Can constipation alternating with diarrhea be caused by irritable bowel syndrome or gallstones?

Hello,

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No, it does not seem like IBS (irritable bowel syndrome). For diagnosis of IBS, one has to have abdominal pain, altered bowel habits and change in consistency of stools, and a change in the abdominal pain severity after bowel moments. All should be present for three months at least, preferably six months.

I think you have constipation because of various reasons. Like low water intake, an ideal water intake is two liters and more in a day. High meat intake and a low fiber diet such as vegetables and fruits also can cause constipation. It is possible that some ulcer has developed in the anus area due to hard stools, which further led to spasm of muscles around the anal canal, causing further worsening of constipation.

I suggest you increase your water and fiber intake along with the following;

1. Use Polyethylene glycol (stool softner) sachet 3.5 gm twice daily with a glass of water; this will soften the stools.

2. Take Isabgol (Psyllium) husk 3 gm daily once with water.

3. Do regular exercise since it improves bowel moment.

And let me know if you are taking any medicines for this constipation or otherwise? Certain medications can cause new-onset constipation. Secondly, considering your age which is reaching 50 years, it is wise to go for a colonoscopy; this will give useful information about the large bowel overall.

Hello,

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If colonoscopy is normal, then there is nothing to worry about. Colonoscopy will tell us everything. Most gut-related conditions present with common symptoms. It is almost difficult to tell the diagnosis; the seriousness of the issue is based on symptoms only.

The digital rectal examination which you had, tells very little about the thing inside the large bowel. The large bowel is 6 m long, so only colonoscopy is designed to tell things clearly. Constipation itself will not be a problem if it is only caused by a functional slowing of your gut and nothing secondary to a serious condition like a tumor or cancer are present.

You are less than 50 years of age, and most cancers start from developing as a polyp which takes another 20 years to develop into cancer.

Yes, stress can cause altered bowel movements, especially of high severity. However, a day to day stress does not impact the bowel movement much. I do not think gall stones are related to your runny stools or constipation.

Hello,

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I meant that stress could lead to loose stools or constipation. The stress which impairs sleep can also cause altered bowel habits. However, the stress which we take during our routine days, like reaching to office, achieving strict timelines, project completion, and stress-related to household work, does not impair sleep and does not impact the gut.

Can you please explain the runny stools? Are there loose stools like water? Are you unable to control stools? Is there a presence of mucus in the stools?

If you mean diarrhea by runny stools, then diarrhea and constipation are two different things. In some patients with long-term complaints of constipation, diarrhea can be there because of the use of laxative agents. But this diarrhea is called spurious diarrhea or false diarrhea. It is called false because it is superimposed on constipation, and the main problem is constipation.

I hope this is understandable.

Hello,

Welcome back to icliniq.com.

I can understand your situation; it is very tough indeed to deal with such a situation.

Overall it seems that you have altered bowel movements, and it is partly due to stress and partly neglect. You need to get some relaxation, exercise, and good sleep.

I suggest you take Isabgol husk (Psyllium) fiber, two tablespoons with water. This will normalize the stool's form and frequency of bowel movements.

I suggest you take a Polyethylene glycol sachet one to two sachets at night, only in case you are unable to pass stools for more than two days. Polyethylene glycol is also a laxative, but it does not lead to diarrhea in most cases.

I hope this will resolve your problem.

Hello,

Welcome back to icliniq.com.

Well, yes, Bristol stool chart types 6 and 7 are considered diarrhea. It is possible that you have irritable bowel syndrome (IBS). And this, too, is precipitated by stress.

Now it is not only stress that precipitates the symptoms of irritable bowel syndrome; the other things that can bring diarrhea are infections and altered thyroid gland functions (typically hyperfunctioning thyroid gland - a gland in front of the neck). Some parasitic infections can also lead to the same.

If you want, then I can suggest some investigations, namely:

1. Complete blood count.

2. Thyroid-stimulating hormone (TSH).

3. Free thyroxine (T4).

4. Stool detail report plus ova parasites.

If your diarrhea is severe, then I suggest you the following medicines.

1. Isabgol (Psyllium) husk two tablespoons full with water.

2. Use an oral rehydration solution (ORS) of around one to two liters per day.

3. If you have abdominal pain, take Mebeverine (antispasmodic) 135 mg as per need, this is for cramps.

4. Polyethylene glycol, although a bulk laxative, it does not cause diarrhea in already diarrheal patients. Do not take it, for now, to be on the safer side.

We will see if your symptoms improve with the above medicines.

Hi,

Welcome back to icliniq.com.

Free thyroxine (T4) is prohormone thyroxine. It is the functional form of thyroid hormone. It is helpful in looking if there are hyperfunctioning thyroid glands. TSH (thyroid-stimulating hormone) sometimes can come normal in the hyperfunctioning thyroid gland.

No, I do not think gall stones are responsible for it.

Well, morning diarrhea is common in a functional disorder of the gut; by function, I mean rapid passage of the large bowel, but it is not peculiar to IBS (irritable bowel syndrome). But yes, since your stools detail report and CBC (complete blood count) is alright, this more suggests irritable bowel syndrome. Given your age which is reaching 50, it is best to go for a colonoscopy now, just to clear any doubt whatsoever.

Yes, Isabgol that you are taking is fine. Take at least 3 gm of whole Isabgol or 1500 mg of refined Isabgol forms. Do not take Polyethylene glycol for now. We can start it later if Isabgol does not improve your symptoms.

Actually, IBS used to predominate with diarrhea or constipation, but although there are cases where diarrhea is unclassified, we mention that as IBS-intermediate.