Constipation, bloating concerns

I 40 years old, 6'4" and about 287.  For the past couple of years, I've had on-and-off constipation concerns.  I had a colonoscopy about 2 years ago, and it came out clean (the doctor said they got the scope farther than usual and to come see him again when I was 50).  I try and take fiber tablets every day.   I keep having these problems, where I feel more bloated, feel constipated which includes my stools coming out in small piece or or ribbon-like thin-ness at time.  I don't have any pain or bleeding (unless I push too hard or have multiple BMs in a day resulting in small fissures or minor hemmoroids (hemorrhoids) occasionally.  Is this constipation and thinner/small stools because I am overweight and the anus and colon is being compressed, or is there likely a bigger concern?   Should I get another colonoscopy?

[Kevin Pho, MD]

The negative colonoscopy would rule out masses or major anatomical diseases that can lead to your condition.

If the stool caliber continues to change, repeating the colonoscopy can be considered to exclude a new mass.  Imaging the abdomen can be done to evaluate for any adhesions or obstruction.

If negative, irritable bowel syndrome can be considered and appropriately treated by your personal gastroenterologist.  Motility studies and anorectal manometry are more specialized tests that can be done to evaluate the constipation.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com

[Lanaiwahine]

Hello Dino,
I have had IBS from gallbladder removal for 15 years, about 5 years ago I was diagnosed with interstitial cystitis ( pain can be as severe as late stage cancer) and they put me on narcotics.  That stopped my chronic diahrea but now I am constipated and bloated all the time.  I have gained 40 lbs in the last 4 months but am not overweight.  I too have deer pellet BM's and thin stringy ribbon like. I dont think it is your weight causing these types of BM's it is constipation.  Have you tried Glucolax? I too have had many negative colonoscopies, just irritation.  I also believe I have a b-12 deficiency too as I went 10 years without absorbtion of vitamins and minerals from the food I could keep in.  I am using senekot OTC right now, not very effective, I have to go back to the gastro for another prescription of glucolax.  Hope this helps

[rhop1952]

Having problems with pain under the right rib cage. STarted a couple of months ago and is progressively becoming more intense. Gall bladder was removed about 3 years ago. Continued to have stomach problems after surgery. After a complete workup by a GI specialist, I was told that I have GERD and IBS. Take Protonix in the a.m. and Reglan in the p.m. Following this regimen for more than a year now. Take a daily fiber supplement and multivitamin. Diet is restricted - no/low fat foods, nothing fried, no carbonated beverages, no alcohol. Quit smoking June 15th. The increasing intensity of the pain is causing concern and would like to know potential causes.