long, skinny bms

[LaLaNickname]

I am a 38 year old woman; otherwise healthy (regular vigorous exercise, healthy diet, 130 lbs). I have had problems with chronic constipation since I was a teenager, initially brought on, I believe, from holding my bowel movements as a child. I had intussusception surgery at 5 months of age. (Also included removal of appendix.) Over the last year, I have had a variety of digestive problems that come and go. None persist permanently.

I have had aching pain throughout my digestive tract (from my stomach and throughout, but mostly in my bowel on lower left side) that is only relieved by fasting for a few days.
I have had chronic (extreme) bloating, not accompanied by gas or digestive noises. It just goes away, without any relation to passing gas or stool.

After a recent 5-6 week episode of extreme, intermittent bloating, my digestion feels like it is back to normal, but now I have had very skinny stool for the last two weeks. I thought I was probably constipated without any other symptoms, but enemas and extremely high fiber laxative foods (organic prunes, etc) have not changed my stool. I also do not feel constipated or bad at all (my stomach is flat again); I just have the long, very skinny bowel movements.

I do not have much pain at all, with the exception of the random aching of my bowel. (Lower left side.)

I NEVER have:
diarrhea
bloody or dark stool
vomiting
fevers
excessive gas

There is no history of colon cancer in my family

Could adhesions from my infant intussusception surgery be causing my random problems?
Could I have a partial obstruction from chronic constipation that can't be relieved by enemas?
Could stress or anxiety cause my symptoms?
Could a malabsorbtion syndrome cause my symptoms?

I don't want to pay $2,500 for a colonoscopy since most of my symptoms have gone away. Do I need to worry about skinny, long bowel movements with no other symptoms?

Thank you.

[Kevin Pho, MD]

Unfortunately, I'm going to recommend a colonoscopy to evaluate the changes in bowel caliber.  A mass or polyp need to be excluded before considering other causes.

If there is concern about an obstruction, an abdominal CT scan would be the appropriate test.  

To answer your other questions:

i) It is possible, but less likely, that the prior intussusception surgery could be causing your problems, but I would pursue a colonoscopy first.

ii) A partial obstruction would be evaluated with a CT scan.

iii) Stress is possible, but more serious causes would have to be ruled out first.

iv) Malabsorption is also possible, and can be evaluated with a blood test looking for celiac disease or blood tests to exclude fat malabsorption.

A referral to a GI physician to evaluate for these possibilities should be done.

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 Pho, M.D.

KevinMD.com
Twitter.com/kevinmd

[Matthew007]

yeah stress and anxiety (too much) can cause spastic colon/IBS issues...but since you're running and pretty healthy I don't know if that's really your problem...but IBS spastic colon or a low diet in fiber can..and with that would do it.. which makes the pain on the left side happen.. that's one possibility.  

Also left sided pain could also be from diverticulitis or colon pouches from too much pressure (straining)... could be a food allergy as well with the system guarding itself and trying to shed the food.  Since you said you haven't had any blood in the stool that's a good sign because usually lower left abdominal pain can be a sign of chron's...or some colitis like ulcerative colitis with lower left pain..

mm.. there's many it could be.. what you *could* do I guess is try a small amount of citrucel (which is a non-allergenic fiber) and just do one serving or half a day and work your way up to a full scoop or 2  a day but start slowly over a month.  Meantime you could eliminate dairy/lactose to see if you're having some form of food allergy without knowing it.. try that for a week or so.. get tested for celiac (blood test) or go see an allergist to double check and make sure you're not eating something that's ticking the body off...and if it's still there you could try a trial of an antispasmotic like librax or hyscomine (I liked librax..) and see if that calms it down.  Another idea is miralax which is safe long term, start at a full cup daily and back off until the diarerrea stops until you get to that right amount.  Whatever you can to take pressure off that colon.

The colonoscopy though would rule out a bunch of things but I totally understand.. I don't have health insurance and the facility fee.. doctor fee.. the actual procedure.. it all piles up real quick.  Good luck though.  Don't give up and keep exercising and for SURE don't strain or try your best not to.  If all fails you probably should get one just to check for a polyp or something dumb that could be causing it.

[Matthew007]

oh and I forgot your question on malabsorption...that would be a big YES to malabsorption.. stool studies and blood testing would help..allergy to fructose/lactose/gluten could easily cause it as well.  Usually if it's lactose/gluten you have a huuuge list of problems, bloating..nausea but not always..insomnia..but small things like oats..soy .. you could go on a super blah diet of eggs/salads/meats/fruits with zero grains/soy/dairy/lactose for 2 weeks and see if you get lucky or feel tons better..

[Matthew007]

dang I keep doing that.. I keep answering in the expert forum i'm sorry - hope the expert helps you out!

[Lori707]

If your stool is skinny like "pencil size skinny" I would go to a Gastrointerologist. I read that could be caused by an obstruction. If you can possibly get up the money for the precedure, I would go ahead with a colonoscopy. It's important that the worst be ruled out as soon as possible and maybe the Gastro doc would tell you that it's just IBS. He may want you to take a Cat Scan. I'm not a doctor, but I put a high priority on health. Talk to the doctor and ask for consideration on his fee. If he says no, then try another. You may get lucky. Try a clinic.

It's good to test diet yourself for any allergies. I stopped eating red meat and felt better. Then I stopped eating dairy. I took a couple allergy blood tests and I found out that I'm allergic to soy,peanut and orange. Now the allergist wants me to take more blood tests. There are also tests to see if you have any bad bacteria infections or yeast in your digestive system. My doctor tested for 3 and one came out high positive. WOW..I was surprised. I see the doc next week to talk about what can be done.

I know how hard it is to get money up when you don't have it. Like I said, maybe a doc or a clinic would wave a large part of the fee.

Good luck and keep us posted.

[Matthew007]

was it SIBO you tested positive for?  That's the test i'm looking for .. frustrating can't find it.

[aar1151]

I have had ulcerative colitus for many years.  Even when I don't have a flare up my bm's are pencil thin.  My gastro Dr. said it is because my colon has been inflamed for so long, it well always be pencil thing.  (That or diarrhea!!)  aar1151

[Lori707]

I came out high positive for Saccharomyces cerevisiae. IGA and IGG. I looked it up on the web and it said it's yeast. It also determines if a person has just ulcerated colitis or crohns disease. Had bleeding ulcers last year in my decending colon. Doc thought I had colitis but I just had another colonoscopy and he said everythng was clean. Now he's thinking it may have been an eschemic colitis. I don't have the usual diarehia. I'm more prone to constipation. So now, my rheumy tells me I have crohns. My bellie hurts. I see my Gastro doc next week and get the low down on this. Thinking if I should ask him why he didn't have me tested for anything. He should have.

LaLaNickname: All throughout this past 1 1/2 yrs. my stool has changed colors and density, size..etc. I did have skinny stools off and on. I'm attributing mine to inflammation of the colon. But you should really get a colonoscopy.

[LaLaNickname]

Thank you all for your comments. They are very helpful.