IBS Recurrence: Symptoms, Diagnosis, and Management

Q: IBS Recurrence: Symptoms, Diagnosis, and Management

Reply： Hello, <br>1. <br>The definition of Irritable Bowel Syndrome (IBS) is characterized by diarrhea or constipation, accompanied by abdominal pain and bloating, occurring frequently and being chronic or recurrent. <br>A diagnosis can be confirmed only after gastrointestinal or

Is it a recurrence of irritable bowel syndrome?

Hello Dr.
Chen, I am Xiao Ming, who asked a question on April 22.
I have been experiencing persistent issues with constipation and abdominal bloating, so I returned to the gastroenterology department for a consultation.
The doctor prescribed laxatives for me, but after taking them, I experienced diarrhea.
However, once I stopped the medication, I faced constipation again.
This led to a diagnosis of Irritable Bowel Syndrome (IBS).
The doctor decided to focus on the constipation issue and prescribed Fludiazepam, Magaldrate, and Cisapride.
After taking these medications for over a month and following a regular, light diet, my constipation and bloating issues were resolved, around the end of May.

Starting in June, due to a busy schedule and being away from home, I began to have irregular meals and started drinking coffee again, which led to mild abdominal bloating.
By July, the symptoms worsened, with constipation (the stool was loose and coffee-colored), bloating, gastric distension, and a sensation of food or gastric acid refluxing into my mouth when lying flat at night.
During my follow-up visit, a different doctor examined my abdomen and noted that the sounds were not indicative of gas.
He suggested a colonoscopy or another type of examination, but due to my previous allergic reaction to iodine during a cardiac catheterization (which I underwent two years ago for complete repair of Tetralogy of Fallot), where I experienced respiratory difficulties and required an oxygen mask, the doctor opted for a stool test instead.
The medications prescribed before the test were Domperidone, Magaldrate, Sennoside A+B calcium, and Lactobacillus casei.
I have a few questions (please refer to our Q&A from April 22):
1.
Based on your experience, do you think my condition from late April to the end of May was indeed Irritable Bowel Syndrome? If so, could the current symptoms of "constipation, bloating, gastric distension, and the sensation of food or gastric acid refluxing into my mouth at night" indicate a recurrence of IBS? Additionally, could the current medications (which seem to include laxatives) exacerbate the sensitivity of the colon?
2.
If the current condition is not a recurrence of IBS, what other potential diagnoses do you think could be possible? If it is difficult to determine at this time, what kind of tests would you recommend?
3.
If the gastric and colonic distension is not due to gas, what else could be causing it?
4.
Besides maintaining a light and regular diet, what else can I do to help myself?

Xiao Ming, 20~29 year old female. Ask Date: 2004/07/18

Dr. Chen Zhiping reply Gastroenterology and Hepatology

Reply: Hello,
1.
The definition of Irritable Bowel Syndrome (IBS) is characterized by diarrhea or constipation, accompanied by abdominal pain and bloating, occurring frequently and being chronic or recurrent.
A diagnosis can be confirmed only after gastrointestinal or abdominal ultrasound examinations show no organic lesions that could explain the symptoms.
Your symptoms may suggest IBS, but since the duration is too short, it is premature to draw conclusions.
It is advisable to undergo a colon examination (barium study or colonoscopy) to rule out any colonic lesions.
If there are symptoms of acid reflux, an upper endoscopy may also be necessary to check for conditions such as gastroesophageal reflux disease (GERD).
2.
A barium study, upper endoscopy, or colonoscopy is not related to your iodine allergy, unless your cardiac condition is severely compromised or you are experiencing significant shortness of breath; in such cases, these tests may not be advisable.
Generally, they should be acceptable.
3.
"Gastrointestinal bloating" is typically due to gas or the presence of food and stool.
If it is not gas-related, it may still be due to poor bowel movements.
Additionally, an abdominal ultrasound can help identify any issues outside the intestines, such as ascites.
4.
Currently, medications should be able to address your symptoms, but it is best to confirm that there are no underlying issues.
If no problems are found, it can provide peace of mind.
5.
Maintain a light and regular diet, avoid spicy foods, and try not to lead a stressful or busy life; avoid anxiety.
Sincerely, Dr.
Chen Chi-Ping

Reply Date: 2004/07/18

More Info

Understanding Irritable Bowel Syndrome (IBS) and its recurrence can be quite complex, especially when symptoms fluctuate and overlap with other gastrointestinal disorders. Based on the information provided, it seems that you have been experiencing a range of symptoms that could indeed be indicative of IBS, but there are also other factors to consider.

1. Diagnosis of IBS
From your description, it appears that your symptoms of bowel irregularity, abdominal bloating, and discomfort align with the criteria for IBS. IBS is characterized by a combination of abdominal pain and altered bowel habits, which can include diarrhea, constipation, or a mix of both. The fact that your symptoms improved with medication and dietary adjustments suggests that IBS could be a valid diagnosis. However, it is essential to rule out other potential gastrointestinal conditions, especially given your history of gastrointestinal issues and the recent exacerbation of symptoms.

