Nighttime Abdominal Bloating and Gastrointestinal Discomfort

Gastrointestinal discomfort with a sensation of bloating in the lower abdomen at night?

Hello, Doctor.
Since I was young, I have had the habit of wanting to use the restroom after eating, approximately 2-3 times a day: once in the morning and 1-2 times in the afternoon or evening.
In September 2013, I experienced groin and lower abdominal pain, and I consulted with the colorectal department at Shou Tuo Hospital.
I underwent tests for occult blood in the stool and a barium enema, both of which returned negative results.
The doctor also indicated that there were no abnormalities in the imaging studies.
Subsequently, my abdominal pain alleviated, and I was advised to monitor my condition.
In November 2013, I underwent a full-body health check, but did not have a colonoscopy; only stool tests and antigen screening were performed, all of which were normal.
After that, my gastrointestinal condition remained relatively normal without discomfort.
In February to March 2015, I began treatment for sinusitis and took antibiotics for over a month, after which I started experiencing gastrointestinal discomfort, including increased stomach acid and stomach pain.
This later improved, but I began to feel discomfort in my intestines.
During the holiday season, I experienced severe constipation with hard, dark stools that I could not pass despite straining.
I eventually had to assist with my finger, which was the only time I recall this happening, and I noticed a small amount of red blood on the surface.
However, I did not see any blood afterward, and I have not experienced severe constipation since.
My bowel movements became more regular, occurring once a day with a large volume.
From June to September, I gradually began to feel bloated in my stomach and lower abdomen after eating.
Walking helped alleviate the discomfort, but wearing tight pants or sitting for long periods sometimes increased the bloating and pain.
Occasionally, I would experience sharp, cramping pain in my lower abdomen and groin, which was not persistent but would come and go frequently.
When I wore tighter clothing or felt stressed, the abdominal bloating and pain became more pronounced.
In the mornings, before using the restroom, my lower abdomen would sometimes feel slightly bloated and crampy, but this would alleviate after a smooth bowel movement.
My bowel movements are generally smooth, expelling yesterday's stool, which is mostly a light yellow color and well-formed at the front, with some twisting or less formed sections in the middle to back.
Occasionally, I pass mucus, which can be either dry and hard at the front and wet and soft at the back, or in a mucus-like state.
The mucus can sometimes be thin and yellow or white and transparent, and at times it is thicker.
When my lower abdomen is bloated, I also frequently pass gas, which does not have a strong odor, but I can pass gas 10-20 times a day.
Recently, I have noticed more mucus, typically after breakfast and in the early afternoon, and sometimes I feel an urge to pass what I had for breakfast.
However, in the evening and at night, I experience bloating but find it difficult to pass gas, even with straining.
Mornings are usually very smooth.
I consulted at a general clinic, where they suggested that my gastrointestinal function might be weak and my activity level low.
They recommended dietary adjustments and increased physical activity.
I was also advised to manage my irritability and consider medication.
After adjusting my diet and exercise, the cramping before bowel movements has improved, and the intermittent sharp pain in my abdomen has lessened, though it still occurs occasionally.
Sometimes, after massaging my abdomen, I feel the intestines moving, which alleviates the bloating.
My daily pattern is mostly consistent: smooth in the morning and tighter at night.
I would like to ask for your advice regarding my current situation, as I did not experience these issues in the past, and this recent condition has been troubling me.
Two years ago, all tests were normal, but I am still worried that there may be some underlying pathology.
Thank you.

