Your Digestive Issues: Is It Irritable Bowel Syndrome?

About diarrhea?

Hello Doctor,
I have a problem where I always need to use the restroom when I get nervous.
At the end of 2013, I had an incident where I really needed to have a bowel movement but held it in while at work.
When I finally went, I had to strain a lot, and I noticed a significant amount of bright red blood, which scared me, so I quickly went to see a doctor.
The doctor advised me to undergo a stool test and a barium enema, not a colonoscopy.
At that time, I didn't realize that a colonoscopy would provide a more comprehensive evaluation.
After the tests, nothing abnormal was found, and my stool was normal.
This was around January 1, 2014.

Since that incident, I often find myself needing to use the restroom at least once in the morning, and sometimes immediately after lunch, I experience watery or loose stools.
In the evenings, I rarely have bowel movements.
On days off, I usually only go in the morning.
This has been happening for over a year now.

Doctor, could this be "irritable bowel syndrome"? I have switched hospitals, and they also suggested stool tests or a colonoscopy.
I have already had a barium enema done.
I am very worried about having some illness, but I also don't want to seek medical help blindly, as those tests are quite uncomfortable.
The main issue is that I often have diarrhea after meals, and I rarely have formed stools, except on days off when I have a better chance of having formed stools.

You, 20~29 year old female. Ask Date: 2015/05/12

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello,
1.
Experiencing frequent diarrhea after eating, with normal findings on a colonoscopy, may indicate irritable bowel syndrome (IBS).
For IBS, it is important to pay attention to your diet by avoiding greasy foods and irritants such as caffeinated beverages and chocolate.
If lactose intolerance is present, limit milk consumption.
Additionally, maintaining a relaxed state of mind can help improve gastrointestinal health.
2.
If there has been a history of bloody stools, in addition to a colonoscopy, it is recommended to undergo a rectal examination to check for issues in the rectum and anus, such as hemorrhoids, polyps, or anal fissures.
Wishing you peace and good health.
Sincerely,
Dr.
Ming-Hui Lin
Attending Physician, Gastroenterology
Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2015/05/12

More Info

Based on your description, it sounds like you may be experiencing symptoms consistent with Irritable Bowel Syndrome (IBS). IBS is a functional gastrointestinal disorder characterized by a combination of abdominal pain and altered bowel habits, which can include diarrhea, constipation, or a mix of both. The symptoms you describe—frequent trips to the bathroom after meals, loose or watery stools, and the presence of blood during bowel movements—are indeed concerning and warrant further investigation.

IBS is often diagnosed based on clinical criteria rather than specific tests. The Rome IV criteria, which is the most recent set of guidelines for diagnosing IBS, states that a diagnosis can be made if a patient has experienced abdominal pain at least one day per week in the last three months, associated with two or more of the following: pain related to bowel movements, a change in frequency of stool, or a change in the form of stool. Your symptoms of urgency and changes in stool consistency align with these criteria.

However, the presence of blood in your stool is a significant red flag. While IBS itself does not typically cause blood in the stool, it is crucial to rule out other potential causes, such as inflammatory bowel disease (IBD), colorectal cancer, or other gastrointestinal issues. The fact that you have undergone a colonoscopy and other imaging studies that returned normal results is reassuring, but it does not completely eliminate the need for vigilance regarding your symptoms.

Given your history of anxiety and the stress-related nature of your symptoms, it is also possible that your IBS may be exacerbated by psychological factors. Stress and anxiety can significantly impact gut function, leading to increased gastrointestinal motility and changes in bowel habits. Therefore, managing stress through relaxation techniques, cognitive behavioral therapy, or other forms of psychological support may be beneficial.

In terms of dietary management, many individuals with IBS find relief by keeping a food diary to identify potential triggers. Common triggers include high-fat foods, dairy products, caffeine, and certain types of carbohydrates known as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols). A low-FODMAP diet, which involves temporarily eliminating these foods and gradually reintroducing them, has been shown to help many patients with IBS.

Additionally, regular physical activity can help improve bowel function and reduce stress levels. Staying hydrated and ensuring adequate fiber intake can also support digestive health, although some individuals with IBS may need to adjust their fiber sources based on their specific symptoms.

In conclusion, while your symptoms may suggest IBS, the presence of blood in your stool and your ongoing concerns warrant a thorough evaluation by a gastroenterologist. They may recommend further testing or a referral to a dietitian or mental health professional to address the multifaceted nature of your condition. It's essential to take your symptoms seriously and seek appropriate care to ensure your overall health and well-being.

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