Do I have IBS or is this another issue? What should I do to try and improve my quality of life?
Hi,
I am a 38 year old man. For several years I had assumed that I had mild IBS due to regular loose stools and diarrhea, and the general thought that I'd always had a "weak stomach".
In the past two years my symptoms have worsened and changed. Now it seems that once a week I will go 3 or 4 days without a bowel movement (with no real desire to do so) and then fairly abruptly I will feel the need to go. This realization is somewhat urgent but not particularly uncomfortable or comparable to urgent diarrhea. The bowel movement itself however is extremely uncomfortable, passing what I suspect is 2-3 feet of stool over 10-20 minutes. The stool is like a long clay snake (not in any way hard or dehydrated) and often terminated by a small quantity of diarrhea (this can also occur as a second/third movement within the next 1-2 hours after the first). Not only is the bowel movement extremely uncomfortable, but it then leaves me feeling very weak and drained with no appetite and a sore lower back (this is often present before as well). This morning it left me feeling so poorly that I took the day off work. I didn't eat until 330pm and now at 530pm still feel drained and hypersensitive (like my joints and the entire surface of my body is sore).
My diet has not changed significantly over the past several years, and I can't seem to identify what causes the period of constipation (?), or the sudden large bowel movement that follows. I am a research scientist with a PhD in Chemistry, so I consider myself quite capable of controlling variables and observing their outcomes, but still I'm not sure what if anything in my behavior causes this.
Other issues I have day to day that I suspect are related include anxiety and a growing inability to deal with consuming alcohol. I have drank for more than 20 years, in some times excessively, but now only ever have a few (3-4) beers or a couple of glasses of whiskey. This however sometimes seems to be more than enough to leave me physically debilitated the next day, especially if I choose to smoke several cigarettes while I drink. The symptoms I feel the next day seem to be highly related to anxiety, as on occasion I've taken a small quantity of xanax and they are then resolved (i.e. the problem isn't nausea/headache). To isolate the impact of alcohol/cigarettes I haven't consumed either whatsoever for 8 days now (but I still had the experience this morning that kept me from going to work).
Another symptom is that on occasion in the middle of the night I wake up in pain feeling like I need to poo, but it is actually some form of obstruction. I deal with it by lying flat on my back and waiting for it to pass. Unfortunately this can be extremely uncomfortable. I have probably experienced this ~10-20 times over the past 5 years, and I seem to have helped learn to manage it by not sleeping in a position that overly contorts my abdomen.
I live in a small town in the US and am not from here originally. I have found the medical system here extremely frustrating and at present do not have a primary care physician. I did obtain a referral to see a gastroenterologist nearly 2 years ago. I was quite surprised and disappointed by their service, essentially just suggesting that I avoid ibuprofen and be mindful of FODMAP foods. As a result I haven't pursued further medical advice, but this is becoming worse and impacting my job and quality of life. If anyone has experienced something similar and has any advice regarding a course of action I would greatly appreciate it. Thank you.
Hi
, I'm so sorry that you're dealing with this.
I completely understand your frustration with the medical system. However, since your symptoms have changed, I would still suggest trying to see a doctor and getting a couple of tests done to rule out other conditions. It does sound like you could be dealing with IBS-M (we have a forum for it here: https://irritablebowelsyndrome.net/forums/ibs-m-forum-discussion, as well as many articles, including this one: https://irritablebowelsyndrome.net/living/mixed-ibs-shift), but sometimes other conditions can have similar symptoms but need different treatment.
Since you mention anxiety, I just wanted to say that it can be a huge trigger for digestive symptoms, as can stress. It took me years to accept that my IBS was more often caused by my anxiety than anything I ate. So if you've started experiencing more anxiety lately, that could potentially explain the change in symptoms.
Regarding alcohol, I wanted to share this article with you: https://irritablebowelsyndrome.net/living/alcohol-drinking. I know that it can be a trigger for many people, me included, although some people still do okay with specific drinks.
Have you noticed any other food triggers at all? Dairy, gluten, caffeine, fried foods, and anything that's difficult to digest are pretty common triggers, but not for everyone of course.
Please let me know if any of this helps.
Hugs, Karina (team member)Hi
,
Thank you very much for the reply.
Regarding seeing a doctor to rule out other conditions, can you provide any details on what I could/should be trying to rule out and what testing is possible? The sentiment I got from my one visit with the gastroenterologist was that I should go away and be mindful of my diet for 3 months and if nothing changes then come back and get a colonoscopy. That was 2 years ago. I know I should have followed it up then but I was left quite frustrated and at the time felt it wasn't going to help.Regarding food triggers, I have always eaten a lot of dairy and bread, and I think I am still able to deal with them relatively well. I do enjoy ice cream and eat it every other day, and I don't think it causes a problem. Caffeine will often trigger a bowel movement, but this is common for most people, right? I chose to limit my caffeine intake and actually only ever consume it as a capsule rather than drinking coffee or energy drinks (which DO tend to cause me abdominal pain). As for fried/fatty foods, yes it seems my system struggles with that more and tends to result in diarrhea (again, probably normal for someone my age regardless?). I've also been concerned that my stools are sometimes quite fatty, which had me concerned that my pancreas may not be metabolizing fat adequately. If so, this is probably exacerbated by my regular alcohol consumption and history of drinking (in the past excessively, now only in moderation but usually daily).