Marsian, 30~39 year old female. Ask Date: 2015/09/09

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, based on the medical history and symptoms, the likelihood of irritable bowel syndrome with constipation is the highest.
Of course, occasional rectal bleeding may be due to hemorrhoids.
It is recommended to reduce oil, dairy, and irritating foods, and to increase water intake and consume a diet rich in fruits and vegetables.
Avoid rushing during bowel movements; take more time to ensure proper elimination, and consider abdominal massage as an aid.
If there is still no improvement, it is advisable to consult a gastroenterologist or a colorectal surgeon.
Sincerely, Dr.
Chi-Feng Chen, Attending Physician, Department of Gastroenterology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2015/09/09

More Info

Based on your detailed description of your gastrointestinal symptoms, it appears that you are experiencing a combination of abdominal bloating, discomfort, and irregular bowel habits, which can be quite distressing. Your history of gastrointestinal issues, including previous examinations that yielded normal results, suggests that your symptoms may be related to functional gastrointestinal disorders rather than structural problems.

Understanding Your Symptoms
1. Bloating and Discomfort: The sensation of bloating after eating, particularly if it improves with movement, is often associated with functional gastrointestinal disorders such as Irritable Bowel Syndrome (IBS). IBS can cause symptoms like abdominal pain, bloating, and changes in bowel habits, including diarrhea and constipation. The fact that your symptoms are exacerbated by tight clothing or prolonged sitting may indicate that they are related to increased intra-abdominal pressure or reduced gastrointestinal motility.

2. Bowel Habits: Your bowel habits, which include frequent bowel movements and occasional mucus in the stool, can also be indicative of IBS. The presence of mucus can be a normal finding in IBS, but it can also be associated with other conditions, so it’s important to monitor any changes in your stool characteristics.

3. Pain and Discomfort: The intermittent sharp or cramping pain you describe, particularly in the lower abdomen and groin area, could be related to bowel spasms, which are common in IBS. The fact that this pain resolves after a bowel movement is also consistent with this diagnosis.

4. Diet and Lifestyle Factors: Your history of dietary changes, including increased consumption of certain foods and irregular eating patterns, may contribute to your symptoms. Foods that are high in fat, sugar, or fiber can exacerbate bloating and discomfort, especially if consumed in large quantities or if you have developed sensitivities to certain ingredients.

5. Emotional Stress: Stress and anxiety can significantly impact gastrointestinal function. Your mention of feeling "impatient" and having a tendency toward irritability may suggest that stress is playing a role in your symptoms. The gut-brain connection is well-established, and emotional well-being can influence gastrointestinal health.

Recommendations
1. Dietary Modifications: Consider keeping a food diary to identify any potential triggers for your symptoms. Gradually eliminate foods that may cause bloating, such as dairy, gluten, or high-FODMAP foods, and observe any changes in your symptoms. Incorporating more fiber gradually can help regulate bowel movements, but be cautious of sudden increases in fiber intake, as this can worsen bloating.

2. Regular Physical Activity: Engaging in regular exercise can help improve gastrointestinal motility and reduce symptoms of bloating and discomfort. Aim for at least 30 minutes of moderate exercise most days of the week.

3. Stress Management: Techniques such as mindfulness, yoga, or cognitive behavioral therapy can help manage stress and anxiety, which may, in turn, alleviate some of your gastrointestinal symptoms.

4. Medical Evaluation: Since you have a history of gastrointestinal issues and have experienced changes in your symptoms, it may be beneficial to follow up with a gastroenterologist. They may recommend further testing, such as a colonoscopy, to rule out any underlying conditions, especially if you notice any alarming symptoms such as significant changes in bowel habits, persistent abdominal pain, or blood in the stool.

5. Medication: If your symptoms persist, discussing the possibility of medications that target IBS symptoms, such as antispasmodics or laxatives, with your healthcare provider may be beneficial.

Conclusion
Your symptoms are complex and multifactorial, and while they may be indicative of a functional gastrointestinal disorder like IBS, it is essential to continue monitoring your condition and seek medical advice if your symptoms change or worsen. Maintaining a healthy lifestyle, managing stress, and being mindful of your diet can significantly improve your quality of life. If you have any concerns about serious underlying conditions, do not hesitate to consult with a healthcare professional for further evaluation and guidance.

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