Abdominal Pain and Excessive Gas: IBS or Something Else?

Abdominal pain and excessive flatulence?

Hello Doctor, in the past six months, I've noticed an increase in the frequency of passing gas (possibly five to six times an hour).
Recently, I've been experiencing intermittent dull pain in my left abdomen (in the upper left, near the navel, and in the lower left).
I've had a history of constipation since childhood.
Two years ago, I was found to have mild anemia (which was previously normal), and I also underwent a colonoscopy two years ago, which yielded normal results.
After researching my symptoms, they seem to resemble constipation-predominant irritable bowel syndrome.
I would like to know your assessment, Doctor.
Could there be other causes for the anemia? Do I need to undergo further examinations? Thank you very much.

Gao, 20~29 year old female. Ask Date: 2016/01/23

Dr. Yang Zhichao reply Gastroenterology and Hepatology

Dear Miss Gao, your symptoms of pain may be related to possible constipation, and it could also be indicative of constipation-predominant irritable bowel syndrome.
However, I recommend first making lifestyle changes, such as increasing physical activity, consuming more fruits, and staying well-hydrated.
If constipation persists, then it may be considered as constipation-predominant irritable bowel syndrome.
Additionally, young women may be at risk for Mediterranean anemia or iron deficiency anemia.
The causes of anemia can be evaluated by a hematologist.
Thank you for your inquiry.
Changhua Hospital cares about your health.

Reply Date: 2016/01/23

More Info

Abdominal pain and excessive gas can indeed be indicative of various gastrointestinal issues, including Irritable Bowel Syndrome (IBS), particularly the constipation-predominant type. Your symptoms of frequent gas, abdominal pain in different areas, and a long history of constipation align with common presentations of IBS. IBS is a functional gastrointestinal disorder characterized by a combination of symptoms, including abdominal pain, bloating, and altered bowel habits, without any identifiable structural abnormalities.

The excessive gas you are experiencing could be due to several factors. One common cause is the consumption of certain foods that are known to produce gas, such as beans, lentils, carbonated beverages, and certain vegetables like broccoli and cabbage. Additionally, swallowing air while eating or drinking can contribute to increased gas production. It's also important to consider your eating habits; eating too quickly or while talking can lead to swallowing air, which may exacerbate your symptoms.

Your history of constipation is particularly relevant. Chronic constipation can lead to a buildup of stool in the intestines, which can cause discomfort and pain. When stool is hard and difficult to pass, it can lead to straining during bowel movements, which may result in abdominal pain and a feeling of incomplete evacuation. This can create a cycle where the fear of pain during bowel movements leads to avoidance, further exacerbating constipation.

Regarding your mild anemia, it is essential to investigate the underlying cause. Anemia can result from various factors, including dietary deficiencies (such as iron, vitamin B12, or folate), chronic diseases, or gastrointestinal bleeding. Given that you have had a normal colonoscopy two years ago, it is less likely that there is a significant structural issue, but it may be worthwhile to discuss your anemia with your healthcare provider. They may recommend blood tests to check your iron levels, vitamin B12, and other relevant markers to determine the cause of your anemia.

In terms of further evaluation, if your symptoms persist or worsen, it would be prudent to consult with a gastroenterologist. They may suggest additional tests, such as a hydrogen breath test to assess for lactose intolerance or small intestinal bacterial overgrowth (SIBO), which can also lead to excessive gas and bloating. Additionally, a stool test may be helpful to rule out infections or malabsorption issues.

In the meantime, lifestyle modifications can be beneficial. Increasing your fiber intake gradually can help manage constipation, but be cautious, as too much fiber too quickly can lead to increased gas. Staying hydrated and engaging in regular physical activity can also promote healthy bowel function. Furthermore, consider keeping a food diary to identify any specific foods that may trigger your symptoms.

In summary, your symptoms are consistent with IBS, particularly the constipation-predominant type, and the excessive gas may be related to dietary factors and eating habits. Your anemia warrants further investigation to determine its cause. If your symptoms persist despite dietary changes and lifestyle modifications, seeking further evaluation from a healthcare professional is advisable.

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