Are symptoms of abdominal soreness and constipation suggestive of IBS?

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I have reviewed your case history and attached reports (attachments removed to protect the patient's identity).

1. The X-ray image suggests right-sided fecal loading in ascending colon, a common finding in patients with constipation and sometimes in normal individuals. Our colon is very large, and we cannot empty it at once when we go to the toilet. Instead, we pass stools in the rectum or the sigmoid colon. Later, the stools with ascending, transverse, and descending colons move forward.
2. You started Miralax (laxative) just two days, and you are already getting responses. I would recommend continuing the same medicine. The target should be you should be passing stools daily once or twice, and they should be soft, without difficulty. If you have a sensitive gut, like IBS (irritable bowel syndrome), and the more you feel like constipation, it is a sub-class of IBS known as IBS-C (irritable bowel syndrome with constipation).
3. I would suggest continuing with Miralax because you are responding to this. If you are not responding to this, we can change it.
4. The abdominal ultrasound and MRI (magnetic resonance and imaging) without contrast were unremarkable, along with CEA (carcinoembryonic antigen) levels and other blood tests.
5. Have you ever had your colonoscopy? Gaseous distension and soreness will improve once your constipation improves, but you should take daily yogurt or probiotics. This will replace harmful bacteria in the gut with good bacteria, reducing gas production.

I hope this helps.

Thank you and take care.

Hi,

Welcome back to icliniq.com.

Wishing you very good health.

Kind regards.

Hi,

Welcome back to icliniq.com.

I am reviewing the case history in detail along with the attached files (attachment removed to protect the patient's identity).

I have reviewed your history in detail, our previous discussion, as well as both X-rays along with their reports.

A) Both X-rays are almost similar, still significant fecal loading on the right side, even though I feel a bit more fecal loading as compared to the previous one and distended bowel loops.

B) Salt and pepper appearance near the first arrow is actually fecal loading. It seems like the right side is full of stools. For the second arrow you pointed out, it might be stricture, may plain X-ray is not the modality of choice for strictures. Barium enemas (contrast study) or CT (computed tomography) scan abdomen with contrast are better imaging for strictures. They seem to be normal haustrations of the large bowel.

C) Risk factors for SIBO are prior abdominal surgeries, immunocompromised patients, and poorly controlled diabetes. In your case, dysbiosis is more likely due to persistent constipation or fecal loading in the large bowel. Treatment for SIBO and dysbiosis is almost similar

1) I prefer antibiotics and probiotics, both about two to three hours apart (one cannot take probiotics and antibiotics at the same time, atleast two to three hours difference in between).

2) I would like to treat your constipation more efficiently. You should be passing two to three stools daily for a couple of days, so laxatives can be improved or increase the dose. I would prefer antibiotics known as "Rifaxamin," available in 550 mg twice daily, half an hour before breakfast and dinner, for ten days atleast. The good thing about these antibiotics is they will not be absorbed into the blood. They will stay in the gut, will do their work, and go out in stools.

3) Usually, my choice is above antibiotics. Please use probiotics regularly, either yogurt or a commercially available sachet, for two to four weeks.

D) Above management plan will be good. I think constipation treatment with locally acting antibiotics and regular probiotics should work for you.

E) Previously, I asked about colonoscopy. Have you ever had your colonoscopy before? If your symptoms are persistent ever after the above plan, I guess you should consider a proper colonoscopy. One can go in and see the colon from the inside.

I hope this helps you out.

Hi,

Welcome back to icliniq.com.

There are very good laxatives available . If your bowel is cleared once, things will improve a lot. Simple constipation or fecal loading is not an indication of surgery. There must be something very concerning before going for surgery.

I think let us follow the above plan, give ourselves some time, and not worry much. Later on, colonoscopy is an option. Do not think of surgery directly.

I hope this has helped you out.

Hello,

Welcome back to icliniq.com.

I have reviewed your history updates and attached pictures (attachment removed to protect the patient's identity) of different laxatives,

So whenever you take any laxative, it will increase bowel contractions and it causes abdominal pain or discomfort, so my first point is, if you are passing stools on Miralax (Polyethylene Glycol), it will gradually clear you off. Do you feel the amount of stool is very less or something?

Another point, are you looking for a laxative to get rid of your right-sided abdominal discomfort? If yes, any laxative may increase your discomfort because it will stimulate the gut to contract more to get rid of stools,

Now regarding your choice of laxatives, there are two options.

1) You can increase the dose of Miralax (Polyethylene Glycol) gradually. The greater the dose, the more effective it will be.

2) Clenpiq is Sodium Picosulfate, this already works effectively in constipation, but you have to be careful regarding gradually increasing the dose.

If you are able to pass stools two to three times a day, that is enough because it will take a few days for the complete emptying of the bowel.

We go for aggressive bowel emptying when we are preparing patients for colonoscopy, which is actually under supervision, especially at your age.

So the above two options are there. You can choose one as per your comfort level, but the important point is to go gradually, and if you are passing stools a few times a day, that is good. Right-sided abdominal discomfort may go actually, or it may get increase somewhat, considering more bowel contractions.

I hope this has helped you out.

Take care.

Hi,

Welcome back to icliniq.com.

You are absolutely right. Any laxative will cause heaviness if it is not working and you are not able to pass stools. Laxatives are supposed to increase bowel movements rather than reduce as in your case.

I think an emergency department visit is important to rule out any other cause, and I would suggest increasing the laxative dose over there, under supervision. Otherwise, if your problem is persistent, you may need an early referral to a gastroenterologist or general surgeon for a proper review and physical examination.

I hope this has helped you out.

Kindly follow up if you have more doubts.

Take care.

Hello,

Welcome back to icliniq.com.

So directly coming back to your questions.

1) For bowel pathology, a CT (computerized tomography)scan with contrast is the investigation of choice; without contrast, the study will be compromised in terms of reading radiological imaging.

2) Best is intravenous contrast; oral will be less helpful, and even some radiologists prefer good bowel cleaning before a CT scan.

3) Anyone surgeon or gastro person can read it for you. Still, always final opinion will be by the radiologist who will report it officially because it is his job and he/she is trained to read and report radiology/CT scans.

My suggestions,

1) You should meet radiology before going for a CT scan and discuss your case scenario with him in detail, so being an expert in his field, I am sure he can figure out what will work best for you.

A) CT scan with minimal IV (intravenous) contract.

B) CT scan with oral contrast.

C) Barium enema studies or even direct colonoscopy by a gastroenterologist after good bowel preparation.

Wishing you good health.

Kind regards.