Gastrointestinal Issues: Symptoms and Concerns Explained

Gastrointestinal issues

Hello, Dr.
Ke.
I recently asked about the issue of positive fecal occult blood and would like to inquire about it along with my symptoms.
I apologize for the lengthy message.
About a month ago, I started experiencing a dull, stabbing pain in my lower abdomen.
Since I had a break from work and often suffer from stomach pain and bloating, I noticed traces of blood in my stool.
Unsure of which specialist to see, I initially visited a family medicine clinic.
I explained my symptoms to the doctor: I have chronic stomach pain and bloating, with bowel movements occurring at least 40 times a day, and I also noticed blood in my stool.
Additionally, I suddenly experienced constipation for over three months.
Initially, I thought the blood was due to constipation, so I did not seek medical attention.
The family medicine physician arranged for me to undergo immunochemical and chemical tests.
A week later, when I returned to the hospital for the results, the doctor informed me that both tests were positive and recommended that I see a gastroenterologist for a colonoscopy and further evaluation.

During my follow-up appointment, the doctor seemed rushed, possibly because I was number 63 on the list, and spent only about 2-3 minutes with me.
He did not ask about my symptoms and even questioned my fecal occult blood test results, insisting that I repeat the test and return in a month (I was unable to do the second test immediately as I was on my menstrual period).
The second test also returned positive, leading to a colonoscopy and endoscopy, as he suggested there might be issues from my stomach to my colon.
He prescribed several laxatives and stomach medications.
My mother accompanied me, and we were both frustrated by the doctor's skepticism, so we decided not to follow his advice any further.
The next day, I consulted another doctor who prescribed stomach medication and medication for functional bowel spasms, advising me to take them as needed.
He also mentioned that if my symptoms did not improve, I should return to see him soon.
However, my constipation has worsened over the past few days, with bowel movements occurring only once a week, resulting in a weight loss of 2 kg during that week.
The pain in my lower abdomen has changed from occasional stabbing pain to a dull ache, sometimes cramping, and I continue to experience excessive flatulence with audible sounds from my abdomen.
My stools have become quite small, and I also have symptoms of anemia, frequent nausea, and persistent fatigue.
Recently, the abdominal pain has been particularly severe, and I even experience chest pain.
Despite taking the prescribed stomach and bowel spasm medications, my symptoms have only slightly improved.
Given that my grandmother had bile duct cancer and my grandfather had rectal cancer, I am concerned that I might be facing similar issues and would like to consult with you, doctor.
P.S.
I forgot to mention that during the fecal occult blood sampling, I specifically observed that my stool was very small and dark, possibly with dark red blood, but I am not certain.
There was also a white, greasy-looking substance on the surface.

Sen Sen, 10~19 year old female. Ask Date: 2016/01/04

Dr. Ke Fangxu reply Surgery

The likelihood of developing colorectal cancer at the age of 18 is not zero, but it is generally very low.
Based on your description, the probability of irritable bowel syndrome (IBS) seems higher.
It is recommended to start with a light diet and maintain a good lifestyle.
If symptoms persist without improvement, you can ask a physician for medication.
If there is still no improvement or if you are very concerned, a colonoscopy can be arranged.
Additionally, a fecal occult blood test can yield positive results not only due to malignant tumors but also due to bleeding from hemorrhoids.
For patients this young, we typically prioritize medication treatment.
If the response to treatment is poor, arranging for an endoscopic examination is also an option.

Reply Date: 2016/01/04

More Info

Understanding gastrointestinal issues can be quite complex, especially when multiple symptoms are present. Based on the symptoms you've described, it seems you are experiencing a combination of abdominal pain, changes in bowel habits, and the presence of blood in your stool, which can understandably be concerning.

Firstly, the symptoms of abdominal pain, bloating, and changes in bowel habits (such as constipation and the presence of blood) can be indicative of several gastrointestinal conditions. Given your family history of colorectal cancer and your own symptoms, it is essential to approach this situation with caution.

1. Abdominal Pain and Bloating: These symptoms can be associated with various conditions, including irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or even functional gastrointestinal disorders. IBS is particularly common and can cause abdominal discomfort, bloating, and changes in bowel habits without any identifiable structural abnormalities.

2. Blood in Stool: The presence of blood, especially if it appears dark red or mixed with stool, can be alarming. It could indicate several issues ranging from hemorrhoids, anal fissures, or more serious conditions such as diverticulosis, polyps, or even malignancies. Given your family history, it is crucial to investigate this further.

3. Constipation: Chronic constipation can lead to straining during bowel movements, which may cause small tears in the anal lining (fissures) that can bleed. However, if constipation is accompanied by significant abdominal pain and blood, it warrants further evaluation.

4. Fatigue and Anemia: Your mention of fatigue and anemia is particularly concerning. Blood loss from the gastrointestinal tract can lead to anemia, which can cause fatigue and weakness. This is a sign that your body may not be getting enough oxygen due to a lack of red blood cells.

5. Next Steps: It is essential to follow up with a gastroenterologist who can perform a thorough evaluation, including a colonoscopy and possibly an upper endoscopy. These procedures can help visualize the gastrointestinal tract and identify any abnormalities such as polyps, ulcers, or signs of inflammation.

6. Diet and Lifestyle Modifications: While awaiting further evaluation, consider keeping a food diary to track what you eat and any symptoms that follow. This can help identify potential dietary triggers. A diet low in processed foods and high in fiber can help with bowel regularity. Staying hydrated and incorporating regular physical activity can also aid in digestion.

7. Mental Health Considerations: Chronic gastrointestinal issues can also lead to anxiety and stress, which can exacerbate symptoms. It may be beneficial to explore stress-reduction techniques such as mindfulness, yoga, or counseling.

In summary, while your symptoms may point towards a functional gastrointestinal disorder like IBS, the presence of blood in your stool and your family history necessitate a thorough investigation to rule out more serious conditions. It is crucial to communicate openly with your healthcare providers about your symptoms and concerns, ensuring that you receive the appropriate care and follow-up. Your health is paramount, and addressing these symptoms early can lead to better outcomes.

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