Gastrointestinal Distress: Insights into IBS and Family Health History

Q: Gastrointestinal Distress: Insights into IBS and Family Health History

Hello： It is not possible to definitively determine whether it is irritable bowel syndrome or cancer. <br>If your only concern is the suspicion of colorectal cancer, and after evaluation by a physician there are no indications for a colonoscopy, you may consider undergoing a scre

Gastrointestinal discomfort

Hello doctors, I am a recent graduate (29 years old this year!).
Before I present my issue, I would like to mention that there is a family history of colorectal cancer (my grandmother passed away from it).
I have informed other doctors about this, and they all said it was too far removed from me (so it doesn't count!).
The reason is that over ten years ago, due to my love for partying, I developed a reversed day-night cycle, which severely affected my health—I often took medication for urticaria, colds, and other issues.
I was afraid of going to the doctor and getting more medications and injections, so I decided to change these bad habits, and my health gradually improved! However, starting last year (while writing my thesis), I sometimes had to stay up late, and my diet became very irregular (sometimes I would skip meals, other times I would binge eat).
Of course, I didn't experience any issues until the day of my oral defense...
until the eve of my graduation when a close family member suddenly fell seriously ill (almost leaving us).
I was scared...
scared of having regrets! During that time, I barely slept for more than ten hours in a week...
(was my body brewing something bad?).
Once the situation stabilized, I quickly returned to normal (with regular sleep and diet).
However, the debts must be paid, right? After pushing myself like this, my body started acting up in September 2015! I was suddenly awakened in my sleep by a sharp pain in my right abdomen (below the rib cage), and I noticed that my breathing was affected (thinking it was late at night, I tried to avoid waking my family, so I held out until morning).
In the morning, I found that the situation seemed okay...
just a bit of diarrhea...
everything else was fine...
so I decided to wait it out until the evening after dinner when I realized the pain hadn't subsided (then I realized dragging this out wasn't a solution and immediately went to a nearby clinic specializing in liver, gallbladder, and gastrointestinal issues).
After I described my situation, the doctor noted that my face wasn't yellow, my limbs had no rashes, and my uric acid test was normal, so he prescribed medication.
After taking the medication for nearly a week, both the diarrhea and the pain disappeared!!! I was happy but unsure if I was truly cured.
I started thinking about maintaining my health (drinking some probiotics advertised on TV).
A few days later...
it suddenly flared up again!!! (I felt like I was back to square one...
I went back to see the doctor, but it seemed the treatment wasn't as effective as before!!! I wondered if there was another issue since the doctor only listened to my description).
So, I found a clinic that had endoscopy and colonoscopy services to continue seeking treatment!!! After the consultation, when I finished explaining, the doctor said I didn't need those tests because my condition was quite obvious.
"Don't you know?" he asked me!!! He showed me a few articles and then used a stethoscope to listen to my abdominal sounds, clearly stating that my issue was Irritable Bowel Syndrome (IBS).
He prescribed a bunch of medications (some for acid reduction, some antidepressants)...
After taking the first dose, I noticed my body reacted abnormally! I felt nauseous at the sight of food, and I was sweating profusely...
My blood pressure was significantly lower than usual, but my heart rate was abnormally high!!! I felt terrible!!! I quickly drank a lot of milk to try to dilute the medication (almost fainted!!!).
I discovered that it was the antidepressants causing this...
Thankfully, I decided to try another clinic at Chang Gung Memorial Hospital's gastroenterology department!!! (I also informed them of my situation).
Coincidentally, my grandmother had her surgery performed by the same doctor there.
The doctor initially said my condition was quite obvious—just IBS.
This time, I thought, after such a long time, it felt like I hadn't received the correct treatment.
I suggested to the doctor whether I could undergo further testing! After agreeing, I had an endoscopy done on the spot, and the results came out immediately! (It was just a matter of taking six pictures).
He said there was no problem! My stomach looked beautiful (but there was a bit too much stomach acid...
he pulled up the photos taken of my stomach to show me! There was slight redness—indicating mild inflammation! He said two weeks of medication would suffice).
I then asked why this happened! Could it be caused by Helicobacter pylori? He said it was possible and drew blood for testing, asking me to return next week for the results!!! When I returned for the follow-up, he told me there was no Helicobacter pylori!!! He told me not to overthink it!!! I thought, since the tests showed no issues, I asked the doctor if I should have a colonoscopy? (I was directly scolded = = for asking me not to joke around!!! He told me that my symptoms were more like hypochondria, thinking too much about problems that weren't there!).
I started taking the medications regularly for two weeks (and my condition really improved...
but a few days later...
it started again...
back and forth!!! I really didn't know what to do! He said the medical help he could provide was limited!!! He continued to prescribe acid reducers, anti-bloating, and general stomach medications for me (as maintenance?).
It has been nearly six months now (although I am still doing well—eating well (my weight is very normal...
at most fluctuating between -2 to +1).
