Multiple bowel movements in a day

[mkram]

Hello,

For the past week my bowel movements have alternated between diarrhea and more substantive - albeit still watery - bowel movements. The diarrhea usually happens around 9:00AM, the watery bowel movements usually sometime between 10-11:00AM with another in the afternoon, around 3:00PM, and later in the evening, around 8:00PM. I should add that I've had episodes of diarrhea, usually about once a week but sometimes twice a week, for the past eight months.

This has been going on and off for a year or so now, but has only gotten more pronounced in the past few weeks. When my digestive problems first started last year, I would experience pain in my lower abdomen, coupled with either constipation or diarrhea and bloating. He ordered some PET scans, and found nothing. He advised me to eat fiber and yogurt with a probiotic, which helped for a while.

But now things seem to have gotten worse. There are the bowel movements; there is also a persistent fatigue and feeling of muscle weakness. I have started to work out regularly, and in the last two months have dropped 12 pounds, and am now down to 185lbs. I don't know if this from the exercise or diarrhea I've been experiencing. I monitor my fluid intake, am not a smoker and rarely consume alcohol. What is causing this?

[Dr. Kokil Mathur]

Hi!
I can appreciate your well placed concerns. Well, since you had a PET scan, gut cancer as the cause is more or less ruled out.
You could be suffering from an inflammatory bowel condition such as 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. Possibility of H pylori infection should be looked into by carbon urea breath test.
A number of times a gastroenterologist is able to diagnose these conditions by clinical examination and detailed medical history. At other times a few tests are conducted. Blood tests to rule out anemia, stool test to look for white blood cells, sigmoidoscopy, colonoscopy etc are used to diagnose ulcerative colitis. Braium meal and follow through, endoscopy etc are done to rule out GERD, Crohn’s disease etc. Irritable bowel syndrome is diagnosed by elimination of other causes. Gluten is a complex protein present in four main grains---wheat, rye, barley and oats. If you have gluten intolerance, then you probably have celiac disease or Non Celiac gluten sensitivity. There are blood tests called celiac test to detect gluten intolerance. Crohn’s disease is a difficult entity to diagnose. Along with gut symptoms skin disorders and arthritis too are commonly seen with Crohn’s. An upper GI series using barium dye is done to see the condition of small intestines. The degree of involvement of the large and small intestine may vary from person to person.  A biopsy is the most confirmatory. An elevated ESR, low protein, minerals and iron in blood are the other findings in Crohn’s which may or may not be present. A recent advancement in Crohn’s diagnosis is video capsule endoscopy.
A comprehensive investigation is required keeping all the points in mind. Please consult your GI doctor regarding this.
I sincerely hope you will find this information useful in your journey towards better health.
Hope you get well soon! Good Luck and take care!

[mkram]

I should also mention I am a 29 year old male.