Dr. Noushif. M
Surgical Gastroenterology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I was diagnosed with IBS-D by a gastroenterologist. My CBC, abdominal ultrasound and FOBT were all normal. I was put on one-month medication consisting of Rifagut 550 (twice per day), Colospa Retard (twice per day) and Librax. My only problem was aggressive BM, not diarrhea but a lot of gas after getting up in morning followed by first BM and then another BM in a span of two hours. I weighed 79 kg seven months back and did drop to 72 kg weighed last month. The doctor says this weight loss is clinically not scary. I did consult another doctor who says this to be gut flora imbalance and not IBS as I have not had any relief from IBS medication and he believes my symptoms does not correlate with typical IBS. At present, I have a frequent passing of gas, especially after eating food or dinner. In the morning BM is smooth however I do feel the gas and pressure again in three hours time and this trend is regular. The stomach gets settled after second BM. I do hear stomach growling and if I press my stomach hard I do feel pain like tenderness but only if I press hard otherwise there is not any pain, cramp or anything. I was advised to take Nexium 40 mg empty stomach for three weeks and I am still continuing with my third week. I was asked to quit smoking, alcohol and all non-vegetarian items which I have done from past one week. I am also taking one capsule of 64 billion probiotic daily along with 100 ml Kefir. My breakfast includes probiotic yogurt along with oats. I also have suspected migraine or occipital neuralgia owing to which I have had a lot of Voltaren 50 mg tablets at least 10 to 15 days in a month from past four years.
I really want to understand what is this gas, morning episode BM and stomach growling all about? And how can I get rid of this once for all if it is an issue? Is this gut flora imbalance or IBS? How can I live an effective and healthy life?
Hi,
Welcome to icliniq.com.
Going through your history and reports, I do not feel anything so scary with you. Your reports are absolutely fine. It is very difficult to say whether you have IBS (irritable bowel syndrome) or gut flora imbalance. The diagnosis of IBS is reached when we exclude all other possible common problems, which was done in your case too. Now the basic issues need to be addressed. This includes gut microbe modification too.
So have your probiotics for a month. Maintain the modified diet for long periods. Avoid excess gas forming foodstuffs. Have two to three liters of water daily. Limit your Voltaren (Diclofenac) use. Colospa Regard (Mebeverine) can be used if you have severe symptoms.
Make a habit to spend some time in the toilet rather than rushing after the first BM (bowel movement). The initial BM is the already collected ones in the rectal pouch and the later one is all which comes slowly from above. So it may not be pathologic. Reflux BM can also happen in some after having food which is called exaggerated gastrocolic reflux. All these are normal variants.
Avoid excess stress in life if you have any. Avoid over attention to this problem too. These also will definitely help. If even after 2 to 3 months you are not getting a response, further evaluation includes a contrast CT scan of abdomen and colonoscopy, which you need not think of now.
For more information consult a general surgeon online --> https://www.icliniq.com/ask-a-doctor-online/general-surgeon
Patient's Query
Hi doctor,
Thanks a lot. So should I avoid non-vegetarian and alcohol for some time (say six months) or can have them occasionally? Also since this episode is happening since last seven months, is this all normal to have two BM in the morning? Also, the nausea feeling in the morning is this all part of the same?
Hi,
Welcome back to icliniq.com.
All this can be present in some individuals. Do not get tensed by them. For the time being keep a modified diet for six months consistently and see. Avoid alcohol. You can have nonveg occasionally with less of masala.
For more information consult a general surgeon online --> https://www.icliniq.com/ask-a-doctor-online/general-surgeon
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Surgical Gastroenterology
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