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Family Medicine (Expert Forum)
Bloating/weight gain
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
Bloating/weight gain
by Laurie36, May 01, 2002 12:00AM
I have had several problems for the past 5 years and have not been able to get a diagnosis or basically any relief. I went to a gastro Dr. complaining of constipation, gas and bloating. I have recently been put on Perdium and charcoal pills. Just this past month I have had a colonoscopy and ultra sounds of the pelvic and abdomen. Nothing has been found with the exception of cysts on the right ovary. The ovaries worried me so I did have the CA-125 blood test and it came back negative. The constipation and gas have somewhat been relieved but I still have this huge bloated abdomen that starts at my belly button down to my pelvic bone. I have been complaining for the last 5 years about the severe abdomen pain, constipation and gas. It has been so bad at times that I have had to unbottom by skirt/pants. At one time I measured in the am and directly after lunch and on a mild day my ab grew 3 inches and that was on a "good" day. My problems usually occur directly after lunch. I usually eat salads, soups, chicken. No burger and fries or heavily seasoned or spicy foods. I have had several worse days. I have tried to self diagnose myself with celiac sprue as well as Candida and have followed a desperate diet of carb elimination. I was successful for a while and then all symptoms came back. 1 1/2 year ago I had several tests done including thyroid, flexible sygmoidoscopy, berium enema, upper GI, cat scan, and ultra sound. NOTHING! Not only does this control my life at times (5 out of 7 days) but I follow a strict exercise program and most people would not even think I do a situp. I seem to hold onto 20 some extra pounds in the last few years. I work out 5 days a week for 1 1/2 hours every morning consisting of running 20 minutes, alternating 45 minute classes of biking and weight training. Plus walk 3 miles every night after work. My pain is not located strictly on the right side which is the question I am always asked. I would say it is usually on the left and when pressed above my belly button besides the cramping and sharp pains in the lower ab when the bloating begins. What is my next step. I am desperate and am contemplating on going to the emergency room the next time it is severe.
Doctor's Answer
by Forum-M.D.-DT, May 01, 2002 12:00AM
Thank you for visiting the Family Practice Forum.
Your symptoms make me think over and over again of irritable bowel syndrome. (or ... IBS).
IBS, also known as irritable colon, spastic bowel or spastic colon, is a disorder of the intestinal tract, causing recurring abdominal discomfort associated with constipation and/or diarrhea and abdominal bloating. It usually starts before age 50 and is worsened by anxiety or stress.
The symptoms of IBS are usually worse under stress such as when you travel or attend social events or change your daily routine. Symptoms may get worse if you go long periods without eating or have a very large meal. Women who have IBS may have increased symptoms during their menstrual periods.
1. Bloating and gas
2. Constipation
3. Diarrhea, especially after eating or first thing in the morning
4. Feeling as though you still need to have a bowel movement after you have had one
5. Abdominal pain and cramping relieved with a bowel movement.
Although foods do not cause IBS, certain foods may make symptoms worse. Foods high in fat or caffeine cause the intestines to contract and may make symptoms worse. Foods causing an increased production of gas such as beans, cabbage or some fruits may also need to be avoided.
Keeping a diary of what you eat for a few weeks is very important in helping to control IBS. Patients are usually able to identify what food or foods will cause their symptoms to be more prevalent. If milk and dairy products bother you, you may have lactose intolerance. Lactose intolerance means your body is unable to digest certain sugars in milk.
Diagnosis of IBS
Your doctor will begin by asking you many questions about what is causing your symptoms. Typically there are certain patterns in your diet or activity which will help the doctor make the diagnosis.
Although there may be mucus present in the stool with IBS, there is no blood. Blood in the stool may signify a more serious problem. If there is the presence of blood in the stool, painless diarrhea, diarrhea at night or the presence of weight loss this may point toward a cause other than IBS. The doctor will perform an examination, paying particular attention to the abdomen. Additionally he/she may order blood tests to check for abnormalities of the blood counts, liver function, evidence of inflammation of the pancreas. Other tests include abdominal Xrays, a barium enema Xray or in some cases a colonoscopy.
