Bowel Issues: Symptoms, Diagnosis, and Treatment Options

Intestinal issues, abdominal problems, intestinal obstruction?

Hello, Director.
For the past seven months, my bowel movements have been infrequent, with very little stool produced, and when I do have a bowel movement, it is often long and infrequent (sometimes every 2-4 weeks or even longer).
The stool is usually sticky, and I notice a lot of mucus when wiping.
I often pass gas, which can be both loud and silent, and it usually has a slight odor.
Occasionally, I experience bowel sounds, and pressing on my abdomen gives a watery sensation.
I have also felt a hard, elongated mass in my lower left abdomen that does not move regardless of how much I press or push.
Even drinking laxative beverages only results in passing a small amount of watery stool.
Three days ago, I visited a doctor who performed an X-ray and indicated that I have fecal impaction in both my lower left and lower right abdomen.
The doctor prescribed magnesium oxide, but it only slightly increased the frequency of my bowel movements and made them more watery.
At the end of January, I noticed a small amount of blood in my stool for one or two days, so I went to the hospital in early February.
The doctor said my blood tests and stool tests were normal, but I am still concerned because I’ve heard that fecal occult blood tests are not completely accurate.
Regarding my weight, it has been decreasing from August to November last year (from 53.8 kg to 50.9 kg), but it has stabilized between 53 and 54 kg in February and March.
Additionally, I experience some pain in both my lower left and lower right abdomen when taking a deep breath.
All these symptoms have led me to visit the hospital multiple times, where I have been diagnosed with irritable bowel syndrome, which has caused me anxiety for seven months.
I would like to know how you would assess my situation and any recommendations you might have.
Thank you, Director.

Niming, 10~19 year old female. Ask Date: 2024/03/03

Dr. Chen Shidian reply Gastroenterology and Hepatology

If a colonoscopy can rule out anxiety, I do not oppose getting the examination done.
I maintain a regular routine, eat a balanced diet, and engage in moderate exercise.

Reply Date: 2024/03/03

More Info

Understanding bowel issues can be quite complex, especially when symptoms persist over an extended period. Based on the symptoms you've described, it appears that you may be experiencing a combination of gastrointestinal issues, potentially including irritable bowel syndrome (IBS) and constipation-related complications. Let's break down your symptoms and the possible underlying conditions, as well as discuss diagnostic approaches and treatment options.

Symptoms Overview
1. Infrequent Bowel Movements: You mentioned having bowel movements every 2-4 weeks, which is significantly less than the normal frequency (typically 1-3 times per day). This can indicate constipation, which can lead to discomfort and other complications.

2. Mucus in Stool: The presence of mucus in your stool can be a sign of irritation in the intestines. While some mucus is normal, excessive amounts can indicate underlying issues such as inflammation or infection.

3. Abdominal Pain and Hard Masses: The hard, immovable lumps you feel in your abdomen could be fecal impaction, which occurs when stool becomes hard and difficult to pass. This can lead to significant discomfort and may require medical intervention.

4. Blood in Stool: The occasional presence of blood in your stool is concerning and should always be evaluated further, even if initial tests come back normal. It could indicate hemorrhoids, anal fissures, or more serious conditions like inflammatory bowel disease (IBD) or colorectal cancer.

5. Weight Fluctuations: Unintentional weight loss can be a red flag for gastrointestinal disorders. While your weight has stabilized recently, the initial drop could indicate malabsorption or other metabolic issues.

Possible Diagnoses
Given your symptoms, several conditions could be at play:
- Irritable Bowel Syndrome (IBS): This functional gastrointestinal disorder is characterized by abdominal pain and altered bowel habits, including constipation and diarrhea. IBS can be triggered by stress, diet, and other lifestyle factors.

- Constipation: Chronic constipation can lead to fecal impaction, which may explain the hard lumps you feel in your abdomen. It can also cause discomfort and bloating.

- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause symptoms similar to yours, including abdominal pain, mucus in stool, and weight loss. These conditions often require more extensive testing, such as colonoscopy.

- Colorectal Issues: Given the presence of blood in your stool, it’s essential to rule out any serious conditions, including polyps or cancer, especially if you have risk factors or a family history.

Diagnostic Approach
1. Medical History and Physical Examination: A thorough history and physical exam are crucial. Your doctor will assess your symptoms, dietary habits, and any stressors in your life.

2. Laboratory Tests: Blood tests and stool tests can help rule out infections, inflammation, and other metabolic issues.

3. Imaging Studies: X-rays, ultrasounds, or CT scans may be used to visualize the intestines and identify any obstructions or abnormalities.

4. Endoscopy: If necessary, procedures like colonoscopy can provide direct visualization of the colon and rectum, allowing for biopsy if needed.

Treatment Options
1. Dietary Modifications: Increasing fiber intake can help alleviate constipation. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying hydrated is also essential.

2. Medications: Laxatives may be prescribed to relieve constipation, while medications for IBS can help manage symptoms. Probiotics may also be beneficial for gut health.

3. Stress Management: Since stress can exacerbate IBS symptoms, techniques such as mindfulness, yoga, or therapy may be helpful.

4. Regular Follow-ups: Given the complexity of your symptoms, regular follow-ups with your healthcare provider are essential to monitor your condition and adjust treatment as necessary.

Conclusion
Your symptoms warrant a comprehensive evaluation to rule out serious conditions and to develop an effective treatment plan. It’s crucial to communicate openly with your healthcare provider about your concerns, especially regarding the blood in your stool and any persistent abdominal pain. Early intervention can lead to better management of your symptoms and overall health.

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