Gastrointestinal Issues: Polyp, IBS, or Inflammation?

Polyp? Irritable bowel? Inflammation?

Two weeks ago, I noticed that I had to exert more effort when using the restroom, and I was passing gas more frequently.
I also felt a lingering urge to have a bowel movement after finishing.
A week ago, before seeing the doctor (I had my appointment that evening), the urge to have a bowel movement disappeared after I used the restroom.
After my appointment, I took the medication prescribed by the doctor, and over the past two days, my stools have become thinner, with small pieces of gas mixed in.
I weighed myself in the morning and noticed a 0.6 kg weight loss.
I still feel an urge to have a bowel movement when sitting down, but I can't seem to pass anything when squatting.
Standing up reduces the urge, but I feel a sense of fullness in my rectum.
If I squat for too long, I experience discomfort in the usual area where I feel menstrual cramps, and I'm not sure if it's because I'm straining too much while squatting.

I also feel that my appetite is not very good, possibly due to psychological or physiological factors.
I had an X-ray, and the doctor said everything looked normal (but I didn't clarify if that meant there was no retained stool).
Can an X-ray detect internal hemorrhoids or polyps? I have no family history of colorectal cancer, and I currently just want to understand these issues better.
Please help me clarify these concerns.

Wang Youxin, 10~19 year old female. Ask Date: 2022/10/04

Dr. Hu Guozheng reply Gastroenterology and Hepatology

Hello Wang Youxin, your situation sounds like you previously experienced some constipation issues.
After medication, your constipation has partially improved, but you are experiencing other symptoms.
Firstly, a weight loss of 0.6 kilograms may not have significant clinical implications, so there is no need to worry too much about it.
Additionally, I would like to know if you still have to exert a lot of effort to have a bowel movement after taking the medication.
Indeed, individuals who frequently strain during bowel movements are more prone to hemorrhoids, and if the hemorrhoids become too large, they may further complicate bowel movements.
I recommend that you return to your doctor to discuss the next steps.
X-rays do not reveal internal hemorrhoids or polyps.

Reply Date: 2022/10/04

More Info

Understanding gastrointestinal issues can be quite complex, especially when symptoms overlap and multiple conditions may be at play. Based on your description, it seems you are experiencing a range of symptoms that could be indicative of several gastrointestinal disorders, including Irritable Bowel Syndrome (IBS), inflammation, or possibly the presence of polyps.

Firstly, let's break down your symptoms. You mentioned needing to exert more effort during bowel movements, increased flatulence, and a sensation of incomplete evacuation. These symptoms can often be associated with IBS, a common functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits, including diarrhea and constipation. IBS can be triggered or exacerbated by stress, dietary choices, and lifestyle factors, such as irregular sleep patterns or high levels of anxiety.

The fact that your stool has become thinner and that you experience a feeling of fullness or pressure in the rectal area could suggest a few things. One possibility is that you may be experiencing a form of constipation, which can lead to straining during bowel movements and the sensation of incomplete evacuation. This can also cause discomfort in the pelvic area, which you described as similar to menstrual cramps.
Regarding your concerns about polyps or other structural abnormalities, it’s important to note that while X-rays can provide some information about the overall structure of the intestines, they are not the best tool for diagnosing conditions like polyps or internal hemorrhoids. A colonoscopy is typically the gold standard for visualizing the interior of the colon and identifying any polyps or other abnormalities. If you have a family history of colorectal cancer or if your symptoms persist, it may be advisable to discuss further diagnostic options with your healthcare provider.

You also mentioned a decrease in appetite and weight loss, which can be concerning. While these symptoms can be associated with gastrointestinal disorders, they can also indicate other underlying health issues. It’s crucial to monitor these changes closely and communicate them to your doctor, especially if they continue or worsen.

In terms of management, dietary modifications can play a significant role in alleviating symptoms associated with IBS and other gastrointestinal issues. A diet low in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) has been shown to help many individuals with IBS. This involves reducing foods that are high in certain carbohydrates that can cause bloating and gas. Additionally, increasing fiber intake gradually can help regulate bowel movements, but it’s important to do this carefully to avoid exacerbating symptoms.

Stress management techniques, such as mindfulness, yoga, or cognitive-behavioral therapy, can also be beneficial, as stress is a known trigger for IBS symptoms. Regular physical activity can help improve bowel function and reduce stress levels.

In conclusion, while your symptoms may suggest IBS or another gastrointestinal issue, it’s essential to work closely with your healthcare provider to explore these possibilities further. They may recommend additional tests, dietary changes, or medications to help manage your symptoms effectively. If you have ongoing concerns about polyps or other structural issues, do not hesitate to seek further evaluation. Your health and well-being are paramount, and addressing these symptoms early can lead to better outcomes.

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