2. Recurrence of Symptoms
The recurrence of your symptoms, particularly after a period of improvement, raises the question of whether IBS is indeed the underlying issue or if another condition is contributing to your discomfort. The symptoms you describe, such as feeling food or acid reflux while lying down, could indicate gastroesophageal reflux disease (GERD) in addition to IBS. Stress, irregular eating habits, and caffeine consumption can exacerbate both IBS and GERD symptoms.

3. Medication and Sensitivity
Regarding the medications you are currently taking, it is important to understand how they interact with your gastrointestinal system. Medications like Domperidone and Magaldrate can help with motility and reduce acid, respectively, but they may not directly address the underlying sensitivity of the bowel associated with IBS. In some cases, medications intended to alleviate symptoms can lead to increased sensitivity or altered bowel function, particularly if they are not tailored to your specific needs.

4. Further Investigations
If your symptoms persist or worsen, further investigations may be warranted. While your previous tests, including a colonoscopy, have ruled out significant pathology, it may be beneficial to consider additional tests to evaluate for conditions like small intestinal bacterial overgrowth (SIBO) or food intolerances, which can mimic or exacerbate IBS symptoms. A breath test for SIBO or an elimination diet could provide insights into whether specific foods are triggering your symptoms.

5. Non-Pharmacological Management
In addition to medication and dietary adjustments, there are several strategies you can employ to manage your symptoms effectively:
- Stress Management: Since stress can significantly impact IBS symptoms, incorporating relaxation techniques such as mindfulness, yoga, or meditation can be beneficial.

- Regular Exercise: Engaging in regular physical activity can help improve bowel function and reduce stress.

- Dietary Modifications: Continuing to follow a low-FODMAP diet or identifying specific food triggers through an elimination diet can help manage symptoms. Keeping a food diary may assist in recognizing patterns related to your symptoms.

- Hydration: Ensure you are adequately hydrated, as this can influence bowel regularity and overall digestive health.

Conclusion
In summary, while your symptoms are consistent with IBS, the recurrence and nature of your symptoms suggest that a comprehensive approach is necessary. This includes careful monitoring of your diet, lifestyle changes, and possibly further testing to rule out other conditions. Collaboration with your healthcare provider to tailor your treatment plan based on your specific symptoms and responses to medications will be crucial in managing your condition effectively. Always communicate openly with your healthcare team about any changes in your symptoms or concerns you may have.

Similar Q&A

Managing Chronic Diarrhea: Insights on Irritable Bowel Syndrome

I have been experiencing watery stools after every meal for several years. I recently underwent a colonoscopy, and the examination showed no abnormalities in my colon. The doctor diagnosed me with irritable bowel syndrome (IBS). I have been taking medication for a few months, but...

Dr. Chen Qifeng reply Gastroenterology and Hepatology
Hello: Management of Irritable Bowel Syndrome (1) Dietary adjustments: reduce oil, dairy, and irritating foods (2) Medication adjustments: individualized prescriptions (3) Consider trying probiotics or enzymes. Best regards, Dr. Chi-Feng Chen, Taoyuan Hospital, Department of Heal...

Understanding Irritable Bowel Syndrome: Symptoms, Diagnosis, and Management

Definition of Irritable Bowel Syndrome (IBS): It is characterized by abdominal pain or discomfort occurring at least three days per month in the last three months, along with two or more of the following symptoms: (1) relief of symptoms after defecation, (2) change in stool form ...

Dr. Cai Anshun reply Gastroenterology and Hepatology
Hello: For questions regarding a definitive diagnosis, you should discuss them with your attending physician. I often tell my patients that gastrointestinal functional issues are often influenced by psychological factors. Medications only alleviate discomfort symptoms and do not ...

Understanding IBS Symptoms: Is It a Recurrence or Something Else?

Hello Dr. Lin, I previously had issues with irritable bowel syndrome. A little over a week ago, after dinner, I experienced mild pain in my lower left abdomen. Initially, my bowel movements were normal, but later they became mixed with watery stools. Since then, for more than a w...

Dr. Lin Minghui reply Gastroenterology and Hepatology
Hello, patients with irritable bowel syndrome (IBS) often experience symptoms including intermittent abdominal pain, diarrhea after meals, and abdominal discomfort. Some may have increased bowel movements, with stools that can be either solid or watery, or may contain mucus. Ther...

Understanding Causes and Treatments for Irritable Bowel Syndrome (IBS)

Frequent acute abdominal pain and diarrhea occur simultaneously, and sometimes there is a sensation of pain at the distal end of the intestines during bowel movements, similar to the pain of scraping over an injured area. I have previously been diagnosed with Helicobacter pylori ...

Dr. Yang Guojun reply Internal Medicine
Irritable Bowel Syndrome (IBS) accounts for 40% of outpatient visits. This condition has three main characteristics: 1. Recurrent episodes, 2. Patients have seen many doctors without improvement, 3. Patients have undergone numerous tests (such as gastroscopy and ultrasound) that ...