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Posted by HFHS-MD/rf on January 02, 1998 at 14:40:16:
In Reply to: Bowel Infection posted by Mrs. Sorensen on December 22, 1997 at 07:44:52:
: Dear Dr.,
I am a 63 year old female and have had irritable bowel syndrome for about the past 10 years. I had a colonoscopy about 2 years ago as I had diarrhea quite a bit. The results of the colonoscopy performed by a gastroenterologist were: Frequent diverticular orifices noted in the transverse colon, descending colon and sigmoid colon. Terminal ileum was normal. Other than the above, the visualized colonic segments were normal.
Impressions: Moderate Diverticulosis. The symptoms are probably explained by the presence of irritable bowel syndrome.
That was 2 years ago. I was prescribed Questran and that has been wonderful. However, the last week of October I started experiencing urgent & frequent bowel movements, diarrhea and a pinkish mucous discharge preceded by slight cramping. Sometimes the mucus would just run out of me and I was unable to control it as my anal sphincter is not strong. After a few days of this I went to see my family doctor. He is a GP.
The results of his exam as copied from his report: Abdomen normal, active bowel sounds, no distension or organomegaly, minimal discomfort with deep palpation. No rebound. No masses. Rectal reveals no bleeding. Very weak sphincter. No stool. Husband and she have been eating the same foods. He is well. I am going to check her stool for ova and parasites. Has a sulfa allergy. I would have tried her on Septra. I will give her Cipro 50 one BID starting now. Hopefully is there are any bacteria, this will take care of it. She may need to see Dr. Gadek for colonoscopy. The stool samples results showed no prasites and many white blood cells with pus. Drs. note said prob. E. Coli. I took the Cipro for ten days and was okay for a few days when symptoms appeared again. The doctor said he didn't know where the bacteria was coming from. This time my doctor increased the Cipro to 500 mg which I have now been on for 2 days only. Still have
cramping and urgent and frequent bowel movements during the day especially after eating and also at night. I am trying to watch my diet and stay away from spicy and fatty foods during this. I usually drink only decaf coffee and usually only 1-2 cups/day. I weight 165 pounds, don't have high blood pressure or high cholesterol. I don't seem to have a fever and otherwise feel well. I would appreciate your opinion on my treatment. Is this ulcerative colitis?
What do you recommend? I thank you in advance for any reply.
Dear Mrs. Sorensen,
The following information is intended for general informational purposes only and is not a substitute for individual
consultation and treatment with your health care professional. No physician-patient relationship or standard of care
is hereby established, nor does this information purport to be all inclusive. The statements and opinions expressed
herein are those of the authors and not necessarily those of the Henry Ford Health System or it's Board of Trustees.
Irritable bowel syndrome and diverticulosis are common medical conditions in North America. As I read your letter, I get the impression that you have had a recent onset of diarrhea and mucous discharge. I also assume that you are still symptomatic. I agree with your physician that it is necessary to exclude an infectious cause. If you have not had stool cultures since Oct., it would be appropriate to repeat this test. Attention should be paid to the exclusion of bacteria as well as parasites. Although people who have an intact immune system (i.e. do not have AIDS), usually do not have chronic infections with other organisms, we will often obtain stool for AFB (acid fast bacilli) in perplexing cases of chronic diarrhea. I would also exclude C. difficle infection in view of your antibiotic use. In general antibiotic usage for diarrhea should be restricted to those patients who have documented infection.
If the stool cultures are not diagnostic it would be appropriate to have sigmoidoscopy or colonscopy done to exclude mucosal causes for your symptoms. Ulcerative colitis usually presents with blood and diarrhea so this diagnosis appears less likely. The visualization of the mucosa and appropriate biopsies will allow your physician to evaluate this diagnostic possibility.
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