Managing Bloating and Constipation: Insights for Young Adults

Bloating and constipation issues?

Hello Dr.
Ke, I am 19 years old and have been experiencing issues with irritable bowel syndrome and bloating, but they haven't been too severe, so I haven't paid much attention to them.
When I was in sixth grade, I was diagnosed with a longer and twisted intestine (through a procedure similar to a colonoscopy with a white contrast agent), but the doctor told me it was not a concern and diagnosed me with irritable bowel syndrome, prescribing medication that I stopped taking in the second year of junior high.
Now, about five years later, I still occasionally have gastrointestinal issues such as bloating and abdominal pain.
In early October of this year, I experienced bloating that initially wasn't severe but eventually developed into pain in the lower right abdomen, prompting me to visit a clinic.
The clinic doctor suspected appendicitis and referred me to the emergency department of a larger hospital.
X-rays and ultrasounds did not reveal any issues, and I also underwent an enema.
After the enema, I felt somewhat relieved, but after being discharged, I noticed an increasing tendency towards constipation and worsening bloating.
I returned to the clinic, where the doctor prescribed laxatives and anti-bloating medication, but after about a week, I only had one bowel movement (which was due to the laxative).
Now, I have stopped taking the medication for about two weeks, and I am completely unable to have bowel movements or pass gas (although I exercise regularly, consume a lot of fruits and vegetables, and drink plenty of water).
Dr.
Ke, do you have any suggestions to improve these symptoms? Thank you for taking the time to respond!

Wu, 10~19 year old female. Ask Date: 2015/11/24

Dr. Ke Fangxu reply Surgery

Chronic constipation in young women is a common issue.
It is generally recommended to maintain good lifestyle and dietary habits; however, many patients report that these measures are ineffective.
Consequently, they often resort to medications to assist with bowel movements.
The first-line treatment typically involves the use of fiber supplements, which most patients find to be effective.
Over time, they can attempt to gradually reduce the dosage of these medications.
If a patient has been using a significant amount of medication without relief, it may be necessary to evaluate for abnormal colonic motility.
In rare cases, partial colectomy may be considered, but most patients experience improvement in their symptoms as they age, so physicians usually do not recommend this option.

Reply Date: 2015/11/24

More Info

Managing bloating and constipation can be particularly challenging for young adults, especially when dealing with underlying conditions like irritable bowel syndrome (IBS) and anatomical variations such as a longer or curved colon. Your experience highlights a common struggle among individuals with gastrointestinal issues, and it's important to approach this with a comprehensive strategy.

Firstly, it's essential to understand that IBS can manifest in various ways, including bloating, constipation, and abdominal pain. The symptoms can be exacerbated by dietary choices, stress, and lifestyle factors. Given your history of IBS and the recent exacerbation of symptoms, it may be beneficial to revisit your dietary habits.
1. Dietary Modifications: Consider adopting a low-FODMAP diet, which has been shown to help many individuals with IBS. FODMAPs are fermentable carbohydrates that can cause bloating and discomfort. Foods high in FODMAPs include certain fruits (like apples and pears), vegetables (like onions and garlic), wheat products, and dairy. By reducing these foods and gradually reintroducing them, you may identify specific triggers for your symptoms.

2. Fiber Intake: While you mentioned consuming a lot of fruits and vegetables, the type of fiber matters. Soluble fiber (found in oats, chia seeds, and psyllium) can help with both constipation and bloating. However, if you're consuming too much insoluble fiber (found in whole grains and some vegetables), it may worsen bloating for some individuals. Aim for a balanced intake of both types of fiber and consider fiber supplements if necessary.

3. Hydration: Staying well-hydrated is crucial, especially when increasing fiber intake. Water helps to soften stool and promote regular bowel movements. Aim for at least 8-10 cups of water daily, adjusting based on your activity level and climate.

4. Physical Activity: Regular exercise can significantly aid digestion and alleviate constipation. Activities like walking, jogging, or yoga can stimulate bowel movements and reduce bloating. Since you mentioned you have a routine, ensure it includes a mix of cardiovascular and strength-training exercises.

5. Stress Management: Stress can exacerbate IBS symptoms. Techniques such as mindfulness, meditation, or yoga can help manage stress levels. Consider incorporating relaxation techniques into your daily routine to see if they positively impact your symptoms.

6. Probiotics: Some individuals find relief from bloating and constipation by taking probiotics, which can help balance gut bacteria. You might want to try a high-quality probiotic supplement or include fermented foods like yogurt, kefir, or sauerkraut in your diet.

7. Medical Consultation: Given the persistence of your symptoms and the recent changes in your bowel habits, it may be wise to consult a gastroenterologist. They can provide further evaluation and may recommend additional tests to rule out other conditions. If medications are necessary, they can tailor a treatment plan specific to your needs.

8. Medication Review: Since you've been prescribed medications for softening stools and reducing bloating, it's essential to discuss their effectiveness with your doctor. If you're experiencing side effects or insufficient relief, your doctor may adjust your treatment plan.

In summary, managing bloating and constipation, especially with a history of IBS, requires a multifaceted approach that includes dietary adjustments, hydration, physical activity, stress management, and possibly medical intervention. It’s crucial to listen to your body and make gradual changes, monitoring how your symptoms respond. If symptoms persist or worsen, seeking professional guidance is essential to ensure proper management and to rule out any serious underlying conditions.

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