Gastrointestinal and Rectal Issues: When to Seek Help

Gastrointestinal and rectal issues?

Hello Doctor: From July to October last year, shortly after dinner, I would feel a strong urge to use the bathroom (with semi-diarrhea) about 4 to 5 times a week.
My daily bathroom frequency was once in the morning (normal) and once in the evening.
I sometimes experienced bloating and pain in the lower left abdomen (below the rib cage), mostly when fasting.
In October, I visited the hospital, and the doctor suspected irritable bowel syndrome (IBS).
After taking medication for a few weeks, I saw improvement and underwent a fecal occult blood test, which came back normal (no blood/no bacteria).
However, I had a small bowel movement that morning, so I'm unsure if the test results were accurate.
After stopping the medication, around mid-November, I still experienced the urge to use the bathroom shortly after dinner, but the frequency decreased (about 2 to 3 times a week).
The frequency of bloating and pain in the lower left abdomen also decreased, but I developed a new symptom: itching or a slight foreign body sensation in the anus that lasted about a month, which I managed to avoid touching; the condition has improved significantly.

Currently, my situation is as follows:
- Shortly after dinner, I feel a strong urge to use the bathroom (semi-diarrhea, about 2 times a week).
- Sometimes (when walking or bending over), I feel a nerve sensation (sharp pain) at the end of my buttocks (rectum?) or in the anus.
- There is itching or a slight foreign body sensation in the anus, which after a few days leads to a little blood on the toilet paper after wiping, but then returns to normal (no itching/no foreign body sensation) before recurring.
- After using the bathroom, there is discomfort at the anal opening.
- Occasionally, I experience bloating and pain in the lower left abdomen (mostly when fasting).
- When the stool volume is high, the surface of the stool feels rough or has a coarse texture (very wet, requiring multiple wipes to feel clean); when the stool volume is low, it is dry or thin (crescent-shaped).
Doctor, do you think the above symptoms still fall under irritable bowel syndrome, or could they indicate another condition? Should I see a gastroenterologist or a colorectal surgeon? Is it necessary for me to undergo a colonoscopy? (I want to check but am concerned about wasting medical resources.) Thank you for your patience in understanding my situation!

Mr. Li, 20~29 year old female. Ask Date: 2016/02/17

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello, (1) it is possible that you have irritable bowel syndrome (IBS).
However, it is important to note that the main characteristics of IBS include periodic and recurrent changes, with abdominal pain alleviating after bowel movements, which may be accompanied by constipation or diarrhea, but there will be no weight loss.
As for the necessity of a colonoscopy, a detailed evaluation by a gastroenterologist is recommended.
(2) Symptoms around the anal area may be indicative of hemorrhoids, and you should consult a colorectal specialist for a definitive diagnosis.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2016/02/17

More Info

Based on your detailed description of your gastrointestinal issues, it seems you are experiencing a combination of symptoms that could be indicative of a functional gastrointestinal disorder, such as Irritable Bowel Syndrome (IBS), along with potential anal or rectal issues. Your symptoms, including the urgency to defecate after meals, abdominal pain, and rectal discomfort, suggest that you may be dealing with a complex interplay of gastrointestinal motility issues and possibly some form of inflammation or irritation in the anal region.

Understanding Your Symptoms
1. Postprandial Urgency: The fact that you feel an urgent need to use the bathroom shortly after eating could be related to the gastrocolic reflex, which is a normal physiological response where the stomach signals the colon to empty when food enters the stomach. In individuals with IBS, this reflex can be exaggerated, leading to diarrhea or loose stools.

2. Abdominal Pain: The left lower abdominal pain you describe, particularly when fasting, could be due to gas buildup or spasms in the intestines. This is common in IBS, where the intestines can become overly sensitive and reactive to food intake or stress.

3. Rectal Symptoms: The itching and sensation of a foreign body in the rectal area, along with the occasional blood on toilet paper, could indicate several conditions, including hemorrhoids, anal fissures, or even a mild infection. The presence of blood, even if minimal, should not be ignored, as it can signify underlying issues that may require further investigation.

4. Bowel Movement Characteristics: The variability in your stool consistency—from loose and urgent to dry and narrow—further supports the possibility of IBS, which can cause alternating patterns of diarrhea and constipation.

When to Seek Help
Given your ongoing symptoms and the changes you've experienced, it is advisable to seek further medical evaluation. Here are some considerations:
- Consult a Gastroenterologist: Since your symptoms are primarily gastrointestinal, a visit to a gastroenterologist would be appropriate. They can provide a comprehensive evaluation and determine if further diagnostic tests, such as a colonoscopy, are necessary. A colonoscopy is particularly important if you have concerning symptoms like rectal bleeding or if there is a family history of colorectal cancer.

- Consider a Rectal Examination: A physical examination, including a rectal exam, can help identify issues like hemorrhoids or fissures that may be causing your symptoms.
- Dietary and Lifestyle Modifications: In the meantime, consider keeping a food diary to identify any potential triggers for your symptoms. Dietary adjustments, such as increasing fiber intake, staying hydrated, and avoiding known irritants (like caffeine, alcohol, and spicy foods), can help manage IBS symptoms.

- Medication Review: If you are currently on medication for IBS, discuss with your doctor whether adjustments are needed, especially if your symptoms have changed or worsened.

Conclusion
Your symptoms suggest a complex interplay of gastrointestinal issues that may include IBS and potential anal conditions. It is essential to follow up with a healthcare provider who specializes in gastrointestinal disorders to ensure a thorough evaluation and appropriate management. Early intervention can help prevent complications and improve your quality of life. Remember, it’s always better to err on the side of caution when it comes to gastrointestinal health, especially with symptoms like rectal bleeding.

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