Gastrointestinal Issues: From Blood in Urine to Digestive Disturbances

Regarding gastrointestinal issues..?

Hello, doctor! About a month ago, I noticed blood in my urine.
I went to see a urologist, but the X-ray did not show anything at that time.
The doctor suspected it might be a case of kidney stones.
Later, the doctor arranged for a contrast imaging test and prescribed some medication to help with stone passage.
Initially, I did not experience any side effects from the medication, but after finishing the course, I started to have symptoms like bloating and nausea after meals.
The day before the imaging test, I took a laxative and used a suppository for the first time.
After clearing my bowels, I went for the imaging test the next day.
However, 2 to 3 days later, I still experienced diarrhea, and the food I ate seemed to pass through undigested.
Eventually, my condition improved somewhat, but I started to experience constipation, with less frequent bowel movements that resembled rabbit pellets.
I still had bloating and nausea without much improvement.
I then consulted a gastroenterologist, who diagnosed me with gastroesophageal reflux disease (GERD) after I mentioned that sometimes food would come back up into my throat after eating too much.
Initially, the doctor planned to perform an endoscopy, but after discussing it, we decided to try medication first.
During the course of the medication, my symptoms improved significantly.
After finishing the medication, I still experienced some belching and nausea, but they were less frequent.
My constipation resolved, but now my bowel movements are often loose and mushy, and they break apart when they come into contact with water.
I apologize for the graphic description, but sometimes I can see undigested food, like vegetables, from the previous day.
This has been going on for two weeks, and during this time, I have been eating a lot of vegetables.
I’m unsure of the cause.
Yesterday, I had a black-boned chicken soup, and today my stool was black.
I would like to ask the doctor what might be the reason for this.
As for the blood in my urine, I passed a stone, and the blood in my urine has not reappeared.
I apologize for the lengthy message.

A Jie, 20~29 year old female. Ask Date: 2011/12/04

Dr. Li Yongming reply Gastroenterology and Hepatology

Hello, let's start by analyzing "hematuria." There are many causes for hematuria, with the most common being urinary tract stones, which have an incidence rate of 15% in the population, particularly affecting individuals aged 30 to 50, with a male-to-female ratio of approximately 3:2.
Most urinary stones contain calcium, such as calcium oxalate and calcium phosphate, which appear as white shadows on X-rays.
Some stones are due to metabolic abnormalities, such as uric acid stones, which cannot be seen on X-rays.
When a stone drops into the ureter, it can cause sudden severe flank pain along with gastrointestinal symptoms like nausea, vomiting, and abdominal distension.

The occurrence of urinary stones is related not only to genetic predisposition but also to urinary tract infections, excessive consumption of high-protein foods, certain medications (such as some antacids containing silica), and external factors like insufficient water intake.
Maintaining a regular lifestyle, moderate exercise, and a balanced diet, along with increased water consumption, can help prevent stone recurrence.
Beverages such as coffee, tea, cola, and fruit juices should not be consumed in large quantities over long periods.
Although beer has a diuretic effect that may help expel small stones, it also contains oxalates and uric acid, making it unsuitable for long-term consumption.
Current treatment methods primarily include extracorporeal shock wave lithotripsy and ureteroscopy or cystoscopy for stone removal.
Of course, some individuals may pass small urinary stones on their own after increasing their water intake.
I personally am not familiar with any "medications to help expel stones"; could it be a smooth muscle relaxant used for pain relief? This medication can have side effects such as constipation and may inhibit gastric emptying, leading to gastroesophageal reflux disease.
Subsequently, after consulting a gastroenterologist, you may have been prescribed medications to promote gastric emptying, which alleviated your symptoms of belching and nausea.
However, the physician who was unaware of the prior context (or perhaps you did not inform the gastroenterologist) might have assumed you had chronic habitual constipation and continued to prescribe laxatives, resulting in the passage of large amounts of unformed stool.
As for the recent "black stool," if it resembles unformed stool and appears very dark, similar to tar, please consult a gastroenterologist promptly to arrange for an upper endoscopy to rule out upper gastrointestinal bleeding.
Wishing you peace and joy.

Reply Date: 2011/12/04

More Info

It sounds like you have been experiencing a complex array of gastrointestinal symptoms, including blood in urine, digestive disturbances, and changes in bowel habits. Let's break down your situation and explore potential underlying causes and management strategies.

Firstly, the presence of blood in urine (hematuria) can be indicative of several conditions, including urinary tract infections, kidney stones, or even more serious issues like tumors. Since you mentioned that the blood in your urine resolved after passing a stone, it suggests that the initial cause may have been related to that stone. However, it's essential to follow up with your urologist to ensure that there are no residual issues, such as additional stones or other urinary tract problems.

Regarding your gastrointestinal symptoms, it seems you have experienced a range of issues, including nausea, vomiting, constipation, and diarrhea. These symptoms can often be interrelated, especially when medications are involved. The medications prescribed for kidney stones, particularly those that aid in stone passage, can indeed cause gastrointestinal side effects such as nausea, constipation, or diarrhea. It is not uncommon for patients to experience a shift in bowel habits after starting new medications or after undergoing procedures that require bowel preparation.

You mentioned that after taking a laxative and an enema, you experienced diarrhea, which later transitioned to constipation. This fluctuation can occur as your gastrointestinal tract adjusts to the changes in diet and medication. The fact that your stools have been described as "soft" or "mushy" and sometimes contain undigested food suggests that your digestive system may not be fully breaking down food, which could be due to several factors, including dietary choices, gastrointestinal motility issues, or even the effects of medication.

The black color of your stools after consuming certain foods, such as chicken soup, could be attributed to the presence of iron or other compounds in the food that can darken stool color. However, black stools can also indicate the presence of digested blood, which is a sign of upper gastrointestinal bleeding. Given your history of gastrointestinal issues, it would be prudent to monitor this symptom closely. If you notice persistent black stools, especially if accompanied by other symptoms like abdominal pain or changes in appetite, you should seek medical attention promptly.

Your symptoms of gastroesophageal reflux (GERD), where food comes back up into the throat, can also contribute to discomfort and may be exacerbated by certain foods or eating habits. It’s good to hear that your doctor has prescribed medication to help manage this condition. Lifestyle modifications, such as eating smaller meals, avoiding trigger foods, and not lying down immediately after eating, can also be beneficial.

In summary, your gastrointestinal symptoms appear to be multifactorial, potentially influenced by medication, dietary choices, and underlying conditions. It is essential to maintain open communication with your healthcare providers, including your urologist and gastroenterologist, to ensure comprehensive management of your symptoms. Regular follow-ups and possibly further diagnostic testing, such as an upper endoscopy or imaging studies, may be warranted to rule out any significant underlying issues. Additionally, keeping a food diary to track your symptoms in relation to your diet may provide valuable insights for your healthcare team.

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