Q. I have recurrent constipation with bloating and gas formation. Are these signs of IBS?

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jan 07, 2021 and last reviewed on: Feb 06, 2021

Hello doctor,

I have been facing stomach issues like constipation for the past several years, for which I have been taking Isabgol for the past decade. For the last four to five years, the constipation was increased, for which I have shown the physician who, after doing a physical examination, said that I have been facing the problem of IBS. He put me on medication for 15 days. Lesuride 25 mg thrice a day and Superia once a day and asked me to take Pegmore instead of Isabgol regularly. This worked well for five to six months. Then, I faced a similar problem again. I again went to the same doctor who suggested taking Ganaton 50 mg forever and asked me to take Pegclear instead of Pegmove. It worked well for some time, maybe for two to three months, but I still faced similar issues like stomach fullness, bloating, constipation.

Subsequently, I showed to a gastroenterologist who prescribed me Cizaspax twice a day, Ganaton total once a day, and Pegred before going to bed. Initially, he prescribed me these medicines for 15 days and later asked me to take them lifelong. These medicines were prescribed to me for the last one and a half years. I have been taking all these medicines on and off but not regularly. But I still feel the stomach fullness, bloating, and hanging sensation in the pelvic zone, which makes me feel like I am carrying a huge weight around my waist area. Even when I sit, it makes me feel that I am sitting on a tube full of air, and while standing for 5 to 10 minutes, I face difficulties. Please advise. My MRI perineum report was normal.

#

Hello,

Welcome to icliniq.com.

Well, I do not know if your treating physician and gastroenterologist told you about avoiding gas-forming diets, reducing weight, and some regular routine exercise? I agree with the possibility of IBS. However, it is always important to rule out diabetes, cholesterol issues, and colon polyps with your age. I did not mean that you have any of these above illnesses, but these are the close possibilities that one must rule out before labeling that IBS (irritable bowel syndrome).

IBS is a diagnosis of exclusion, meaning other close possibilities should be ruled out initially. Celiac disease, carbohydrate malabsorption are some other close differentials that should be ruled out. The medicines you take are good medications otherwise, and you can continue them until another workup is available. Get the following tests and let me know once the reports are available.

I would encourage you to talk to me online via phone or video consultation, on your follow up, as we can discuss in detail the diet plan, exercises, mode of exercises, and some lifestyle modifications which would improve your weight and might help you to withdraw these medications while keeping your problem in remission.


The Probable causes:

IBS, SIBO (small intestinal bacterial overgrowth), Celiac disease, Endocrinopathy such as diabetes, and thyroid issues.

Investigations to be done:

CBC (complete blood count). TSH (thyroid-stimulating hormone). Anti TT IgA and IgG
HbA1c. Fasting lipid profile (on 12 to 14 hours of fasting). LFT (liver function test). Stool for H.pylori. Stool detail report for ova parasites. Stool for reducing substance, fat globules, and Sudan stain. Stools for calprotectin.

Regarding follow up:

Follow up with the above-investigations as advised.


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