IBS or something worse, do I need a colonoscopy?

[SuzanneL]

I am a 43 year old woman and had diarrhea often since I was about 21.  It has gotten worse over the past 5-10 years. (My weight has also gone up about 50 lbs. in the past 15 years.) I have a lot of abdominal pain (gas) and sometimes constipation, plus occasional mucus in the stool and I often get feelings that I have to pass gas or a stool but can't, and it can be very painful down by the anal area when the gas builds up.

I get the diarrhea problems more often if eat greasy foods, if I am very nervous (like if I have to sing in front of strangers), if I have been drinking the night before, after a large meanl, or when I am around the time of my period.  Sometimes I just get it for no apparent reason. Imodium (immodium) helps but not always. I take it pretty regularly at the first sign of any pain or discomfort, and I usually take the kind with the anti-gas medicine added.

Ithe early 90's, I went to various HMO GP's who told me that I had irritable bowel syndrome.  They took stool and urine tests but nothing else.  The same occurred in the late 90's after we moved to another state.  They also suggested fiber products such as Metamucil or Fibercon, but they didn't work.  They tried three different medicines, none of which helped me (and a couple had bad side effects such as making me dizzy or constipated).  

I moved to yet another state four years ago.  My GP here  recommended I go to a gastroenterologist, who is supposed to be the best in town  He also took stool and urine samples.  First he told me to eat more fiber. He suggested All Bran, which Ihad trouble eating because of the taste/texture.  After a week of that, it didn't work, he gave me a drug (don't remember the name but when I looked it up on the net it was said to be an anti-depressant), but it didn't help.

I also went to an allergy doctor and he had me try not eating milk or wheat products for two weeks, but that did not help either.  According to his tests, I have an allergy to rye and wheat so he thought that might the trouble.  Meanwhile, the gastro guy says that he wants to a colonoscopy because I might have cancer or an obstruction. (I don't have weight loss or any bleeding) I made the appointment but canceled it later. I am reluctant to reschedule for several reasons.  I have had this problem for over 20 years so why would it just now be an obstruction or cancer or anything like that?  The doctor did not instill much confidence because he did not seem interested in trying anything else. I don't think he's all that knowledgable because he didn't seem to think that frequent diarrhea would be IBS.  I am reluctant to have a colonoscopy, not just because of the exam itself but because of the night before where I have to not eat solid food for 12 hours (I am diabetic) and because I have to give myself an enema, which sounds unpleasant.

I'm thinking of getting a second opinion before I decide to have this colonoscopy.  What do you think?  Thanks!

[Kevin Pho, MD]

If you are having chronic diarrhea symptoms, you want to rule out the most serious disease first - namely a cancer or obstruction.  Being in the early 40's, the chances of these disease are admittedly low, but given that other tests have come back negative, a colonoscopy would not be an unreasonable option.

This is a comprehensive test that can also evaluate for inflammatory bowel disease or colitis.  

Thus, a colonoscopy is not an unreasonable option.  If negative, you can then consider looking for more uncommon GI conditions (i.e. malabsorption, celiac disease etc).

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

[yoshi]

have you tried eating yogurt with live culture??

[SuzanneL]

So cancer and obstructions are things you can have for over 20 years? That's what I don't understand.

You didn't mention whether you thought a second opinion was a good idea or not.

I have looked at the symptoms for other bowel diseases but they don't seem to fit me.  If they are possibilities, shouldn't the doctor test for those?

Yes, I eat yogurt and it doesn't help.

Thank you for the answers!

Suzanne

[yoshi]

Have you checked for parasitic worms?
If you want to neutralise gas,you can try chewing gum,use GAS X,alkaselzer.
You did not mention any acid reflux medicine like nexxium,prevaicid,prilosec??

[planetmars]

I have had the exact symptoms since I was in my teens...I am now 37 years old and have had 2 upper GI's, gallbladder ultra sound...all normal results.  I have diarreah as you described..when I am nervous, after fatty foods sometimes for no reason, have the gas pains with no bowels...everything you said is cloned to my situation.  This past January I had a 1.5 month flare up of nonstop diarreah which I now attribute to some stressful situations I was going through at the time.   I went to a GI doctor who told me IBS (again) which my Int Doc had told me a couple times before.  So, I did research on a website and found a womens link which had tons of info on IBS.  I think her name is Heather Von Vourous which you can find in your search engine.  I changed my diet to mostly starchy foods, white breads, pasta, rice, banana's, apples without peels, green iced tea, etc...I stay away from red meat, not too much dairy, but I still eat cheese, cereal...Not to mention I lost weight from all those carbs because they are all low in fat.  I take fibercon, acidopholous (good bacteria for your stomach comparable to yogurt) everyday, and I take xanax for my nerves if I know I am going to be in an anxiety situation.  So far, I have been feeling pretty good.  I don't have the diarreah out of no where anynore, sometimes I get gas and my normal morning bowels aren't alway's great, but I feel so much better, and I accept that it is IBS and now know trigger foods & moods will certainly have a huge effect on my stomach!!  Good Luck, Maria

[planetmars]

PS...I also don't want to get a colonoscopy...my doctor perscribed Levbid and said he would see me in three months and then decide if I needed one (colonoscopy) since presently I do not have any other symptoms of Colitis, Crohns etc...I never took the levbid since I changed eating habits and the way I think about things, so I don't plan on getting that awful test until it is necessary or I am at least 45 or 50!!