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Question: Good Morning. I have a question. For the most part, I am usually constipated. Sometimes 'go' everyday, sometimes 3x a week, occasionally I go 5-6 days with no BM. 99% of the time with straining, hard or soft stool, usually hard. The last time I believe I had an episode was in April which was like from hard stool, then minutes later (no urgency just a small urge) mushy stool, like in a pile that resembles a small beehive (the only way I can describe it) then minutes later normal soft stool. I did have a teeny bit of pain before the last one which was normal. I go thru this pattern for a week or 2, then 6 mos or so normal (which is normal for me, sometimes hard, sometimes a perfect stool (with straining). Now, I haven't had a decent BM since I think Tues or Wed of last week. Since then every morning I have tried to go with only managing a hard pebble each time. Last night I had apple juice, which helps and a large Dunkin coffee this morning. I have experienced these stool changes in such a short span of time (with gas) within 6-7 mos. In other words I go normal, alto there is straining, and then 6-7 mos later, this happens. Is this classic IBS? Or can the changes in stool appear because I haven't gone for so long? I have been constipated since I was a baby, with having TRUE diarrhea about 3 or 4 times in my 62 years. I am healthy, no health problems. The change in BM's started when I was 55 with certain foods like sauces, gravies, too much fruit, but over the last 2 years with this occurring every 6 to 7 mos. Sometimes, like today, I had to REALLY strain and it was like a XXXXXXX felt completely empty,that satisfied feeling. An hour later, I had a teeny urge with straining, some gas, and then stool was like long snakes, semi hard, normal color always. I am wondering IBS-C, diet-related, this is frustrating. :( I had tacos last night. I hate to admit this, but I only drink between 2, 8 0z bottles of water a week or a little more.I am trying to drink more. Just wondering why I have different types of BM in a short span on 2 to 3 hrs time, why I don't feel I have emptied fully. Thank you
Brief Answer:
It can be IBS but you need to exclude few things first
Detailed Answer:
Hi! Welcome to health care magic.
Based on the history you have shared, it seems like IBS and more likely IBS-C because most of the symptoms are favoring this diagnosis specially the stressers and anxiety history, however the only questionable thing being the age of onset. Normally IBS sets in before 60 years of age. also that it is a diagnosis of exclusion. To label it as IBS one definitely meets to rule out certain similar conditions through tests like stool analysis and microscopy to exclude infective causes and workup for food allergies like coeliec disease and lactose intolerance. A colonoscopy may also be needed in some cases to exclude IBD.
In any case, the first line of management aims at proper gut motility and using stool softeners for constipation and using opioid, loperamide or antispasmodics for loose motions like drotaverine or hyoscyamine. Using SSRI drugs like fluoxetine or drugs like Olanzapines have shown promising results. Do discuss all these options with your treating physician.
Meanwhile keep an eye on malabsorption symptoms. Using lactose and fructose free diets and using oligosaccharides rich diets will be beneficial. Use fibre rich diets and include ispaghol husk in the diet.
Hoping you a speedy recovery. If you dont have any more questions, please close the discussion. You can also reach me directly through my profile in future, in case of any more questions. Regards.
It can be IBS but you need to exclude few things first
Detailed Answer:
Hi! Welcome to health care magic.
Based on the history you have shared, it seems like IBS and more likely IBS-C because most of the symptoms are favoring this diagnosis specially the stressers and anxiety history, however the only questionable thing being the age of onset. Normally IBS sets in before 60 years of age. also that it is a diagnosis of exclusion. To label it as IBS one definitely meets to rule out certain similar conditions through tests like stool analysis and microscopy to exclude infective causes and workup for food allergies like coeliec disease and lactose intolerance. A colonoscopy may also be needed in some cases to exclude IBD.
In any case, the first line of management aims at proper gut motility and using stool softeners for constipation and using opioid, loperamide or antispasmodics for loose motions like drotaverine or hyoscyamine. Using SSRI drugs like fluoxetine or drugs like Olanzapines have shown promising results. Do discuss all these options with your treating physician.
Meanwhile keep an eye on malabsorption symptoms. Using lactose and fructose free diets and using oligosaccharides rich diets will be beneficial. Use fibre rich diets and include ispaghol husk in the diet.
Hoping you a speedy recovery. If you dont have any more questions, please close the discussion. You can also reach me directly through my profile in future, in case of any more questions. Regards.
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Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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