Chronic Diarrhea for Four Months: Gastrointestinal Concerns Explained

Having experienced abdominal pain for four months?

Hello Dr.
Chen, I have a few questions I would like to ask you!
1.
I have irritable bowel syndrome (IBS).

2.
My mother had colon cancer while she was pregnant with me and has since passed away.

3.
I have been experiencing diarrhea for four months with no improvement.
It starts with severe pain, and after a long time, I finally have a bowel movement.
My stool is brownish-black and has a sticky consistency, and I am losing weight.
After a bowel movement, I have to wait three weeks to a month before I can go again, and I have not had a normal bowel movement.

4.
I do not eat spicy food, rarely consume fried or heavily salted foods, and I do not drink dairy products (because I have IBS, consuming dairy causes diarrhea).
I have been careful about my diet.

5.
I went to a clinic for a colonoscopy, but the doctor said I am too thin, and the scope could not pass the first bend in my colon (this is very concerning for me).

6.
I used to be constipated, but over time my stools have become smaller, and now they are consistently hard.
I have not had a normal bowel movement, and I am starting to feel a sense of fullness and bloating.

Yongjun, 30~39 year old female. Ask Date: 2015/07/27

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, if there is a family history of colorectal cancer and you have been experiencing diarrhea for four months, it is essential to undergo a colonoscopy.
Only if the results are normal can a diagnosis of irritable bowel syndrome (IBS) be made.
Sincerely, Dr.
Chi-Feng Chen, Attending Physician, Department of Gastroenterology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2015/07/27

More Info

Chronic diarrhea can be a challenging and distressing condition, especially when it persists for an extended period, as you have described. Given your history of irritable bowel syndrome (IBS) and your family history of colorectal cancer, it is essential to approach your symptoms with caution and thoroughness. Here’s a comprehensive explanation of your situation and some recommendations.

1. Understanding Your Symptoms: Chronic diarrhea lasting four months, especially when accompanied by severe abdominal pain, changes in stool consistency, and significant weight loss, warrants a detailed evaluation. The presence of brownish-black stools with mucus can indicate several potential issues, including inflammation, infection, or even a more serious condition like malignancy, particularly given your family history. The fact that you experience pain before bowel movements suggests that there may be underlying gastrointestinal motility issues or inflammation.

2. Irritable Bowel Syndrome (IBS): IBS is a functional gastrointestinal disorder characterized by symptoms like abdominal pain, bloating, and altered bowel habits (diarrhea or constipation). While IBS can cause chronic diarrhea, it is crucial to rule out other conditions that may mimic or exacerbate IBS symptoms. Your avoidance of spicy foods, fried foods, and dairy is a positive step, as these can trigger symptoms in many individuals with IBS. However, the persistence of your symptoms suggests that there may be additional factors at play.

3. Family History of Colorectal Cancer: Given your mother's history of colorectal cancer, it is vital to be vigilant about your gastrointestinal health. While your recent colonoscopy was limited due to anatomical challenges, it is crucial to ensure that no significant lesions or polyps are present. If the colonoscopy could not be completed, you may need to discuss alternative imaging studies, such as a CT colonography or a repeat colonoscopy with a different approach, to ensure thorough evaluation of your colon.

4. Weight Loss and Nutritional Concerns: The weight loss you are experiencing is concerning and could be due to malabsorption, chronic diarrhea, or inadequate caloric intake. It is essential to monitor your nutritional status and consider working with a dietitian who can help you develop a balanced diet that meets your needs while minimizing gastrointestinal symptoms.

5. Further Evaluation: Since your symptoms have not improved and you have significant concerns, further evaluation is warranted. This may include:
- Repeat Colonoscopy: If feasible, to ensure that the entire colon is evaluated.

- Stool Studies: To check for infections, inflammatory markers, or malabsorption issues.

- Blood Tests: To assess for anemia, electrolyte imbalances, or signs of inflammation.

- Imaging Studies: Such as an abdominal ultrasound or CT scan to evaluate for structural abnormalities.

6. Management Strategies: In the meantime, consider the following management strategies:
- Hydration: Ensure you are adequately hydrated, especially if experiencing diarrhea.

- Dietary Adjustments: Continue to avoid known triggers and consider a low-FODMAP diet, which may help reduce IBS symptoms.

- Medications: Depending on your symptoms, medications such as antidiarrheals or medications specifically for IBS may be beneficial. Discuss these options with your healthcare provider.

7. Follow-Up: Regular follow-up with your gastroenterologist is essential to monitor your symptoms, adjust treatment as necessary, and ensure that any potential complications are addressed promptly.

In summary, your chronic diarrhea and associated symptoms require careful evaluation and management, especially considering your family history. It is crucial to work closely with your healthcare provider to determine the best course of action for your specific situation. Don’t hesitate to seek a second opinion or further evaluation if you feel your concerns are not being adequately addressed. Your health and well-being are paramount, and proactive management is key to improving your quality of life.

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