fatigue spells accompanied by flatulence/ distention

I am mid twenties in age.  For the last 10 - 12 years I have suffered from daily onsets of fatigue and flatulence/ distention.  I am very flatulent, almost independent of diet.  The fatigue is sometimes profound and can cause temporary noticeable cognitive impairment.  It is also quite different from the sleepiness one may experience at the end of a long day or after having gotten inadequate sleep.  

******The two symptoms exhibit an unusual pattern:  they always accompany each other.  That is to say, never does one occur without the other also occurring.  So, if the GI symptoms are present, then fatigue symptoms are present.  And if fatigue symptoms are present, then the GI symptoms are present.  This holds true also for stages of onset and passing.******

I am in quite good health, both physically and psychologically.  I have been tested very extensively for GI disorders.  Some observations of abnormal tissue colouration or motility have been noted, but never with sufficient evidence for a reasonable diagnosis.

What troubles me:

The biochemical etiology of this is a complete mystery.  What is causing the fatigue?  And how is it related to flatulence and/ or distention?

Further, I have never met nor heard of anyone who has suffered from this.  Any thoughts?

[LivingInHope]

With your fatigue- do you have any rapid heart beat, very low blood pressure, light headedness?  Have you gotten your ferritin and blood iron levels checked to see if you have low iron in your blood?  One might wonder if you are not properly absorbing iron in your diet.

Another thought- fatigue and an irritable bowel flare up can both be symptoms of stress- even if you don't tend to be an anxious person.  Are you someone who has things that come up that tend to be stressful?

[Dr. Kokil Mathur]

Hi
Welcome to the MedHelp forum!
You are possibly suffering from Celiac Disease/Ulcerative Colitis/Irritable Bowel Syndrome/ Crohn’s disease. All these result in tender abdomen, loose stool or loose stools alternating with constipation, abdominal distention, cramps etc. Parasites in the gut like threadworm, tape worm, giardiasis etc can behave this way. Hence a stool test is a must. Problems of gall bladder and liver or that of pancreas too cannot be ignored. Because of any of the above problems, there is probably blood loss from gut causing anemia. Hence get an occult blood test for the stool. Diabetes and hypothyroidism too cause fatigue and slow the gut and can cause flatulence.
Hope this helps. It is difficult to comment beyond this at this stage. Do consult your doctor. Please let me know if there is any thing else and do keep me posted. Take care!

[arekgb]

I had these same symptoms for about 6 months.  Finally the doctor did bloodwork and I was iron deficeant anemic.  Also had a colonoscopy.  After the colonoscopy I feel 100% normal.  The doctor believes I had some kind of bacterial infection and it was washed out by the prep for the test.  Have you had a stool test to see if there is blood in your stool?

[layeredsnail]

SuriMenopause:

None of these symptoms, no.  I am, however, an athlete, and the effects of the fatigue on my training is significant.  Rarely are the symptoms completely absent, but when they are present I feel much weaker, systemically.  Both strength and endurance decline noticeably.  

Regarding ferretin levels, when I was regularly visiting doctors I would have blood work done periodically.  Typically levels were normal.  On one occasion they were slightly elevated, and on another slightly depressed.  My nutritional profile in general has consistently been quite good.  

The main reason, however, that issues of malabsorption etc. seem unlikely candidates is that the fatigue symptoms immediately pass as the GI symptoms pass.  So it is not a chronic condition.  Whether or not the fatigue is present at a given time depends entirely on how gassy/ distended I happen to feel.  

Finally, the symptoms seem mostly independent of stress.  Even if I'm nicely relaxed for many days the symptoms persist.  They have persisted each day consistently over the years, with not much variation in intensity or frequency.  

[LivingInHope]

Are you saying that you have actually had a high ferritin level at some point?  With the cognitive impairment- like a brain fog?  Would the discoloration in your colon be consistent with a lack of oxygen issue I wonder?  With the intermittant cognitive problems- have you ever had an MRI of your brain?  

I am also wondering if you are suffering from a form of partial dysautonomia- a dysfunction of the autonomic nervous system.  

Have you had any endocrine hormones tested during one of these attacks, such as thyroid function?

[layeredsnail]

First, thanks for the original response, and for this one as well.

Yes, at one point my ferritin level was high (this measurement was taken seven years ago, however).  And yes, the term 'brain fog' is close enough.  Learning new things in this state is very difficult.  Comprehension is sometimes significantly impaired.  For example, I could read over and over a sentence or two, and despite focusing fully on the words, it would not impart much meaning.  

