Doctors Lounge - Gastroenterology Answers
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Forum Name: Gastroenterology Topics
|QuickTech9 - Wed Mar 25, 2009 4:00 am||
I'm a male, white, early 20s. I have controlled hypothyroidism and suspected but undocumented SVT (family history of heart disease). I have a history of joint pain, muscle spasms, eye pain, jaw pain, cluster headaches, migraines (with a family history), 140/80 BP (with a family history of high blood pressure), generalized anxiety with minor panic attacks, meloncholy depression, and insomnia. I've sought treatment for pain and headaches previously, but managed no diagnoses.
I have also had stomach pain in the past. I mention it specifically because when it does happen, it has felt similar in nature to the pain experienced recently during bowel movements. However, my past pain (a crampy and "carpal-tunnelish" feeling) was unrelated to my bowels as far as I could tell.
Generally though, I have trouble with bowel movements in that they can often take a while to initiate even after I feel the need to go. I also sometimes feel as if a bowel movement is incomplete. My day starts almost without exception with a half hour spent on the toilet.
My problem originally started with severe constipation. Other symptoms included excessive bloating, gas, mild nausea, regurgitation but not vomiting, increased bowel sounds, abdominal pain, and back pain. I was able to pass very small, dark (not black), hard stool with strain. Doing so generally did not relieve the symptoms and was accompanied by mucus but no blood. The gas was relieved by OTC medications, but OTC laxatives and stool softeners proved to be ineffective. I also began taking a multivitamin and fiber supplements with a similar lack of results.
The pain intensified one day after about three weeks of symptoms resulting in a trip to the emergency room. An echo of the gall bladder was taken along with blood and urine work. All tests came out negative. I was given fluids as well as anxiety and pain medication. I was also given something that allowed me to have a bowel movement some time afterwards, but don't recall the medication. The bowel movement was a mixture of normal stool and the small black stool "combined" and passed with relative ease. Pain subsided but remained in upper quadrants of the abdomen and could also be felt in the back in the same area. The pain limited my range of motion in that I felt like I could not twist from side to side or bend back and forth.
Two days later a significant (in terms of volume) bowel movement occurs. The stool is normal up until the very last part of the bowel movement. I am hit with extreme, difficult to define pain (mentioned up top) of shocking intensity in my belly at this point. After getting up and moving around a little I feel a very distinct "filling" sensation in my rectum, while still in pain. I manage to have another bowel movement. The pain spiked to the point that I can say that is the most pain I have ever felt before. The pain came with dizziness, lightheadedness, goosebumps, full body shudders, quesiness, fatigue, and a general "sick" feeling. I also remember feeling sort of "drunk" afterwards like I was having trouble thinking and moving.
I see my GP the next day and she pokes around. She thumps me on the back around the kidney areas and it rocks me to the point that my eyes tear up. I think it was one of those reactions you get where you just slammed your thumb with a hammer. It didn't hurt at first even though I knew it was REALLY hurting, and then pain steadily built. Once I had recovered, she moved on to my stomach. The stomach pain seemed to be coming from the top right quadrant, below the ribs. We discovered this when she tagged me with a forceful finger jab in the area that felt more like her hand had gone inside of me. Thisnput me in a mode of distress with pain and nausea. She suspected intestinal abscess or lesions and ordered immediate blood/urine work and an abdominal CT scan with with and without contrast. Blood test came back negative for sepsis with the only finding being a heightened red blood cell count. CT scan also comes back completely and utterly normal, which is frustrating, relieving, and scary all at the same time.
I can sleep, but usually not for more than a few hours before I wake up in order to try and use the bathroom. I am no longer constipated to the point that I can't use the bathroom, but it is still difficult to do such. Although I can go to the bathroom now, I also feel as if I need to defacate more or less constantly. Most of my bowel movements result in similar pain, but not nearly of such an extreme degree. All of the symptoms present with the first painful bowel movement have continued with the subsequent. Stool was normal but on the mushy side with bouts of diarreah. Diarreah is significantly less painful than passing solid stool, but still has a negative sensation. Diarreah has since stopped, but my stool has been consistently green. I've read this can mean your bowels are moving things along too fast, but I assume this is a result of high fiber intake. My back has also stopped hurting, but I still feel I do not have my full range of motion.
The next step at this point is to move onto a GI specialist. I lack insurance and would like to try and avoid as many additional tests as possible. Anything that you think might help towards a diagnosis would be appreciated. I am also interested in learning about what tests I should look into getting done and possibly what order it might be best to do them in as well.
My current thoughts were to treat this like some manner of IBD and provide treatment for symptoms (mainly pain and the urge to go to the bathroom). I also wanted to try anti-depressants before further testing as I have read about links between depression/anxiety and bowel issues.
|John Kenyon, CNA - Tue Apr 21, 2009 11:20 pm||
While a GI consult would be ideal, if you're not willing or able to do that right now, you're going to have to work on the symptoms, based on guesses as to what's causing them. This sounds primarily like IBS with associated mood disorder and possible panic disorder aggravating it. There's also the possibility of a nerve inflammation somewhere confusing the picture, based on the visceral response to certain manipulations and prodding, as well as loss of range of motion. These might respond to over-the-counter anti-inflammatories, and the only thing you can really use to help normalize bowel movements without prescription medication would be something that increases the bulk in the stool, which oddly will work on both ends of the spectrum of abnormal stool with IBS. A good start might be Citrucell tablets, although in the beginning most people do experience some bloating -- this only mentioned on the off chance you decide to try this.
Please bear in mind there's no rule you can't have more than one thing going on at the same time.
Again, the best thing you could do for yourself would be to have a comprehensive GI workup, including probably colonoscopy, but that could get expensive, so assuming this is a consideration, you might try symptomatic care and perhaps a limited GI consult with discussion of the need for tests other than colonoscopy, which would probably be the most useful of all.
Good luck to you. Please follow up with us here as needed.
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