Abdominal Bloating and Constipation: When to Seek Further Testing

Abdominal bloating and constipation?

Hello, doctor.
In November 2023, I suddenly began experiencing abdominal bloating and constipation.
There are audible rumblings in my abdomen, and sometimes I feel the urge to pass gas, but I can only release a small amount or none at all.
I also have constipation, with bowel movements occurring every few days, mostly consisting of pellet-like stools.
My abdomen does not hurt, but it is becoming increasingly distended, and I have a decreased appetite.
In January 2024, I visited a gastroenterology clinic where the doctor prescribed a stool softener (MgO), gas relief medication, probiotics, and digestive aids.
I took the medication continuously for over a month, and as long as I was on the medication, my symptoms improved (I adjusted from taking the medication three times a day to once a day, and I had no issues with gas or bowel movements).
However, once I stopped taking the medication, the bloating and difficulty passing gas returned.
I usually sit in an office and have reduced my physical activity compared to the past.
Given this situation, do you recommend that I undergo a colonoscopy to check for any intestinal obstruction? (I had a colonoscopy at the end of November 2021, which only revealed hemorrhoids.
A close relative, my aunt, has a history of colorectal cancer; I had an upper endoscopy in August 2023, which showed no significant issues; and I experienced a period of anxiety from 2021 to 2022 during which my bowel movements were very regular.)

Niming, 30~39 year old female. Ask Date: 2024/02/20

Dr. Lin Minghui reply Gastroenterology and Hepatology

If there are concerns about organic issues, follow-up examinations in an outpatient setting can be conducted.
There have been no problems with gastrointestinal endoscopy within the past three years.
While medication is effective, the recurrence may be due to gastrointestinal dysfunction or irritable bowel syndrome.
It is advised to pay attention to dietary habits, avoid eating too quickly, refrain from talking while eating, and limit the intake of gas-producing foods.
Regular exercise, stress relief, maintaining a positive mood, adequate hydration, and sufficient dietary fiber intake, along with establishing good bowel habits, are recommended.
If there is a family history of colorectal cancer, it is suggested to undergo stool tests, and if any issues arise, further examinations can be performed.
Best wishes for your health!

Reply Date: 2024/02/20

More Info

Abdominal bloating and constipation can be quite uncomfortable and may indicate underlying gastrointestinal issues. Given your symptoms and medical history, it's essential to approach this situation with careful consideration.

Understanding Your Symptoms
Abdominal bloating is often characterized by a feeling of fullness or swelling in the abdomen, which can be accompanied by changes in bowel habits, such as constipation. Constipation is typically defined as having fewer than three bowel movements per week, and it can manifest as hard, dry stools that are difficult to pass. The fact that you are experiencing these symptoms intermittently, with some relief from medications, suggests that there may be a functional component to your condition, possibly related to diet, lifestyle, or stress.

Potential Causes
1. Dietary Factors: A diet low in fiber can lead to constipation and bloating. Foods that are high in fat or sugar can also contribute to these symptoms. It's important to ensure you're consuming adequate amounts of fruits, vegetables, and whole grains.

2. Lifestyle Changes: A sedentary lifestyle, especially if you have transitioned to more office-based work, can affect gut motility. Regular physical activity is crucial for maintaining healthy bowel function.

3. Medications: While medications like magnesium oxide (MgO) and probiotics can help alleviate symptoms, the return of bloating and constipation after stopping medication suggests that the underlying issue may not be fully resolved.

4. Psychological Factors: Your history of anxiety may also play a role in gastrointestinal symptoms. Stress can significantly impact gut health and motility, leading to symptoms like bloating and constipation.

When to Seek Further Testing
Given your history and the persistence of symptoms, it may be prudent to consider further evaluation. Here are some indicators that suggest further testing, such as a colonoscopy, may be warranted:
- Persistent Symptoms: If bloating and constipation continue despite dietary changes and medication, further investigation may be necessary.

- Family History: With a family history of colorectal cancer, particularly in a first-degree relative, it is essential to remain vigilant about gastrointestinal health.

- Change in Symptoms: If you experience any new symptoms, such as weight loss, blood in the stool, or significant changes in bowel habits, these warrant immediate medical attention.

- Previous Findings: Although your last colonoscopy showed only hemorrhoids, if your symptoms have changed or worsened, a follow-up may be necessary to rule out any new developments.

Conclusion
In summary, while your symptoms may be manageable with medication, the recurrence of bloating and constipation after discontinuation suggests that further evaluation could be beneficial. A colonoscopy can help rule out any structural issues, such as bowel obstruction or polyps, especially given your family history. Additionally, consider discussing lifestyle modifications, including dietary changes and increased physical activity, with your healthcare provider. They may also recommend working with a dietitian or a mental health professional to address any psychological factors contributing to your symptoms. Regular follow-ups with your gastroenterologist will ensure that any changes in your condition are monitored closely.

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