The only other advice my gastroenterologist suggested was taking miralax every other day when I experience my regular episodes of 3-4 days without a bowel movement. I was confused by this, because I thought this product was designed to hydrate and soften bowel movements. This isn't at all the issue I have. Although I don't poop for several days my stool is still hydrated. Any thoughts on this?
Thank you again for your feedback. I greatly appreciate it.
DylanIn my case, the tests I had done were blood work and stool tests to rule out IBD. However, since you mentioned that you struggle with fatty foods, you might also want to get your liver and pancreas checked, I think. Colonoscopies are also often done before getting diagnosed, although I personally didn't have one. I'm not a doctor though!
The trigger foods I mentioned are the common ones, however, not everyone reacts to them (it's amazing that you can eat dairy and wheat without issues!), and people can also have very random triggers. For me personally, fatty foods aren't an issue, but I can't eat squashes or pumpkins, although I've never heard anyone else have that as a trigger. So if you feel like food might impact your symptoms, I'd recommend keeping a food journal. We have one here: https://irritablebowelsyndrome.net/living/food-journal-download, and I also find this article about how long it takes for foods to cause symptoms very helpful: https://irritablebowelsyndrome.net/living/fodmaps-trigger-ibs-symptoms. Is there any way that you could avoid alcohol for a little bit to see if that helps?
As for Miralax, I'm wondering if your doctor thought that by relieving the constipation you have for 3-4 days, maybe you would avoid the discomfort that comes after? I don't have any personal experience with this medication though, so I don't know how exactly it works.
Karina (team member)
Dylan, I do feel that if you're not sure if you have IBS or worry that you may have some other problem, you should get some tests run. In my own case the initial tests were blood and stool testing only which are not invasive. It turned out that my doctor was satisfied with the results of those for it not in his view, to warrant further testing, but I was instructed to "come back if anything changed" and more investigations would be done.
Nothing really changed except maybe some improvement as time went by.
But I do encourage you to go to a doctor and get some testing done.
Now the long endless bowel movement after a few days of constipation kind of makes perfect sense. The body is compensating and giving you maybe three or four days of bowel movements all at once, to clean out your system. I wouldn't be too upset about that in itself and be grateful that you are getting some form of balance back.
But the more worrying thing for you is what you feel like when this happens. Drained and awful, and with loss of appetite,
I also get weird things happen with my appetite whenever my gut decides to "get frisky". I just accept it, and eat as much or as little as I get signals for. Days of bad flare ups occasionally can stop me wanting to eat until about 6pm when I am suddenly ravenous. I kind of roll with it and have herbal teas, or China tea, and maybe a few spoonfuls of honey just to keep my strength up. I know it's more important to keep hydrated, especially with an IBS D flare up when fluids and electrolytes are lost. So I just do that and wait for my appetite to give me cues. Then I eat small amounts of very bland foods to start with.
If you find consuming alcohol difficult, then I think the obvious way forward is to perhaps stop drinking alcohol? Your body is trying to tell you something. If cutting it out entirely is difficult, there may be a bit of alcohol dependence going on, That's separate issue to deal with really, but another way is to cut down to no more than 2 units per day (if those don't upset your gut!) Or if you deeply want to stop and find it hard to do, taper down gradually, and/or seek support.
And what people may not expect is suddenly giving up alcohol can ALSO upset the gut!! So to see health results might take a few weeks.
I wonder if that sensation you feel in the night might be from wind (gas) moving in the gut and perhaps getting stuck a bit here and there around all the bends? I sometimes wake up in the morning with the most uneasy sensation in my gut until I shift a bit of wind. Then the sense of urgency passes until I get going properly, have a coffee, and do a toilet visit.
If we have IBS, anything going on in the gut which may even be totally normal, can feel awful and ominous as we're more sensitive in that respect.
The FODMAP diet may help you? Lots of people swear by it. I only found it partially helpful though but am glad I tried the 8 week trial.
And yes, -avoid Ibuprofen. Good idea. Paracetamol might be better if you ever need a painkiller. Anything with Codeine is likely to give you constipation, though might be mitigated by more fibre in your diet and a stool softener.
But your lack of a PCP is a nuisance as you could do with someone to run tests and at least be as helpful as possible.
The only way I have found to help manage my IBS has been my own balance on a daily basis, with foods...sometimes more fibre, sometimes less. A constant balancing act. Plus I have regular consultations with a Homeopath, which I am sure have helped me over the past 4 years, so things are now not anywhere near as bad as they were (though still no miraculous "cure".)
I do hope you can find some relief from the worst of your symptoms. Wishing you the very best.Thank you very much for taking the time to give such a detailed response.