Treatment of IBS
Essentially, the best way to control IBS is to control stress, avoid certain foods and to maintain a healthy, consistent diet. Fiber may be helpful as well. Increase the fiber in your diet slowly. Increasing fiber content in your diet to rapidly will increase the likelihood of gas and bloating. As your body becomes more accustomed to the increases in fiber, the gas and bloating will resolve.
1. Eat a variety of foods and avoid foods high in fiber or caffeine
2. Drink plenty of water
3. Eat smaller meals (6 small meals/day instead of 3 large meals)
4. Keep a diary for 2 weeks and avoid foods which seem to aggravate your symptoms
5. Learn ways to control your stress
6. In severe cases consider the use of prescriptions medications such as hyoscyamine (Levsin) to help control stomach cramping or Imodium when diarrhea is severe.
7. Increase fiber in your diet
It really sounds like you have had an extensive workup. Maybe a second opinion from another Gastroenterologist will prove helpful.
Your symptoms make me think over and over again of irritable bowel syndrome. (or ... IBS).
IBS, also known as irritable colon, spastic bowel or spastic colon, is a disorder of the intestinal tract, causing recurring abdominal discomfort associated with constipation and/or diarrhea and abdominal bloating. It usually starts before age 50 and is worsened by anxiety or stress.
The symptoms of IBS are usually worse under stress such as when you travel or attend social events or change your daily routine. Symptoms may get worse if you go long periods without eating or have a very large meal. Women who have IBS may have increased symptoms during their menstrual periods.
1. Bloating and gas
2. Constipation
3. Diarrhea, especially after eating or first thing in the morning
4. Feeling as though you still need to have a bowel movement after you have had one
5. Abdominal pain and cramping relieved with a bowel movement.
Although foods do not cause IBS, certain foods may make symptoms worse. Foods high in fat or caffeine cause the intestines to contract and may make symptoms worse. Foods causing an increased production of gas such as beans, cabbage or some fruits may also need to be avoided.
Keeping a diary of what you eat for a few weeks is very important in helping to control IBS. Patients are usually able to identify what food or foods will cause their symptoms to be more prevalent. If milk and dairy products bother you, you may have lactose intolerance. Lactose intolerance means your body is unable to digest certain sugars in milk.
Diagnosis of IBS
Your doctor will begin by asking you many questions about what is causing your symptoms. Typically there are certain patterns in your diet or activity which will help the doctor make the diagnosis.
Although there may be mucus present in the stool with IBS, there is no blood. Blood in the stool may signify a more serious problem. If there is the presence of blood in the stool, painless diarrhea, diarrhea at night or the presence of weight loss this may point toward a cause other than IBS. The doctor will perform an examination, paying particular attention to the abdomen. Additionally he/she may order blood tests to check for abnormalities of the blood counts, liver function, evidence of inflammation of the pancreas. Other tests include abdominal Xrays, a barium enema Xray or in some cases a colonoscopy.
Treatment of IBS
Essentially, the best way to control IBS is to control stress, avoid certain foods and to maintain a healthy, consistent diet. Fiber may be helpful as well. Increase the fiber in your diet slowly. Increasing fiber content in your diet to rapidly will increase the likelihood of gas and bloating. As your body becomes more accustomed to the increases in fiber, the gas and bloating will resolve.
1. Eat a variety of foods and avoid foods high in fiber or caffeine
2. Drink plenty of water
3. Eat smaller meals (6 small meals/day instead of 3 large meals)
4. Keep a diary for 2 weeks and avoid foods which seem to aggravate your symptoms
5. Learn ways to control your stress
6. In severe cases consider the use of prescriptions medications such as hyoscyamine (Levsin) to help control stomach cramping or Imodium when diarrhea is severe.
7. Increase fiber in your diet
It really sounds like you have had an extensive workup. Maybe a second opinion from another Gastroenterologist will prove helpful.
or Increased Intestinal Permeability?