HomeAnswersMedical GastroenterologyconstipationMy chronic constipation affects my normal life. What should I do?

I experience severe constipation with abdominal pain and inability to pass gas. Please help.

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Ajeet Kumar

Medically reviewed by

Dr. Vinodhini J.

Published At November 25, 2020
Reviewed AtAugust 28, 2023

Patient's Query

Hi doctor,

I am hoping to get a second opinion on my current symptoms. I am a 23-year-old female. I am experiencing severe constipation and inability to pass gas with left side abdominal pain. It feels as if my bowel shrunk down to the size of a pencil. It started with mild constipation and left side abdominal pain a little over a year ago and escalated to this. I have had a colonoscopy and ultrasound, and my gastro said it looked normal, not sure how, as I have only gotten worse, not better. They continue to prescribe me laxatives, which do not help. I get incredibly nauseous and bloat really bad after I eat. The only time I feel relief is if I do not eat for a few days. When I eat again, it all comes back. My doctor advises me to take fiber supplements, laxatives, etc., which do not help. This feels more serious as it is not occasional constipation. It is chronic. This has taken over my life, and nobody answered as I have talked to four doctors about this, at a loss of what I should do moving forward.

Answered by Dr. Ajeet Kumar

Hello,

Welcome to icliniq.com.

I can imagine how much you have been upset about your health. Constipation and left side lower abdominal pain with no alarming features (such as ongoing bleeding, weight loss, reduced appetite, and normal colonoscopy) make me think that you have irritable bowel syndrome IBS-C constipation-predominant. I assume you have heard this term before.

So in IBS-C, it is not uncommon to have constipation, lower abdominal pain, plus association with stomach-related symptoms such as burping, belching, early stomach fullness after meals, upper abdominal pain.

Your previous history of gut infection requiring hospital admission can be a provoking factor in IBS development. Studies show that most patients with IBS have prior gastrointestinal infections. This is medically termed as post infections IBS. I want you to understand two things about your problem. First is IBS will remain with you for life, but symptoms can be well controlled so that it does not affect your quality of life.

The second is IBS is a harmless condition. In the long term would not cause you to develop complications such as narrowing of bowel or cancers. So do not get tensed thinking that it will cause you some serious damage.

The treatment is multidirectional, starting from some symptomatic treatment and later on escalating therapies based on the improvement of your symptoms.

  1. Take tablet Xifaxan (Rifaximin) 200 mg thrice daily for three weeks. This is an antibiotic with a good safety profile and used to correct abnormal gas-producing microorganisms (microbiota).
  2. Avoid FODMAPs diets.
  3. Take tablet Levosupiride 75 mg twice daily half an hour before meals for two weeks.
  4. Do not use Ispagol or increased fiber in diets since they are notorious for increasing gas and bloating. You can take, however, if it does not trouble you. Or use Polyethylene glycol (Miralax) 17 gram twice daily to help your constipation.

Please update me about your symptoms next week as I can reassess your symptoms and adjust medications accordingly. I do not suggest any investigation for now since you already had some. I want you to upload the tests you had already as I review them before embarking on any further tests.

I hope this helps.

Patient's Query

Hello doctor,

I will have to reach out to my gastroenterologist to prescribe me these antibiotics. I have attached the test results. My doctor prescribed me Hyoscyamine, but I have not tried it yet, as I am a little afraid of the side effects, including constipation, which is my main symptom. Do you think this is something that I should be taking?

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

Hyoscyamine is a muscle relaxant of gut smooth muscles and can cause constipation. You should not be taking this. I have reviewed your lab test as well as USG (ultrasound) abdomen. They all are perfectly fine (attachment removed to protect patient identity).

You should start the regimen as I mentioned above and let us see in one to two weeks. I expect that it would take three to four weeks even to affect your gut and before you, and I know an improvement in your symptoms. So I want, and I know that you will adhere to the above treatment regimen for the said duration.

Patient's Query

Hello doctor,

My current gastroenterologist did not prescribe me Xifaxan as she advised that it would not help me being that it’s for "travelers diarrhea". She had me continue taking Miralax and watch my diet. Over this period of time, my symptoms have gotten worse. I have developed joint pain and stiffness along with abdominal pain bloating and swelling. I will wake up bloated even after not eating and when I do eat (depending on how much) I get chest pain and collarbone pain. Not sure why. It feels like a lot of built-up pressure being that It’s very difficult for me to have a bowel movement along with the swelling.

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

This joint pain and stiffness of the joints seems new. Can you tell me more about this? For how long you have developed this? And which joints are involved? Are these small joints of hands and wrists, or large joints like knee, hip, elbow, and shoulder? How long the stiffness lasts?

Patient's Query

Hello doctor,

As for the joint pain, it is my hips, knees, and ankles. My hip joint hurts the worst, I notice when I fast for a day or two and stay with a liquid diet my stomach swelling and joint pain feel much better. But as soon as I start eating again it all comes back. I have attached the results from my X-ray as well as a few blood tests including a breath test I had last year for helicobacter pylori.

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

No, the Prednisone is not necessary at the moment, may we get some more blood tests, and see if you need it later in time? Actually, there are certain conditions with abdominal symptoms with large joint pains namely celiac disease, vitamin D deficiency, food allergies, and rarely Crohn's disease with arthritis; but remember all are treatable things.

Last time I did not suggest any investigations since it was of short duration and negative blood tests for celiac disease, and thyroid, probably more favoring diagnosis of acute gastroenteritis. However, if you were able to take medications then, we would have a good idea, since in case if it were resolved, the diagnosis of acute gastroenteritis and post-infection IBS could have been made.

Patient's Query

Hello doctor,

I saw that my blood sugar was high but my doctor said that was normal. I will check with my doctor to try and get these other laboratory tests done. I believe I have had lipid and HBA1c, I have attached these results. I am not sure if these are the correct ones. I do not know what to take right now to help with any of my symptoms. Right now I am not taking anything besides Tums a couple times a day to help with the bloating. Do you think it could be diverticulitis? Would that come up in any blood tests?

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

The HbA1c, lipid profile, and insulin, are all normal. The fasting blood sugar that you uploaded earlier was high i.e. 109, normal should be less than 100. But remember they are just blood tests, their value depends upon the machine, and the machine can have an error at times. Given your Hb1Ac normal, suggests that you do not have diabetes. You should the other blood tests as suggested including the hydrogen breath test HBT. For bloating, I want you to get the HBT before starting you on any treatment otherwise the results will be masked and erratic.

Hope this helps.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Ajeet Kumar
Dr. Ajeet Kumar

Medical Gastroenterology

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