Diarrhea, Abdominal Pain, Mucus And Blood In Stools, Membranous Strands. Prescribed Librax. Help

Posted on Tue, 23 Oct 2012

Question: I've been having diarrhea and loose stools for the past 2 months. I felt better for couple days after i tried the BRAT diet but my diarrhea came back with abdominal pain. the pain is sometimes on the upper left side and is sharp, sometimes it's up at the stomach level and sometimes it's a burning sensation in my whole abdomen. I've noticed mucus in my stools and i also noticed long thin strands of membrane like structures in my stool. I am a very anxious person and my symptoms started to get worse after I started worrying too much about it. I've also noticed bright red blood on the toilet tissue once. I have lost some weight but this happened because I felt depressed and scared because of my diarrhea and stopped eating the way i used to. I went to a gastroenterologist and he said that i might have IBS and prescribed me Librax for 2 weeks ( 2 pills a day) and said that if i don't get better then he has to check for celiac disease and IBD, it's been 4 days since i've started the Librax and still no change. My anxiety is very very bad now and i can't stop thinking about having colon cancer and when I asked my doctor he said that I don't have it. However, I have read that many young people get that and they are often misdiagnosed with IBS. My abdominal pain is getting worse and i can't stop thinking about it day and night. I just need to know if my symptoms sound like colon cancer and if i should request a colonoscopy now. I also need to ask if parasite is a possibility in my case. I can say that my stress level is very high now and my family think that i am exaggerating things because my sister has been having diarrhea for 2 months and she doesn't care. i should also mention that last year I was having heart palpitations and panic attacks and after having an echocardiogram, holter monitor and EKG the cardiologist said i was fine.

Answered by Dr. Om Lakhani (1 hour later)

Hi XXXXXX,

Thanks for writing in.

First and foremost, take a XXXXXXX breath and relax and stop worrying. Let us tackle your problem and I am sure we would find a permanent and stress free solution.

Your symptoms are very similar to IBS (Inflammatory Bowel Syndrome). However, I would disagree with your gastroenterologist. IBS is a diagnosis of exclusion when everything pathological is ruled out. Presence of blood in stool is not seen in IBS.

Weight loss I believe is intentional; however presence of weight loss if unintentional requires evaluation before we label it as IBS.

In addition, the very definition of IBS requires symptoms to be present for at least 3 months with onset of symptoms at least 6 months before the diagnosis. Since you have been having symptoms for only 2 months, this is another reason why I would not label you with IBS.

Therefore, you are right, with blood in stools and lower GI symptoms you are justified in asking for a colonoscopy/sigmoidoscopy. Bring this to the notice of your gastroenterologist and I am sure he would advice a colonoscopy as well.

However, you must remember going for a colonoscopy does not mean you have a colon cancer! Many other conditions can cause similar symptoms- a colon cancer being less likely possibility at your age.

Having said that, presence of small amount of blood in the tissue paper gives a clinical impression of hemorrhoids or an anal fissure. This would be easily picked up even by a GP on per rectal examination. So, I would suggest you undergo a good physical examination first before we go ahead.

You also asked if some parasite can cause these symptoms, the answer is yes and no. Generally, infectious causes are short lasting and they cause symptoms for not more than 1-2 weeks, a prolonged diarrhea due to some bacterial or parasitic infection is possible but rare. If you have not travelled outside your US in recent past, infection with rare exotic parasites or bacteria that cause such prolonged diarrhea is unlikely.

There are some other tests, which I would suggest. They are:
1. Stool culture
2. Ultrasound of abdomen
3. Fecal calprotectin

So in summary discuss the justifications I have given for a colonoscopy with you treating physician. Finally once again XXXXXX, do not worry so much, you will be fine.

Hope I have answered your query. If you have any further questions, I will be happy to help.

Regards
Dr. Om Lakhani

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Om Lakhani (22 minutes later)

Thanks a lot for your help Dr.Lakhani. I have been having loose stool (occasionally) and abdominal discomfort (bloating, acid reflux) especially after eating for at least 3 years now along with the heart palpitations. I was also experiencing rectal bleeding around 6 months ago which i assumed was due to an anal fissure or hemorrhoid because i could feel the lumps on the anus. The bleeding continued for several weeks and i also had rectal pain. The bleeding and pain stopped and the lumps are not there anymore and that's why i did not seek medical help and did not mention this to my Gastro. My Diarrhea started around 3 months after the end of my rectal bleeding and now I check my stool everyday for blood and i only found it once on the toilet paper. I know that I should get the colonoscopy done but is it dangerous? I'm so worried because my parents are not here and I live alone. Do you think that celiac disease or IBD are possible according to my symptoms and also for Celiac disease to be diagnosed do I need a colonoscopy or endoscopy? I really appreciate your help.

Answered by Dr. Om Lakhani (14 minutes later)

Hi XXXXXX,

Celiac disease is caused by sensitivity to a product called gluten often present in wheat and other cereals like barley and rye. It causes changes in the small intestine which reduces the absorption of nutrients which is hence lost in stool causing diarrhea. It is diagnosed by upper GI endoscopy with a biopsy from your duodenum. There are also some blood tests which can be used for screening for celiac disease.

Inflammatory bowel disease is mainly of two type Crohn's disease and ulcerative colitis. The symptoms include, increase stool frequency, urgency for passing stool and rectal bleeding. Some people also have fever, weight loss etc in severe cases. It is common at a younger age. Ulcerative colitis can be ruled out with a colonoscopy / sigmoidoscopy. The evaluation of Crohn's disease also requires a colonoscopy initially.

Is colonoscopy safe ? well our center we do about 40-50 in a day and we never had any complication ! However any procedure carries certain risk which a doctor would discuss with you before the procedure. Also it is often done under short general anesthesia which also carries certain risk of its own. Since you live away from your parents I would suggest you have a friend or a relative accompany you for the procedure.

Finally it would be helpful to your gastroenterologist if you reveal the entire history the next time when you consult him/her. That would aid in therapeutic decisions.

Hope you have a healthy life.

Regards.
Dr. Om Lakhani

Note: For further follow up on digestive issues share your reports here and Click here.

Above answer was peer-reviewed by : Dr. Aparna Kohli