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Gastroenterology (Expert Forum)
IBS Questions
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
IBS Questions
by ROMF, Jan 19, 2005 12:00AM
Dear Doctor:
I'm a 35-year-old, healthy male with a history of stress-related IBS that was finally determined as such in 2001 after every test in the books came up negative -- abdominal/pelvic CT, sigmoidoscopy, barium X-ray, colonoscopy, and complete bloodwork, all normal.
Symptoms were lower right quadrant pain radiating into hip, lower abdominal pressure, sense of discomfort radiating into the pelvis/groin/prostate region, etc. Testicular ultrasound and tests for prostate and bladder also negative.
These symptoms are obviously stress-related: I am a medical researcher and a hypochondriac, so I know way too much (or too little) about symptoms, and worry about possible horrible things that will happen to me. They also went away completely once I "got over it," and came back in the past few years only mildly and occasionally during probable stress situations.
My current symptoms include all of the above, PLUS, for the first time, one month of fairly consistent mild/moderate nausea. This has been quite disturbing and uncomfortable. Lower abdomen/pelvis (centered above genitals) feels tight/pressure. Bowel noises as well. Bowel habits don't seem unusual. Definitely feels like I need to release gas/etc. more, although not always successfully. Bowel movement, eating, etc., don't seem to affect symptoms for better or worse; it ebbs and flows on its own during the day (somewhat persistent).
Only recent history is a car accident (4 days before all this started, one month ago) -- broken collarbone from shoulder belt, slight bruising on both hips from lap belt.
My doctor examined me briefly, including a vigorous manual exam of the abdomen, and said the fact that the nausea is a new symptom does not bother him; it's still just stress and IBS. He also mentioned it could be a lingering consequence of the lap belt pulling into the abdomen.
So, after all that, here are my questions:
1) Even though the nausea is a new symptom, is there any reason to think this isn't just stress-induced IBS again? Or is the lap belt a reasonable culprit?
2) One week ago, after the doctor pushed and manipulated my abdomen fairly vigorously/deeply, I started to feel worse -- more persistent low-grade nausea and tightness in the middle of the pelvis. I want to assume this is ME making the symptoms worse because I didn't get the question of "is there a problem in my colon?" answered. Correct? Or do you think it means something is going on down there, and he made it worse?
3) Am I correct that if a colonoscopy came up completely normal three years ago, there's no way I could have symptomatic colon cancer now, especially at my age?
4) Living with IBS, I worry that one day, it really will be colon cancer, but I will just think it's IBS, and so will my doctor, until it's too late. Any suggestions?
Thank you in advance for reading and responding to my exhausting story. I would appreciate as specific and comprehensive a response as possible.
I'm a 35-year-old, healthy male with a history of stress-related IBS that was finally determined as such in 2001 after every test in the books came up negative -- abdominal/pelvic CT, sigmoidoscopy, barium X-ray, colonoscopy, and complete bloodwork, all normal.
Symptoms were lower right quadrant pain radiating into hip, lower abdominal pressure, sense of discomfort radiating into the pelvis/groin/prostate region, etc. Testicular ultrasound and tests for prostate and bladder also negative.
These symptoms are obviously stress-related: I am a medical researcher and a hypochondriac, so I know way too much (or too little) about symptoms, and worry about possible horrible things that will happen to me. They also went away completely once I "got over it," and came back in the past few years only mildly and occasionally during probable stress situations.
My current symptoms include all of the above, PLUS, for the first time, one month of fairly consistent mild/moderate nausea. This has been quite disturbing and uncomfortable. Lower abdomen/pelvis (centered above genitals) feels tight/pressure. Bowel noises as well. Bowel habits don't seem unusual. Definitely feels like I need to release gas/etc. more, although not always successfully. Bowel movement, eating, etc., don't seem to affect symptoms for better or worse; it ebbs and flows on its own during the day (somewhat persistent).
Only recent history is a car accident (4 days before all this started, one month ago) -- broken collarbone from shoulder belt, slight bruising on both hips from lap belt.
My doctor examined me briefly, including a vigorous manual exam of the abdomen, and said the fact that the nausea is a new symptom does not bother him; it's still just stress and IBS. He also mentioned it could be a lingering consequence of the lap belt pulling into the abdomen.
So, after all that, here are my questions:
1) Even though the nausea is a new symptom, is there any reason to think this isn't just stress-induced IBS again? Or is the lap belt a reasonable culprit?
2) One week ago, after the doctor pushed and manipulated my abdomen fairly vigorously/deeply, I started to feel worse -- more persistent low-grade nausea and tightness in the middle of the pelvis. I want to assume this is ME making the symptoms worse because I didn't get the question of "is there a problem in my colon?" answered. Correct? Or do you think it means something is going on down there, and he made it worse?
3) Am I correct that if a colonoscopy came up completely normal three years ago, there's no way I could have symptomatic colon cancer now, especially at my age?
4) Living with IBS, I worry that one day, it really will be colon cancer, but I will just think it's IBS, and so will my doctor, until it's too late. Any suggestions?
Thank you in advance for reading and responding to my exhausting story. I would appreciate as specific and comprehensive a response as possible.
Doctor's Answer
by Kevin Pho, MD, Jan 20, 2005 12:00AM
, Jan 20, 2005 12:00AM
To answer your questions:
1) Certainly IBS can lead to nausea. If most of the initial GI tests were negative, you can consider more specialized testing including esophageal motility or gastric emptying studies.
2) Tough to say - if the colonoscopy and CT scans were negative, it is unlikely that a major GI disease is present.
3) Never say never, but I would say it would be less likely.
4) The best that you can do is maintain routine colon cancer screening. This means a colonoscopy every 10 years, or flex sig every 5 years/stool cards every year.
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.
Medical Weblog:
kevinmd_b
1) Certainly IBS can lead to nausea. If most of the initial GI tests were negative, you can consider more specialized testing including esophageal motility or gastric emptying studies.
2) Tough to say - if the colonoscopy and CT scans were negative, it is unlikely that a major GI disease is present.
3) Never say never, but I would say it would be less likely.
4) The best that you can do is maintain routine colon cancer screening. This means a colonoscopy every 10 years, or flex sig every 5 years/stool cards every year.
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.
Medical Weblog:
kevinmd_b
