Colon cancer? Or, what, possibly?

[jhorse]

Im a 36yr old, 5'10", 155lb, white female with a life history of "digestive" problems. Starting with when I was a kid, when I would only have bowel movements 1x/wk, them being softball size (no joke, really) and ripping my rectum every time, as you can imagine. My cousins used to tease me that I had to break my BM apart w/something, usually empty cardboard TP holder or they wouldn't flush. I was always worried about my weight, and it fluctuated as I dieted a lot. Skip to adulthood, where I got married at 19, had two kids in 18 mos, still constipation my main challenge. Went through "poor" period of time - no money to eat, lost 30 lbs, bowels changed and were more "normal" when I had them. I have large bones and pictures from that time look horrible to me.  Constipation still on my mind and main challenge and in mid-20s I discovered bran and rediscovered salads, fruit, natural anything, really.  I drank lots of not from concentrate OJ with lots of pulp. Still had the tendency to diet. Bowels stayed solft/loose as long as I drank lots of water and kept up the bran, orange juice, salads, etc. About 13yrs ago I pain/bloating started in my lower ab. I thought it was gas. Was drinking juice, water, eating salad, crackers, pretzels, little or no meat. I'd walk after meals and that seemed to help. During these "gas attacks" it seemed my bowels would "freeze up" and nothing wanted to move. It hurt to have sex with my husband and I couldnt figure it out.  Doc said IBS.  Prescribed Bentyl, but possible side effect was constipation and I'd had enough of that in my life so didnt take it.  Put up with this for years and it got worse, but the thing that made me seek medical attention was I almost passed out in the drug store for no reason. Doc did EKG, blood tests, blood count low, bowels had been black for a week, sent me for colonoscopy and endoscopy (?); colon was fine, esophagus had bleeding, ulcerated tissue.  Prescribed Prevacid for 3 months, "and call me if you have more problems".  Me being stubborn and wanting natural remedies for things, I researched AR and found something that said, just stick to natural things.  So, I did.  Had more pain over the years and finally decided it might be something more than IBS/AR probs. Gyno did surgery to look at ovaries, etc.-normal.  Doc sent me for ultrasound on gallbladder because 3 years ago, sharp pains in my "middle", making it hard to breathe, radiating upward in my chest and around to my back-happened once-in-a-while over a period of 2 yrs or so.  Ultrasound - normal.  Last yr larynx swollen-AR.  Now, I have oval shaped sore under right ribcage, there for 3-4 weeks, doesn't hurt outside, tenderness inside.  Bowels have been erratic/constipated mostly, some soft-not diarrhea.  I've also had acid reflux more lately, taking Nexium right now.  Was taking coral calcium when these probs started.  Quit, thinking that'd help.  Not.  Eating bran (helps) again/almost whatever I want-not gaining weight. Help if U can

[Kevin Pho, MD]

Hello - thanks for asking your question.

You note a history of digestive problems.  There are constant "gas attacks" and constipation.  Questionable diagnosis of IBS.  Colonoscopy was normal.  Upper endoscopy had bleeding ulcerated tissue.  Gyno exam normal.  Abdominal ultrasound normal.  

The endoscopies are reassuring since it does not show any masses or tumors that may be causing your symptoms.  There are several other more specialized tests that you can consider.

There are many other causes for constipation.  Diseases associated with constipation include neurologic and metabolic disorders, and endocrine disorders such as diabetes mellitus. Other abnormalities leading to impairment of defecation include aganglionosis (Hirschsprung's disease) and acquired functional outlet disorder (pelvic floor dyssynergia). In addition, patients with irritable bowel syndrome often complain of periods of constipation, which may alternate with periods of diarrhea or normal bowel function.

Colonic marker studies, anorectal manometry and defacography can all be used to evaluate for pelvic floor dysfunction or colonic transit problems.  

If the diagnosis continues to be irritable bowel (i.e. all the tests were negative), you may want to try a medication called Zelnorm.  It has recently been FDA approved for constipation-predominant IBS.  

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.

Thanks,
Kevin, M.D.