Chronic Diarrhea and Abdominal Pain: IBS and Its Symptoms

Chronic diarrhea and abdominal pain?

Hello Dr.
Chang, I am 28 years old and have generally had good gastrointestinal health.
However, between the ages of 25 and 27, my diet was poor, consuming a cup of bubble tea every day for about six months and frequently eating late-night snacks (grilled food).
Around September of last year, I started experiencing gastrointestinal discomfort, with diarrhea occurring every 3 to 4 days (normal bowel movements the next day).
However, my stool shape has not returned to normal, and I have been experiencing frequent bowel sounds.
I have tried both traditional Chinese medicine and Western medicine, but nothing has completely resolved the issue.

I went to a small hospital (Ren'ai, Yilan) for a CT scan (4 cuts) and also underwent a colonoscopy (at Beirong) and an upper endoscopy (at Yilan Yangming), which only showed Grade A gastroesophageal reflux.
The test results did not indicate any major problems, but my symptoms have not improved at all.
In December of last year, I heard about a friend my age who had late-stage pancreatic neuroendocrine tumor symptoms that sounded very similar to mine, which heightened my anxiety.
I began to experience insomnia, a sensation of a foreign body in my throat, dizziness, frequent urination, and other symptoms of autonomic nervous system dysregulation.
Eventually, with the help of friends, I slowly overcame my panic, and these symptoms began to alleviate, but the diarrhea issue remains unresolved.
I have seen many doctors, each diagnosing me with irritable bowel syndrome (IBS) and advising me to coexist with it.
If that is the case, I could accept it, but later on, I even noticed mucus and bubbles in my stool, resembling phlegm, with a foul odor.
My abdomen occasionally experiences dull pain and cramping (whenever I have cramping, I definitely have diarrhea).
I have taken medications like Enteric-Coated Tablets and Cholecystokinin, but they were ineffective.
I started taking Wakamoto, which seems to have improved things somewhat (my bowel movements have become every 7 to 8 days).
However, I keep thinking I am getting better, only to experience unexpected diarrhea again.

For the past three days, I have been having diarrhea (2 to 3 times a day), and my stomach has been gurgling continuously.
Yesterday, I tried to pass gas, but I thought it was a bowel movement; when I wiped, I found mucus mixed with blood.
I rushed to Taipei Medical University, where they again diagnosed me with IBS.
Is it really possible for IBS to be this severe? Today marks the third day of diarrhea, and there are no signs of relief.
I also felt a hard mass under my left rib cage (it doesn’t hurt when I touch it), but certain positions cause pain in that area.
I also experience tenderness near my navel when lying flat (but it’s not unbearable).
Sometimes I wonder if the previous CT scan equipment was outdated and failed to reveal the problem.
I apologize for writing such a long message, but I truly feel helpless.

A-Zhen, 20~29 year old female. Ask Date: 2022/07/02

Dr. Zhang Kebin reply Gastroenterology and Hepatology

Hello, A-Zhen.
After examination, no abnormalities were found, and the symptoms have not improved despite treatment.
It is recommended that you return to the medical facility where you previously had your check-up (Beirong or Yilan Yangming) for further consultation.
Thank you.

Reply Date: 2022/07/02

More Info

Chronic diarrhea and abdominal pain can be distressing symptoms that significantly impact your quality of life. Based on your description, it appears that you may be experiencing Irritable Bowel Syndrome (IBS), a functional gastrointestinal disorder characterized by a combination of symptoms including abdominal pain, bloating, and changes in bowel habits, such as diarrhea and constipation.
IBS is often diagnosed based on the presence of symptoms rather than through specific tests, as there are no definitive laboratory tests for this condition. The Rome IV criteria, which is widely used for diagnosing IBS, requires that patients experience recurrent abdominal pain, on average, at least one day per week in the last three months, associated with two or more of the following: related to defecation, associated with a change in frequency of stool, or associated with a change in form (appearance) of stool.

Your history of poor dietary habits, including frequent consumption of fast food and sugary drinks, may have contributed to the onset of your symptoms. The gut microbiome can be significantly affected by diet, and an imbalance can lead to gastrointestinal issues. Additionally, the stress and anxiety you experienced after hearing about your friend's serious health condition could have exacerbated your symptoms, as stress is a known trigger for IBS.

The presence of mucus in your stool and the occasional blood streaks can be concerning. While these symptoms can occur in IBS, they can also indicate other gastrointestinal issues, such as infections, inflammatory bowel disease (IBD), or even colorectal cancer, especially given your age and the changes in your bowel habits. It is crucial to discuss these symptoms with your healthcare provider, as they may warrant further investigation, such as stool tests for infections or inflammatory markers.

The fact that you have undergone various diagnostic tests, including CT scans and endoscopies, and have not found any significant organic disease is reassuring. However, it is essential to continue working with your healthcare provider to manage your symptoms effectively. Treatment for IBS often includes dietary modifications, such as increasing fiber intake, avoiding trigger foods (like fatty, spicy, or dairy products), and possibly incorporating probiotics to help restore gut flora.

Medications may also be prescribed to help manage symptoms. Antispasmodics can relieve abdominal pain, while antidiarrheal medications can help control diarrhea. In some cases, antidepressants may be prescribed to help manage pain and improve gut function, as they can have a calming effect on the gut.

Cognitive-behavioral therapy (CBT) and other forms of psychological support can also be beneficial, especially if anxiety and stress are contributing to your symptoms. Mindfulness and relaxation techniques may help reduce the overall stress response and improve your gastrointestinal symptoms.

In summary, while IBS can be a chronic condition that requires ongoing management, it is essential to maintain open communication with your healthcare provider. If your symptoms worsen or new symptoms arise, such as significant weight loss, persistent vomiting, or severe abdominal pain, seek medical attention promptly. Your health and well-being are paramount, and there are various strategies and treatments available to help you manage your symptoms effectively.

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