My sleep varies from good to bad!!! During these six months (due to job requirements), I had a pre-employment health check, and I received the report a week after the examination! The highlighted areas were: SGPT (serum alanine aminotransferase): 46 U/L (reference value: 4-44) *I don't know if this was caused by taking stomach medication for over four months before the test! Total Cholesterol: 226 mg/dl (reference value: 130-200) Other: Urine sugar: negative Urine protein: negative Urine blood: negative WBC: 10.43*10^3/cumm (reference value: male: 3.9-10.6) HB: 15 gm/dl (reference value: male: 13.5-17.5) AC Sugar: 81 mg/dl (reference value: 70-110) Creatinine: 1.01 mg/dl (reference value: 0.6-1.3) Triglycerides: 147 mg/dl (reference value: 50-150) HDL: 42 mg/dl (reference value: 36-76) *Height: 166 cm, Weight: 89.5 kg, Waist circumference: 89.5 (ideal male <90 cm), examination date: 2015.11.25.
After this, I visited every Western medicine doctor I could find (I really didn't know what to do), and I started looking for Traditional Chinese Medicine (thinking I could gradually adjust my health).
During this time, my symptoms? I should say it was about the same, but I gradually noticed that prolonged bloating caused my lower back to ache (is this nerve compression?).
After informing the TCM doctor, he also found it strange and said it was similar to IBS (prescribing medicine that felt similar to Western medicine, including acid reducers and digestive aids!).
I started treatment, and after the first week of medication, wow! It seemed to work....
I thought I finally had the right treatment!!! Because! Because! My bowel movements became very normal (just like before, long and colored bright yellow with a slight dark tint, and I had no feelings of lower back pain!!! (no bloating, and my sleep was normal!!! I thought if it was effective, I would continue taking it, so this time I got two weeks' worth of medication.
During this time, I was very normal, then I thought I could stop taking the medication (I left about three packs) and didn't take it.
I maintained this for about 7-10 days! The bloating started again (on the 29th before the Lunar New Year).
I took those three packs in the morning, noon, and night, and returned to normal (maintained for 13 days).
I thought this time I could rely on myself!!! (exercise!!! and willpower to suppress it ><), but contrary to expectations, the bloating did not subside, and at night I felt like I had a bit of stomach cold!!! (I started feeling cold in my hands and feet): no fever, just around 36.2! But in the morning, I noticed new symptoms in my abdomen, sharp pains (on both sides below the navel, and also around the anus @@ and I also started having diarrhea >< not watery, but sticky stools!!! (It felt like this happened when there was too much stomach acid).
Finally, unable to bear it, on February 22, 2016, I went to see a Western doctor to inform him of my current situation.
He started lecturing me, saying it must be because I had an irregular diet during the New Year and ate random things!!! (Okay! You are right! Please help me! He prescribed two weeks' worth of maintenance medication and sent me home.
During the process, I told the doctor that I would often experience bloating at irregular intervals, and this time there would be sharp pains (but not constant, just occasionally).
I gave an example: if you puff your cheeks for half an hour, will it feel prickly? (Okay! I can't argue with you, I will listen to you!!!! I took the medication home.
*I forgot to tell him that my lower back was sore! (Forget it...
it should be the same as before, caused by bloating! Finally, I thought of Western medicine as a lifesaver, after all, Western medications are stronger) and on the way back, I went to see a TCM doctor to get medication (this time I got a month's worth).
This time I told the TCM doctor all my symptoms (because I was afraid of forgetting, I wrote down all the issues before the consultation, informing him where I was uncomfortable and what symptoms I had).
After going home and taking the medication, the next day I woke up (my lower back was sore, but I felt much better! However, my bowel movements, I didn't know how to describe! Because the first stool (I don't know what unit to use) was about 8 cm long (with a diameter of about 3-4 cm), and the color was quite normal, bright yellow with a slight dark tint! But the subsequent stools were all sticky (the color was dark yellow and a bit black).
What does this count as??? About an hour later (after eating), I had another bowel movement (this time it was watery), and in the end, it was also sticky (the color was dark yellow and a bit black).
Summary of symptoms: 1) Abdominal pain sometimes on the right side, sometimes on the left, sometimes radiating to below the navel (it moves around! Now sometimes accompanied by sharp pain).
2) My stomach occasionally rolls! (making sounds), which is probably when the symptoms are about to appear!!! 3) My stomach is often bloated (full of gas), especially when not taking medication (there is also a lot of stomach acid...
sometimes my throat feels uncomfortable and my tongue feels sour? bitter?).
4) After taking the medication, all symptoms can be alleviated (even bowel movements become very normal).
*As described above, during the process of taking TCM, starting around the second week, my bowel movements became completely normal (and they were long and continuous @@ about 10 cm long! And the diameter was also about 3-4 cm) and the color was normal!!! I want to ask the doctors at Chang Gung, based on the symptoms I described, do you still think it is IBS? Can cancer present like this??? Or is this another issue??? (Currently, taking medication improves my condition! If my stomach acid is not excessive, everything is normal! *Excess stomach acid also leads to bloating and burping >< cold hands and feet (is this anemia?) But my weight and everything are very normal @@ (I should say my appetite has always been particularly good @@ two bowls of rice per meal is basic (but since September, I've been afraid and changed to one bowl >< although I still want to eat after finishing, I must restrain myself >< exercise!!! I get home very late!!! Sleep is controlled around 12-1 AM).

