Digestive Issues: When to Seek Further Testing - Gastroenterology and Hepatology

Bowel issues

Hello Doctor, I have been experiencing frequent diarrhea and constipation for about 10 years.
Initially, my bowel movements were normal, but later on, I started having diarrhea.
Sometimes I go to the bathroom 2 to 3 times a day, while other times it can be 2 or 3 days before I have a bowel movement.
Out of ten times, I have diarrhea 7 or 8 times.
Recently, I had blood and stool tests for the first time, and the results were all normal.
Should I undergo any other tests? Thank you.

STW, 20~29 year old female. Ask Date: 2022/11/06

Dr. Yang Zhichao reply Gastroenterology and Hepatology

Hello Ms.
STW, based on your symptoms, if there is no improvement with treatment, it is recommended to schedule a colonoscopy to rule out inflammatory bowel disease.
Thank you for your inquiry.

Reply Date: 2022/11/06

More Info

When it comes to digestive issues such as alternating diarrhea and constipation, it is essential to understand the underlying causes and when further testing may be necessary. Your symptoms, which have persisted for about ten years, indicate a chronic condition that warrants a thorough evaluation.

Firstly, it is important to recognize that the symptoms you describe could be indicative of several gastrointestinal disorders, including Irritable Bowel Syndrome (IBS), inflammatory bowel disease (IBD), or even food intolerances. IBS is particularly common and is characterized by a combination of abdominal pain and altered bowel habits, which can include both diarrhea and constipation. While your initial blood and stool tests returned normal results, this does not entirely rule out the presence of a functional gastrointestinal disorder like IBS.

Given the chronic nature of your symptoms, further testing may be beneficial. Here are some considerations:
1. Detailed Medical History and Physical Examination: A healthcare provider may want to take a more detailed history of your symptoms, including any dietary habits, stress levels, and family history of gastrointestinal diseases. A physical examination can also provide valuable insights.

2. Additional Laboratory Tests: While your initial tests were normal, additional tests may be warranted. This could include:
- Lactose Intolerance Testing: If you suspect dairy products may be contributing to your symptoms, this test can help determine if you have lactose intolerance.

- Celiac Disease Testing: This involves blood tests to check for antibodies related to celiac disease, which can cause gastrointestinal symptoms when gluten is consumed.

- Thyroid Function Tests: An underactive or overactive thyroid can affect bowel habits.

3. Imaging Studies: If there are concerns about structural issues in the gastrointestinal tract, imaging studies such as an abdominal ultrasound or CT scan may be recommended.

4. Endoscopy or Colonoscopy: If there are any red flags in your symptoms (such as weight loss, blood in stool, or severe pain), a gastroenterologist may recommend an endoscopy or colonoscopy to visualize the gastrointestinal tract and obtain biopsies if necessary.

5. Dietary Evaluation: Consulting with a dietitian can help identify potential food triggers. Keeping a food diary can also be useful in correlating your symptoms with specific foods.

6. Trial of Treatment: Sometimes, a trial of dietary changes or medications can help clarify the diagnosis. For instance, a low FODMAP diet is often recommended for individuals with IBS.

In summary, while your initial tests were normal, the chronic nature of your symptoms suggests that further evaluation is warranted. It is advisable to consult with a gastroenterologist who can guide you through the appropriate tests and help develop a management plan tailored to your specific situation. Early intervention can lead to better outcomes and improved quality of life. Remember, it’s essential to advocate for your health and seek further testing if your symptoms persist or worsen.

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