I have abdominal discomfort with CT showing lot of stools in bowel. Please help.

Hello,

Welcome to icliniq.com.

I can imagine your reason of concern for such ongoing on and off symptoms.

Well first of all, if it were ulcerative or Crohn's disease it should have shown something abnormal on CT (computed tomography) scan which I presume it did not. However, remember the CT scan reporting is completely a subjective thing. It depends highly on the expertise of radiologists who has reported that. I would urge if you upload the report in reply to this response, I would be glad to see that. There will be no charges for that I will allow you one free follow up.

Now the presence of too many stools is not an uncommon finding on CT Scan. Since it is basically the function of the colon to reserve stools transit them timely in anterograde direction and finally to be evacuated through the rectum and anal canal. If the presence of stool with dilation of the lumen of colon or presence of stools within small bowel (fecalization of small bowel) and/or dilation of the lumen of small bowel suggest an alarming finding. Normally our small bowel does not usually contain stools, it rapidly empties matter to in to large bowel, hence the presence of stool in small bowel suggests an abnormal finding.

I will tell you why this information on CT scan is important. For example, you have a normal size of the lumen of bowel (ideally less than 3 cm of small bowel and less than 5 cm of large bowel) with the symptoms you mention, it can be irritable bowel syndrome with constipation. If the diameter of the lumen is above the normal it can be functional constipation of which two further types. The one is chronic colonic constipation or colonic pseudo-obstruction called as Ogilvie's syndrome. The other where the small bowel is dilated called chronic small bowel pseudo obstruction. I hope you now have an idea why it is important to correlate symptoms with the CT scan findings.

Now coming to your symptoms, the pain or discomfort is often common when bowel loops are distended with gas or stools and your discomfort which readily resolves after you have good bowel movements suggest the possibility of the same and not otherwise due to a serious underlying cause. The intensity of discomfort that changes with the bowel movement again suggests it might secondary to irritable bowel syndrome IBS.

Metamucil is fiber laxative and really it does not have any harm if taken for years and years. The fiber is nonabsorbale molecule it does not go into blood circulation so have no side effects. However, in some it can cause bloating or belching. You can switch to other fibers such as Fibrocol if Metamucil does not suit you. Otherwise, it is completely normal if you want to resume the same.

Take plenty of water it makes stool bulk large and soft and easy to pass. I myself have a habit of taking 3 liters of water in a day and this really makes wonder. You should continue that.

I would wait for your CT scan report to see the findings then I will right you some investigations to rule out other possibilities. I believe you would not have anyone but just to be on the safe side.

Hello,

Welcome back to icliniq.com.

I really wonder that the file you uploaded I can see in console, mean complete dynamic images. I also reviewed the report of CT scan you uploaded (attachment removed to protect patient identity).

Thankfully everything thing seems normal. The bowel wall and diameter of its lumen appears unremarkable. There is one 1.1 cm lesion in the liver, since it is not an contrast enhanced images (intravenous contrast was not given), cannot comment on this. Otherwise, it does not appear concerning to me. So do not worry about it.The colon appears filled with stools, however, it seem normal, and there was no stools (fecalization) in small bowel.

Well skeletal muscles (muscle over our joints, hand, legs) can cause pain, but there are typical features of the pain which arising from the muscle. Such as the pain can be easily brought up while movement of that particular muscle, and it can vanish when particular muscle is in rest or relaxed. Person often feel pain/tenderness on touching the muscle.

There is other set of muscles in the bowel called smooth muscles. They even can bring pain when overstretched such as in abdominal distension, and can generate pain when ulcers/inflammation are there.

I do not know whether you feel signs of skeletal muscle pain, but yes, the smooth muscle in your bowel can cause this discomfort. The condition is called irritable bowel syndrome or IBS. Since you have constipation as a main feature it is termed as IBS-C (constipation).

Well the IBS is itself a huge topic difficulty to elaborate in one page, but this is a disorder with recurrent abdominal pain lasting for three months and the pain resolves after passing stools and given no other explanation for the pain suggestive of IBS. I think that would be easy for you to understand. So basically it is condition of hypersensitive gut.

The treatment is rather straight forward and has three steps.

1. Symptomatic relief-like relieve of constipation with fiber in diet or otherwise, taking plenty of water, exercising regularly particularly swimming, maintaining weight, and avoidance of unnecessary antibiotics. Avoidance of FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diets. The FODMAPs are the diets which produces excessive of gases, they should be reduced or possible completely be avoided in meals.

2. Medicine use. Since your pain very well resolve with the Isphagol and fiber, I am not deemed to prescribe you any medication for now. Because they will add side effects and cost as well. But yes, I can consider you a medication for regular use if your symptoms does not improve with the step. The common medication for this is Mebever 200 mg once or twice daily or tablet Librax one table twice to four times daily before meals. Unfortunately, these both are anti-spasmodic which relaxes the smooth muscles of the bowel and can cause constipation (again a reason I am not recommending you now).

3. Low dose anti-depressant medication is believed that our bowel and stomach secrete large amounts of nervous hormones which cause pain, diarrhea in some, constipation in others. In order to control the excess of these hormones leading to unbearable symptoms, low dose antidepressants can be prescribed. But again I would see if you just improve with step 1 of the management.

So to summarize, your CT (computed tomography) scan is fine. You likely have irritable bowel syndrome. The first step of management discussed above is the preferred and most beneficial method for controlling your symptoms.

Below I write down some investigations, you can get it done in the coming four weeks (not urgent). And once available share with me the reports. I believe they will be normal, but just to be on the safe side.

I hope this helps.