IBS with heavy bloating is causing sleep disturbance. Kindly help.

Hello doctor,

I want to know some general queries about SIBO and IBS-alternating.

Thank you doctor,

I have many queries about my IBS-alternating and SIBO (diagnosed by my gastroenterologist before five years). I shall write to them as I remember them. I have currently been prescribed Colospa-retard, Colonise-forte, and Lactifiber. After two days on Colospa-retard. I had great bloating and pain and decided to stop it but continue with the Lactifiber and Colonise-forte.

I am noticing that I have great bloating in the evenings starting anywhere between 5 - 8 PM and causing me difficulty sleeping. I keep having the urge to fart, but I cannot. It is as if something inside the abdomen has gotten stuck. Sometimes while I have the urge for flatus, I do get moderate burps. It has gotten very bad, that I have to sometimes force myself to have a bowel movement (BM) via digital stimulation. This also releases gas, so I know that the urge for flatus was not totally imagined.

What is the mechanism behind this getting stuck in the evenings and also the increased gas? Does this have anything to do with neural signaling or a mechanical/ bacterial reason? Also, is the increased gas in the evenings something to do with a circadian rhythm of bacteria or whatever?

I notice that the bowel movements are soft, so this is not standard constipation where the stools would be hard from what I have read. Is the inability to have a BM without manual stimulation in the evenings due to the same reason as feeling bloated, or does it have something to do with the feces' nature as well? In the mornings, I can have un-stimulated bowel movements, though they are usually thin.

I have had a coloscopy and endoscopy, and my gastro is recommending a CT enteroclysis for the sake of completion. Nothing conclusive was found in the endoscopy/colonoscopy, and it is getting frustrating to spend so much money and end up with nothing conclusive. Rather than forsake completion, what condition would you guess that might be better diagnosable with an enteroclysis.

Sometimes I feel distended after having a bowel movement but can release this gas via flatulence or burping. Is this due to food moving around in regions of bacteria or an unclenching of the intestines? I often feel very sleepy after afternoon meals, and 30 minutes later, I end up having either some bloating or a BM. Is this sleepiness due to greater activity in my digestive system?

In all, I have had a SIBO breath test, a colonoscopy, and endoscopy and now might have the enteroclysis. What other tests would you suggest, or if you would like more info from me, I can provide it here? From the internet, I have heard about GI motility, comprehensive digestive stool. Analysis/Parasitology tests and gut biome analysis. Would you have any comments about these?

Thank you doctor,

With my queries, I think you have taken a viewpoint that I am getting myself too wrapped up in this and adding to my anxiety. You mention at various places that things are normal or natural and say that I do not have major symptoms.

This is a misunderstanding. I am not able to sleep for two hours in the night due to bloating. I mention the movements in the morning are thin and not sufficient. How are any of these things normal?

In the lack of any effective treatment (I have mentioned I have had this for at least 3 years now), how is a patient supposed to cope? The only way is to gather as much information as they can because this is an unpredictable disease. I think you dont understand that gathering data is a way to reduce anxiety when nothing seems to be working, rather than fueling it.

Yes, the bowel frequency varies for people, but a person can understand when he feels stuck. I think like a human; you would also know what it feels like when you cannot go. So when I say I am stuck, I think I should be taken at face value for knowing the uncomfortable sensations I can feel in my abdomen.

By recommending ceasing manual stimulation, I think you fail to notice that I have to do this otherwise, the bloating will not let me sleep.

About distension, my point was not the movement of bacteria but the movement of partially digested food into regions that have more bacterial concentration.

In particular, I think your suggestions to relax and lead a stress-free life are patronizing, and ineffective for any patient. Do you think that anyone wants a stressful life and that they could not have noticed that they need to reduce stress without this advice? Do you know that 38% of IBS patients have been observed to have suicide ideation due to the disease?

My reason for consulting here is only to gather medical information, the points you have made, I can get from my gastro trying to rush me out of his office for his next appointment. Please help me with my problems.