numerous, including physiological, psychological, medication-related, dietary, and lifestyle factors.
It is difficult to determine the cause and appropriate management based solely on the description of the problem.
It is advisable to consult a gastroenterologist and cooperate patiently with the diagnosis and treatment.
Seeking advice from a traditional Chinese medicine practitioner may also be beneficial.
It is quite rare to develop intestinal allergies in middle age, so a medical evaluation to assess the necessity of testing is recommended.
Thank you for your question.

Reply Date: 2022/05/27

More Info

Bloating and constipation are common gastrointestinal complaints that can significantly affect a person's quality of life. Your symptoms, including persistent abdominal bloating, difficulty with bowel movements, and the sensation of incomplete evacuation, suggest a possible underlying issue that may require further exploration and management.

Understanding Your Symptoms
1. Bloating: This sensation is often caused by the accumulation of gas in the gastrointestinal tract. It can be exacerbated by certain foods, swallowing air while eating, or underlying conditions such as irritable bowel syndrome (IBS) or food intolerances.

2. Constipation: The characteristics of your bowel movements—small, pellet-like stools—indicate that you may be experiencing constipation. This can be due to a variety of factors, including inadequate fiber intake, dehydration, lack of physical activity, or even stress and anxiety.

3. Frequent Urge to Defecate: The feeling of needing to go to the bathroom frequently, yet having difficulty passing stool, can be frustrating. This may be related to rectal sensitivity or a condition known as "tenesmus," which is the feeling of incomplete evacuation.

Possible Causes
Given that you have undergone a colonoscopy with normal results, it is essential to consider other potential causes of your symptoms:
- Irritable Bowel Syndrome (IBS): This functional gastrointestinal disorder is characterized by a combination of bloating, abdominal pain, and altered bowel habits (constipation or diarrhea). Stress and dietary factors can play a significant role in exacerbating symptoms.

- Food Intolerances: You mentioned considering a chronic food sensitivity test. This could be beneficial, especially if you suspect that certain foods may be contributing to your bloating and discomfort. Common culprits include lactose (found in dairy) and gluten (found in wheat products).

- Gut Dysbiosis: An imbalance in the gut microbiota can lead to symptoms of bloating and constipation. While you have been taking probiotics, it may take time to see significant improvements, and the specific strains of probiotics can also make a difference.

- Pelvic Floor Dysfunction: Sometimes, the muscles involved in bowel movements may not function correctly, leading to difficulty in passing stool. This can be assessed by a specialist if deemed necessary.

Management Strategies
1. Dietary Adjustments: Continuing with a low-FODMAP diet can be helpful, as it reduces fermentable carbohydrates that can cause gas and bloating. It may also be beneficial to keep a food diary to identify any specific triggers.

2. Hydration: Ensure you are drinking enough water throughout the day, as dehydration can worsen constipation.

3. Physical Activity: Regular exercise can stimulate bowel movements and reduce bloating. Even light activities such as walking can be beneficial.

4. Stress Management: Since anxiety can exacerbate gastrointestinal symptoms, consider incorporating stress-reduction techniques such as mindfulness, yoga, or meditation into your routine.

5. Medications: If over-the-counter remedies have not provided relief, discussing prescription options with your healthcare provider may be warranted. Medications that promote bowel motility or address specific symptoms of IBS may be beneficial.

6. Follow-Up: Given the duration and persistence of your symptoms, it may be worthwhile to follow up with a gastroenterologist for further evaluation. They may suggest additional tests, such as a breath test for lactose intolerance or a more comprehensive assessment of gut motility.

Conclusion
Bloating and constipation can be complex issues that require a multifaceted approach to management. It is essential to work closely with your healthcare provider to develop a tailored plan that addresses your specific symptoms and concerns. By taking proactive steps in your diet, lifestyle, and possibly seeking further medical evaluation, you can work towards finding relief and improving your overall well-being.

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