Bowel Issues: Constipation and Diarrhea Cycles Explained

Q: Bowel Issues: Constipation and Diarrhea Cycles Explained

Hello： You may try increasing your intake of fruits and vegetables, as well as fluids, while also reducing the consumption of irritant foods such as fried and spicy foods. <br>If there is no improvement, you can consult a gastroenterologist for medication to assist with bowel mov

Bowel movement issues

Hello doctor, for the past two years, I've been experiencing a cycle of constipation for several days a week, followed by a day of diarrhea, and then back to constipation.
During constipation, I often feel like there is a large stool stuck in my rectum, but I don't have the urge to defecate.
I find myself frequently wanting to urinate, and I have to strain to pass even a small amount of stool.
More concerning is that before I feel the urge to defecate, I start passing gas that has a fecal odor.
In the past, I would only feel a sense of urgency when I needed to go, without the excessive flatulence.
These symptoms have been troubling me for a long time over the past two years.
I had a colonoscopy two years ago which showed no issues, and I also had an internal hemorrhoid removed.
Could you please advise what these symptoms might indicate?

A Cheng, 30~39 year old female. Ask Date: 2022/12/14

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: You may try increasing your intake of fruits and vegetables, as well as fluids, while also reducing the consumption of irritant foods such as fried and spicy foods.
If there is no improvement, you can consult a gastroenterologist for medication to assist with bowel movements.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2022/12/14

More Info

Understanding bowel issues, particularly the cycles of constipation and diarrhea, can be quite complex and often requires a multifaceted approach to diagnosis and treatment. Based on your description, it seems you are experiencing a pattern of alternating constipation and diarrhea, which can be indicative of a condition known as Irritable Bowel Syndrome (IBS). This is a functional gastrointestinal disorder characterized by a combination of symptoms, including abdominal pain, bloating, and changes in bowel habits, such as constipation and diarrhea.

What is Irritable Bowel Syndrome (IBS)?
IBS is a common disorder that affects the large intestine. It is classified into different subtypes based on the predominant symptoms:
1. IBS with Constipation (IBS-C): Characterized by hard or lumpy stools and infrequent bowel movements.

2. IBS with Diarrhea (IBS-D): Characterized by loose or watery stools.

3. Mixed IBS (IBS-M): A combination of both constipation and diarrhea.

The exact cause of IBS is not well understood, but it is believed to involve a combination of factors, including abnormal gastrointestinal motility, visceral hypersensitivity, and psychosocial factors. Stress and anxiety can exacerbate symptoms, leading to a cycle of discomfort.

Symptoms You Described
From your symptoms, it appears that you are experiencing:
- Alternating Bowel Habits: A cycle of constipation followed by diarrhea is common in IBS. The sensation of having difficulty passing stool, along with the feeling of incomplete evacuation, is also typical.

- Flatulence: Increased gas and the presence of foul-smelling flatulence can occur due to changes in gut flora or the fermentation of undigested food in the intestines.

- Straining: The need to strain during bowel movements can indicate constipation, which may be exacerbated by dietary factors, dehydration, or lack of physical activity.

Diagnostic Considerations
Since you have previously undergone a colonoscopy that showed no significant issues, it is less likely that you have a structural problem in your intestines. However, it is essential to consider other potential causes of your symptoms, including:
- Dietary Factors: Certain foods can trigger IBS symptoms. Common culprits include dairy products, high-fat foods, and certain carbohydrates known as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols).

- Stress and Anxiety: Psychological factors can significantly impact gastrointestinal function. Stress management techniques, such as cognitive-behavioral therapy, mindfulness, or relaxation exercises, may help alleviate symptoms.

- Gut Microbiome: An imbalance in gut bacteria can contribute to gastrointestinal symptoms. Probiotics may be beneficial in restoring a healthy gut flora.

Management Strategies
1. Dietary Modifications: Keeping a food diary can help identify trigger foods. A low-FODMAP diet may be effective for some individuals with IBS.

2. Hydration: Ensure adequate fluid intake, especially when experiencing diarrhea.

3. Regular Exercise: Physical activity can help promote regular bowel movements and reduce stress.

4. Medications: Depending on your symptoms, your healthcare provider may recommend medications such as laxatives for constipation or antidiarrheal agents for diarrhea. In some cases, medications specifically for IBS, such as antispasmodics or certain antidepressants, may be prescribed.

5. Stress Management: Techniques such as yoga, meditation, or counseling can help manage stress, which may, in turn, alleviate gastrointestinal symptoms.

Conclusion
Given the complexity of your symptoms and their impact on your quality of life, it is crucial to work closely with a healthcare provider who can help tailor a management plan specific to your needs. Regular follow-ups and open communication about your symptoms will be essential in finding an effective approach to managing your bowel issues. If symptoms persist or worsen, further evaluation may be necessary to rule out other gastrointestinal disorders.

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