Luff, 20~29 year old female. Ask Date: 2016/02/23

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: It is not possible to definitively determine whether it is irritable bowel syndrome or cancer.
If your only concern is the suspicion of colorectal cancer, and after evaluation by a physician there are no indications for a colonoscopy, you may consider undergoing a screening colonoscopy to address your concerns.
Additionally, maintaining a regular lifestyle is very important, and food choices are even more crucial.
If you can choose exercises that suit you, I believe your health will improve.
Furthermore, managing your mood and relieving stress in a timely manner is also essential.
If you still have concerns, it is advisable to consult a gastroenterologist.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2016/02/23

More Info

Understanding gastrointestinal distress, particularly in the context of Irritable Bowel Syndrome (IBS) and family health history, is crucial for both diagnosis and management. Your situation, characterized by a family history of colorectal cancer and your own gastrointestinal symptoms, raises several important considerations.

Firstly, IBS is a functional gastrointestinal disorder that can manifest as abdominal pain, bloating, and altered bowel habits, including diarrhea and constipation. It is often exacerbated by stress, dietary choices, and lifestyle factors. Given your academic pressures and irregular eating patterns, it is plausible that these factors contribute to your symptoms. The fact that your symptoms improved with medication and dietary adjustments suggests a strong link to IBS.

Your family history of colorectal cancer, particularly with your grandmother's case, does place you at a higher risk for developing colorectal issues. However, it is essential to note that having a family history does not guarantee that you will develop the same conditions. Regular screenings, such as colonoscopies, are recommended, especially for individuals with a significant family history of colorectal cancer. The general guideline suggests starting screenings at age 40 or 10 years earlier than the age at which your family member was diagnosed, whichever comes first.

Regarding your symptoms, the presence of abdominal pain, bloating, and changes in bowel habits can indeed be indicative of IBS. However, the concern about potential malignancy due to your family history is valid. While the likelihood of developing colorectal cancer shortly after a clean colonoscopy is low, it is not impossible. If you experience persistent or worsening symptoms, it is advisable to consult a gastroenterologist for further evaluation, which may include repeat colonoscopy or other imaging studies.

Your mention of anxiety and stress is also significant. Psychological factors can greatly influence gastrointestinal health. Anxiety can lead to increased gut motility, resulting in symptoms like diarrhea or urgency. Conversely, stress can also cause constipation in some individuals. It may be beneficial to incorporate stress management techniques, such as mindfulness, yoga, or cognitive-behavioral therapy, into your routine to help alleviate some of the psychological burdens that may be contributing to your gastrointestinal symptoms.

In terms of dietary management, it is crucial to identify any food triggers that may exacerbate your symptoms. Keeping a food diary can help you track what you eat and how it correlates with your symptoms. Common triggers for IBS include dairy products, high-fat foods, and certain carbohydrates known as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols). A low-FODMAP diet may be worth exploring under the guidance of a dietitian.

Lastly, your weight loss and changes in bowel habits warrant attention. Rapid weight loss can sometimes indicate underlying health issues, and while it can be a result of dietary changes, it is essential to monitor this closely. If you notice significant fluctuations in weight or persistent gastrointestinal symptoms, follow up with your healthcare provider for a comprehensive evaluation.

In summary, while your symptoms may align with IBS, your family history necessitates a cautious approach. Regular screenings, dietary management, stress reduction techniques, and open communication with your healthcare provider are key components in managing your gastrointestinal health effectively.

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