Abdominal pressure, mucous in stools, no clear diagnosis

[David__0__0]

  I'm 29, male, have been having gastro problems that have lasted a year and half and have not been able to get a satisfactory diagnosis from my HMO.
  All my life I have been reasonably healthy with normal bowel habits and no gastro problems. The only exception is if I consumed a great deal of dairy foods I would feel crampy.
  About 1.5 years ago, I went to be evaluated because I had a sudden change in bowel habits (things seemed to be moving more slowly through my system) and had a bloated feeling in my abdomen just below my ribs and above my navel. I went from passing stools everyday like clockwork to once every two days or so. I have no obvious blood in my stool, although I have a fair amount of stringy mucous. Occasionally, I will see a piece of mucous that appears pink. It sometimes appears that small bits of things are making it through undigested. The symptoms seem to come and go but I have never gone back to feeling perfect and being completely regular. Sometimes the symptoms are more severe than others almost like my large intestine is inflamed or irritated. I say this because it feels the like stool is much larger than it turns out to be as it passes out of me or it feels like I need to pass a stool despite having just gone and finished. Sorry for all the gory details.
  The original doctor ordered an abdominal ultrasound and anti-spasmodics which showed nothing of note.
  I continued to go back to the HMO since the original visit.
  * Another doctor ordered an upper GI which showed nothing. Prescribed Tagamet for a month with no effect.
  * A third doctor suggested I eat more fiber and exercise which doesn't seem to have any significant effect on the symptoms.
  * A fourth doctor (my primary physician at the HMO) order a barium enema (while I would like to avoid ever having again) and another CBC. Since I had no weightloss, no obvious blood, and the symptoms had not gotten significantly worse, he could not justify me having more tests.
  
  Combined Test Results:
  Liver Function: Normal
  H. Pylori: Normal
  CBC: Normal
  Ultrasound: Normal
  Upper GI: Normal
  Lower GI: Showed nothing despite suboptimal conditions (but they said my preparation could have been better) :(
  I apologize for the long posting but I'm at the end of my rope with this. I don't know what more to ask of the HMO. I generally feel like that have not invested the time to accurately pin it down. My worry is that it will be something significant that could have been better treated had they figured it out.
  
  Thank you for your time,
  David

[HFHSM.D.-rf]

_
Dear David,
Thank you fo ryour question. The prolonged nature of your symptoms would argue against life threatening conditions but this is small solace if you are chronically ill.
Several thought scome to mind to explain your symptoms.  Infections especially with parasites e.g. Giardia must be considered.  The floating stool suggests the possibility of pancreatic insufficiency.  A stool test for fecal fat will indicate if the possibility of pancreatic disease should be pursued. Small intestine barium study will exclude structural cuases in the small intestine from the causes for your symptoms.  Finally, one must consider the possibility of irritable bowel syndrome, a constellation of symptoms in the absence of evident disease of the GI tract.  Increased fiber is the treatment of choice for this last diagnosis.
This information is presented for educational purposes only.  ASk specific questions to your personal physician.
HFHSM.D.-rf
*keywords: constipation, irritable bowel syndrome
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