Diarrhea and Constipation: Insights on Gastrointestinal Health

Diarrhea and constipation?

Hello doctor, I underwent a colonoscopy around May to July last year due to frequent diarrhea, which had a yellow, muddy consistency and lasted for over six months.
After the colonoscopy, the doctor said there were no issues, but the diarrhea persisted.
The doctor diagnosed me with irritable bowel syndrome (IBS) and prescribed medication, including antacids and anti-diarrheal drugs.
After taking the medication for a while, my diarrhea improved, and I experienced fewer episodes of muddy stools.
However, I then developed some constipation, with the initial part of my stool being hard and dark, but the rest appeared normal.

I was quite overweight last year at 137 pounds, but I started exercising and have reduced my weight to 123 pounds this year.
However, last week I experienced two instances of fresh blood during bowel movements.
I am unsure if this is due to anal fissures or another condition.
After the first episode of bleeding, I did not see blood during subsequent bowel movements.
A couple of days later, my stool was again hard and dark at the beginning, and I noticed fresh blood again, but it was only on the tip of the stool and not mixed in with it.
Since my stools have improved from the muddy consistency, I have experienced some constipation; previously, when my stools were muddy, I would go to the bathroom 1-3 times a day, but now, with normal-shaped stools, I only go about once every 1-3 days.
Additionally, my stools have a very foul odor, somewhat similar to a rotten smell.

Could this indicate a problem with my colon or my stomach? The doctor did not perform an endoscopy last year, only a colonoscopy, but do my symptoms relate to my stomach? I had a history of gastric ulcers, and I am concerned about my fluctuating weight, as it varies between 122 and 124 pounds upon waking.
Could you please help me analyze this?

Mr. Li, 30~39 year old female. Ask Date: 2024/03/26

Dr. Xu Kaixi reply Surgery

The characteristics of stool can vary with diet and lifestyle habits.
If you had a colonoscopy last year that showed no abnormalities, there is no need to worry about changes in stool characteristics being related to colon issues.
However, it cannot be ruled out that these changes may be associated with gastric problems, such as inflammation or gastric ulcers, especially considering your previous history of gastric ulcers.
It would be advisable to consult a gastroenterologist to evaluate whether you need to undergo an upper endoscopy.

Reply Date: 2024/03/26

More Info

Understanding gastrointestinal health, particularly issues like diarrhea and constipation, can be quite complex, especially when symptoms are persistent and multifaceted. Based on your description, it appears that you have been experiencing a range of gastrointestinal symptoms, including diarrhea, constipation, and rectal bleeding, which can be concerning.

Firstly, it's important to note that your history of diarrhea resembling "muddy" stools for an extended period, followed by a diagnosis of irritable bowel syndrome (IBS), suggests that your gastrointestinal tract has been sensitive and reactive. IBS is a functional gastrointestinal disorder characterized by symptoms like abdominal pain, bloating, and altered bowel habits, which can include both diarrhea and constipation. The fact that you have experienced a shift from diarrhea to constipation indicates a common pattern in IBS, where patients may alternate between these two states.

The presence of fresh blood in your stool, especially if it appears only on the surface of the stool and is not mixed in, raises the possibility of a few conditions. One common cause could be an anal fissure, which is a small tear in the lining of the anus that can occur due to passing hard stools. This could explain the fresh blood you observed, particularly if your stools have been hard and difficult to pass. However, it is essential to rule out other potential causes of rectal bleeding, such as hemorrhoids or more serious conditions like diverticular disease or colorectal polyps, especially given your history of gastrointestinal issues.

Your mention of foul-smelling stools could also be indicative of malabsorption or an imbalance in gut flora, which can occur in various gastrointestinal disorders. The odor of stools can be influenced by the types of food consumed, the presence of undigested food, or an overgrowth of bacteria in the intestines.

Regarding your weight fluctuations, it is not uncommon for individuals with gastrointestinal disorders to experience changes in weight due to alterations in appetite, dietary habits, and the body's ability to absorb nutrients. The fact that you have lost weight through exercise is generally positive, but the variability in your weight can be concerning, especially if it is accompanied by gastrointestinal symptoms.

Given your history of a peptic ulcer, it is also worth considering that your stomach may still be sensitive, and any changes in your diet or stress levels could exacerbate symptoms. While you have not undergone an upper endoscopy (gastroscopy), it may be beneficial to discuss this with your healthcare provider, especially if you continue to experience abdominal pain or other gastrointestinal symptoms.

In summary, your symptoms suggest a complex interplay of IBS, potential anal fissures, and possibly other gastrointestinal issues. It is crucial to maintain open communication with your healthcare provider, who may recommend further diagnostic testing, including a gastroscopy, to evaluate your upper gastrointestinal tract. Additionally, dietary adjustments, stress management, and possibly a referral to a gastroenterologist for specialized care may be beneficial in managing your symptoms effectively. Regular follow-ups and monitoring of your symptoms will be essential in ensuring your gastrointestinal health is maintained.

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