Bowel Issues: Symptoms and Next Steps for Diagnosis

Bowel-related issues?

Hello Doctor, I am 39 years old and have had irregular sleep patterns for a long time (I have recently adjusted my schedule).
I have been a long-term smoker (I have quit smoking) and have experienced gastroesophageal reflux for an extended period.
For the past year and more, I have been taking both traditional Chinese medicine and Western medicine.
About seven to eight months ago, I noticed that my stools had a foul odor, and after bowel movements, I would experience fecal incontinence, leading to a sensation of friction around the anal area (though this does not happen every time).
Sometimes, when wiping, there is a small amount of blood on the toilet paper (not much, just a little), but there is no blood in the stool.
When I apply pressure with toilet paper to the anal area, I notice blood stains, which have been persistent around the anal region.
Six months ago, while taking traditional Chinese medicine, I discovered that the left side of my tongue was prone to ulceration (in different spots, but concentrated on the left side).
After applying medication, it would heal in two to three days.
Initially, I would have an ulcer about once a month, but it has become more frequent.
During this time, I have seen many doctors, but the ulcers continue to occur.
I consulted with a rheumatologist, and blood tests came back normal.
I am currently taking medication prescribed by the rheumatologist, but the ulcers have now appeared under my tongue.
I am also seeing a traditional Chinese medicine practitioner.
A few days before starting the Chinese medicine, I may have eaten something bad, resulting in mild diarrhea for three days.
After starting the Chinese medicine, I feel like my bowel movements have increased; sometimes I feel the urge to go to the bathroom right after meals.
Previously, I would have a bowel movement once every one or two days, but now it is about twice a day, with a smaller volume than before.
I also experience mild urges to defecate, but not to the point of frequent trips to the bathroom.
When I do go, the amount is less than before, roughly half of what it used to be.
The color of the stool appears normal, but it feels incomplete, coming out in segments.
The stool also seems somewhat loose and does not maintain a solid form.
Doctor, what further examinations should I consider?

GOSSIP, 30~39 year old female. Ask Date: 2023/10/06

Dr. Chen Shidian reply Gastroenterology and Hepatology

If a colonoscopy has been performed, follow-up treatment should be coordinated with the immunology department.

Reply Date: 2023/10/06

More Info

It sounds like you are experiencing a complex set of gastrointestinal symptoms that have been ongoing for quite some time. Based on your description, you have a history of gastroesophageal reflux disease (GERD), irregular bowel habits, and some concerning symptoms such as blood on toilet paper and changes in stool consistency. Let's break down your symptoms and discuss potential next steps for diagnosis and management.

Symptoms Overview
1. Bowel Movements: You mentioned that your bowel movements have a foul odor, and you experience a sensation of incomplete evacuation, which can lead to irritation around the anal area. The presence of blood on the toilet paper, even if it is minimal, is a symptom that should not be ignored.

2. Stool Characteristics: You noted that your stools are sometimes loose and not well-formed, which can indicate a possible issue with your digestive process. The fact that you are experiencing changes in frequency and consistency, especially after meals, may suggest a functional gastrointestinal disorder such as irritable bowel syndrome (IBS).

3. Oral Symptoms: The recurrent sores on the left side of your tongue could be related to a few different factors, including nutritional deficiencies, stress, or even autoimmune conditions. The fact that they have become more frequent is concerning and warrants further investigation.

Potential Diagnoses
Given your symptoms, several conditions could be considered:
- Irritable Bowel Syndrome (IBS): This is a common functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits. It can be triggered by stress, diet, and other factors.

- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis could present with similar symptoms, including abdominal pain, diarrhea, and rectal bleeding.
- Hemorrhoids or Anal Fissures: The blood on the toilet paper could be due to hemorrhoids or anal fissures, especially if you are experiencing discomfort during bowel movements.

- Nutritional Deficiencies: The sores on your tongue and changes in your bowel habits could be related to deficiencies in vitamins such as B12, folate, or iron.

Recommended Next Steps
1. Consult a Gastroenterologist: Given the complexity of your symptoms, it would be prudent to see a gastroenterologist who can perform a thorough evaluation. They may recommend tests such as:
- Colonoscopy: This is essential to rule out any structural abnormalities, polyps, or inflammatory conditions in the colon. Given your symptoms of rectal bleeding and changes in bowel habits, this is a critical step.

- Stool Tests: These can help identify infections, inflammation, or malabsorption issues.

- Blood Tests: To check for anemia, inflammatory markers, and nutritional deficiencies.

2. Dietary Assessment: Keeping a food diary may help identify any dietary triggers that could be exacerbating your symptoms. A dietitian can assist in creating a balanced diet that may alleviate some of your gastrointestinal issues.

3. Symptom Management: Depending on the findings, your doctor may recommend medications to manage symptoms, such as antispasmodics for IBS or topical treatments for hemorrhoids.

4. Oral Health Evaluation: The recurrent sores on your tongue should be evaluated by a healthcare professional, possibly an oral surgeon or dentist, to rule out any underlying conditions.

Conclusion
Your symptoms are concerning and warrant a comprehensive evaluation to rule out serious conditions. It is essential to address both your gastrointestinal symptoms and the oral lesions to ensure a holistic approach to your health. Please make an appointment with a gastroenterologist as soon as possible to discuss your symptoms in detail and determine the appropriate diagnostic tests and treatment options.

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