Irritable Bowel Syndrome: Symptoms and Solutions - Gastroenterology and Hepatology

Q: Irritable Bowel Syndrome: Symptoms and Solutions

Hello： It may be necessary to review your examination reports, family history, diet, etc., for further assessment in order to understand your condition. <br>You might need to consult a gastroenterologist for treatment. <br>Wishing you good health.

Long-standing gastrointestinal issues?

Hello, doctor.
I would like to describe my symptoms in detail, which is why I chose to seek help here.
I feel that doctors in general hospitals often do not listen to patients' detailed accounts of their conditions (thinking it takes too much time), which makes me hesitant.
I have irritable bowel syndrome (IBS), and I do have daily bowel movements, but I often experience a sensation of urgency.
In recent years, I have noticed a specific pattern: every morning when I wake up, I feel the urge to have a bowel movement, but I may not go immediately.
The issue arises here: (1) If I have a bowel movement in the morning, I may feel the urge again during lunch or dinner, especially if the food is greasy.
However, if (2) I do not have a bowel movement in the morning, I might not feel the urge after lunch, and I can even hold it until after dinner (though there have been times when I felt no urge at all).

In summary, these two situations occur, and it feels like my stool acts like a "plug" blocking my rectum.
When I have a bowel movement in the morning, the "plug" is removed, and I then feel the urge to go again (as the absence of the "plug" allows for smoother bowel movements).
Conversely, if I do not have a bowel movement in the morning, the "plug" remains, which can block the rectum and reduce the urge to go after meals (due to the obstruction).
If my description is unclear, please imagine two pipes: one has a blockage inside, and the other does not.
When water is poured into both, the pipe without the obstruction (stool) will flow smoothly (leading to an increased urge to have a bowel movement), while the opposite is true for the blocked pipe.
I would like to ask why this happens.
Could it be caused by psychological factors, or is there a related medical condition (name) associated with these symptoms? I have previously undergone examinations that showed no signs of colorectal cancer, and the doctor concluded that it is just IBS (or poor gastrointestinal function).
However, I remember that my body did not behave this way about 5 or 6 years ago, so could it be that long-term psychological factors (such as stress or anxiety) have caused a change in my condition? Thank you.

Kevin, 20~29 year old female. Ask Date: 2013/12/13

Dr. Cai Jinji reply Gastroenterology and Hepatology

Hello: It may be necessary to review your examination reports, family history, diet, etc., for further assessment in order to understand your condition.
You might need to consult a gastroenterologist for treatment.
Wishing you good health.

Reply Date: 2013/12/13

More Info

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder characterized by a combination of symptoms that can significantly impact a person's quality of life. Your description of experiencing frequent urges to defecate, particularly after meals, along with the sensation of having a "plug" in your rectum, aligns with typical IBS symptoms. Let's delve deeper into the nature of IBS, its symptoms, potential causes, and management strategies.

Understanding IBS
IBS is classified as a functional gastrointestinal disorder, meaning that it is diagnosed based on symptoms rather than identifiable structural or biochemical abnormalities. The Rome IV criteria, which are widely used for diagnosing IBS, require that patients experience recurrent abdominal pain, on average, at least one day per week in the last three months, associated with two or more of the following criteria:
1. Related to defecation.

2. Associated with a change in frequency of stool.

3. Associated with a change in the form (appearance) of stool.

Your experience of alternating bowel habits, where you may feel the need to defecate after meals or have a sensation of incomplete evacuation, is common among IBS patients. The "plug" sensation you describe could be related to the way your intestines are responding to food intake and the motility patterns that are altered in IBS.

Symptoms of IBS
The symptoms of IBS can vary widely among individuals but often include:
- Abdominal pain or discomfort.

- Bloating and gas.

- Diarrhea, constipation, or alternating between the two.

- Mucus in the stool.

- A sensation of incomplete evacuation after a bowel movement.

Potential Causes
The exact cause of IBS is not fully understood, but several factors may contribute to its development:
1. Gut Motility: Abnormalities in how the intestines contract can lead to symptoms. For instance, rapid contractions can cause diarrhea, while slow contractions can lead to constipation.

2. Visceral Hypersensitivity: Some individuals with IBS have a heightened sensitivity to sensations in the gut, leading to discomfort or pain.

3. Psychological Factors: Stress, anxiety, and depression can exacerbate IBS symptoms. The gut-brain axis plays a significant role in how stress affects gastrointestinal function.

4. Dietary Triggers: Certain foods, particularly those high in fat or certain carbohydrates (like lactose or gluten), can trigger symptoms in some individuals.

Management Strategies
Managing IBS often requires a multifaceted approach, including dietary modifications, lifestyle changes, and sometimes medication. Here are some strategies that may help:
1. Dietary Changes: Keeping a food diary can help identify specific triggers. Many people with IBS benefit from a low-FODMAP diet, which reduces certain fermentable carbohydrates that can cause bloating and gas.

2. Regular Meal Patterns: Eating smaller, more frequent meals rather than large meals can help regulate bowel movements and reduce symptoms.

3. Stress Management: Techniques such as mindfulness, yoga, and cognitive-behavioral therapy can help manage stress and its impact on IBS.

4. Medications: Depending on your predominant symptoms, your doctor may recommend medications such as antispasmodics for cramping, laxatives for constipation, or anti-diarrheal medications.

5. Probiotics: Some studies suggest that probiotics may help restore gut flora balance and alleviate symptoms in some individuals with IBS.

Conclusion
Your symptoms suggest that you are experiencing a classic case of IBS, which can indeed be influenced by psychological factors such as stress and anxiety. It is essential to work closely with a healthcare provider who understands IBS and can guide you through the diagnostic process and treatment options. Remember, IBS is a manageable condition, and many people find relief through a combination of dietary changes, lifestyle adjustments, and medical treatment. If you have not already done so, consider seeking a gastroenterologist who specializes in functional gastrointestinal disorders for a comprehensive evaluation and tailored management plan.

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