Chronic Diarrhea and Abdominal Pain: Seeking Medical Advice and Solutions

I have been experiencing diarrhea for a long time..?

Dear Doctor: I have been suffering from chronic diarrhea for many years, occasionally experiencing constipation, but mostly diarrhea.
Recently, this past week, I have been going to the bathroom an average of twice a day, accompanied by abdominal pain, even when I don't feel the urge to go.
My abdomen constantly feels gurgling sounds, especially when I tighten my stomach or take deep breaths.
Despite the ongoing diarrhea, I feel a lot of bloating.
I have been feeling fatigued, and in the mornings, I experience brief dizziness (which I have never had before) along with a sensation of chest tightness.
In mid-February, I went to the emergency room due to unexplained dizziness and vomiting during the Lunar New Year.
The symptoms included only vomiting and fatigue, and I vomited four to five times in one afternoon, eventually bringing up stomach acid and bile.
After the emergency visit, I felt groggy and slept for two days before feeling somewhat better.
I am unsure which specialist I should see or what kind of tests I should undergo.
Could you please provide me with some guidance? Thank you.

ocean, 20~29 year old female. Ask Date: 2005/03/16

Dr. Chen Jingwen reply Internal Medicine

Hello, the symptoms you mentioned in your letter are very similar to Irritable Bowel Syndrome (IBS).
This condition often affects individuals who are prone to anxiety.
If the symptoms are severe, it may be advisable to visit a gastroenterology clinic for medication management.
It is important to learn to control your emotions, maintain a regular lifestyle, and have a balanced diet, as these measures can help improve your symptoms.
Thank you!

Reply Date: 2005/03/16

More Info

Chronic diarrhea and abdominal pain can be distressing symptoms that significantly impact your quality of life. Given your history of long-term diarrhea, abdominal discomfort, and the recent exacerbation of symptoms, it is crucial to approach this situation systematically to identify the underlying cause and determine the appropriate treatment.

Understanding Your Symptoms
1. Chronic Diarrhea: This can be caused by various factors, including infections, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), malabsorption syndromes, or even certain medications. The presence of abdominal pain alongside diarrhea suggests that the gastrointestinal (GI) tract is likely involved.

2. Abdominal Pain: The sensation of gurgling or "water sounds" in the abdomen, especially when you engage your abdominal muscles or take deep breaths, indicates increased intestinal activity. This could be due to irritation or inflammation in the intestines.

3. Bloating: Feeling bloated despite frequent bowel movements can occur in conditions like IBS or food intolerances, where the intestines may not be absorbing nutrients properly, leading to gas and discomfort.

4. Fatigue and Dizziness: These symptoms can be related to dehydration, especially if diarrhea is frequent and severe. Electrolyte imbalances can also contribute to feelings of fatigue and dizziness. The fact that you experienced significant vomiting and fatigue in February suggests that your body may be struggling to maintain proper hydration and nutrient levels.

Recommended Steps
1. Consult a Gastroenterologist: Given the complexity of your symptoms, it would be prudent to see a gastroenterologist. They specialize in digestive disorders and can provide a comprehensive evaluation.

2. Diagnostic Tests: Your doctor may recommend several tests to pinpoint the cause of your symptoms:
- Stool Tests: To check for infections, parasites, or signs of malabsorption.

- Blood Tests: To assess for anemia, electrolyte imbalances, and markers of inflammation.

- Imaging Studies: An abdominal ultrasound or CT scan may be necessary to visualize any structural abnormalities in the GI tract.

- Endoscopy: If indicated, an upper endoscopy or colonoscopy can help visualize the lining of the GI tract and obtain biopsies if needed.

3. Dietary Modifications: Keeping a food diary can help identify any potential food intolerances or triggers. A low-FODMAP diet is often recommended for individuals with IBS, as it can help reduce bloating and diarrhea.

4. Hydration and Electrolyte Management: It is essential to stay hydrated, especially if you are experiencing diarrhea. Oral rehydration solutions can help replenish lost fluids and electrolytes.

5. Stress Management: Since stress can exacerbate GI symptoms, consider incorporating stress-reducing techniques such as mindfulness, yoga, or counseling into your routine.

Conclusion
Chronic diarrhea and abdominal pain warrant a thorough investigation to determine the underlying cause. By consulting a gastroenterologist and undergoing appropriate diagnostic tests, you can work towards finding a solution that alleviates your symptoms and improves your quality of life. It is essential to address these symptoms promptly, especially considering your recent experiences with dizziness and fatigue, which may indicate a need for immediate attention to your hydration and overall health.

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