The thought of lack of oxygen is interesting to me.  In general I seem to suffer from poor cutaneous circulation (with often a bluish/ purplish colour to the skin, even in moderately warm settings).  I have wanted very strongly to have brain imaging scans done, but insurance would not cover this without prior appropriate diagnosis.

Regarding partial dysautonomia, I have also seriously considered this.  In the fatigued state I also have difficulty making decisions and am prone to feeling anxious.  It seems, maybe, that nerves responsible for detecting distention of the gut are resulting in this.  

My thyroid function appears to be normal, on the basis of the tests I have had done.  This holds for other endocrine markers.  However, I am not sure if any of the tests would have been sensitive to fluctuations that might be associated with the coming and going of the spells.

[LivingInHope]

The insurance sounds like it's using a lame excuse- MRI is a DIAGNOSTIC tool- to help find a diagnosis at times, so to say you have to have an appropriate diagnosis before letting your doctor order something that may help lead to a diagnosis sounds to me like another insurance company trying to evade paying for something at the expense of the patient!  Another thought- have you ever had sleep apnea testing (particularly if you have headache with your fatigue)?

[layeredsnail]

Hello,

I have undergone two upper endoscopies, a colonoscopy, and a multitude of tests for biological markers of disease.  You listed:  Celiac Disease/Ulcerative Colitis/Irritable Bowel Syndrome/ Crohn’s disease.  Among these, all has been ruled out with exception of IBS.  IBS seems to be a heading for a somewhat nebulous group of symptoms.  In that event, though, that I do suffer from IBS, then the only apparent symptom is the excessive flatulence/ distention.  

A stool analysis had been done a couple years following initial appearance of the symptoms.  No evidence was found suggesting parasitic presence, and I do not suffer from bouts of diarrhea (that might be expected in the event of parasitic colonization).  

My gastroenterologist and I both acknowledge that I did not likely have IBS, but on the basis of findings in this study (http://www.ncbi.nlm.nih.gov/pubmed/16454838) I went ahead and tried a 10 course of rifaximin, without change.

Gall bladder and pancreas function were both normal.  

A scan of circulation in the gut was also performed, and the outcome was normal.  

I have also been tested (by blood analysis) for diabetes and hypothyroidism (on multiple occasions), each time with a negative result.  

[layeredsnail]

The thread below is of interest to me, as the symptoms described are similar.  The main differences between my case and this case are patient ages, the fact I have not suffered from diverticulitis, and of course, my sigmoid colon was not removed.

http://www.medhelp.org/posts/Gastroenterology/Explosive--continuous-stomach-gas-and-fatigue/show/234833

In the thread's last post a user directs us to another (apparently) similar case:  http://www.medhelp.org/posts/Gastroenterology/fatigue/show/524358

[layeredsnail]

Hypochlorydia is of some interest to me.  I read in the wikipedia article (http://en.wikipedia.org/wiki/Achlorhydria) that this can cause GERD-like symptoms but haven't been able to verify this in a more reliable source.  In any case, I do suffer from chronic GERD.  For this I use calcium glycerophosphate tablets (Prelief), which significantly reduces symptoms.  

Foods rich in protein tend to trigger the most intense episodes of flatulence/ distention (and therefore fatigue, too).  This observation supports the hypothesis of hypochlorydia.  Still, even if I do suffer from hypochlorydia, I cannot explain why the flatulence/ distention is associated with fatigue.

[tabiatha]

I suffered from the same symptoms for 6 years. I was at my lowest point of depression, after having spent years researching the source of my horrific flatulence, brain fog, thyroid problem, adrenal fatigue, memory loss and exhaustion and finally a my latest gastroenterologist pointed out that my pain in my side (  which i thought was diverticulitus) was actually caused by a condition called conchochronditis.  I made an appointment the next day with a chiropractor.  He did x-rays and found that my spine was so mis aligned that it was causing pressure against my ribs.  take a look at a autonomic nervous system chart and you will find your answer.  the nerves that were being pinched were actually nerves affecting my stomach, large intestings, pancreas, etc...  Now I have lots of visits to the chiropractor to look forward to but I can't tell you how happy I am to have found an answer to this most embarrasing issue.   I have a bachelors in computer science and an MBA and for year, I could barely form complete sense or think straight due to this issue.  Not to mention, the embarrasing gas that pretty much kept me in isolation. For six sad years.  I hope this is your problem too so you can begin finding relief.  No one understands how difficult it is to lose your mental ability and not be able to control gas.