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I have moderate abdominal pain on left side with white balls in stools. What is my problem?

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

Medically reviewed by

Dr. Vinodhini J.

Published At April 23, 2020
Reviewed AtAugust 9, 2023

Patient's Query

Hello doctor,

I have a gastroenterology issue for over a month. I have a mild to moderate upper and lower abdominal pain on the left side. The pain also extended to my left leg. Also, I pass stool twice a day (diarrhea-like stool) with large white balls in it and I am facing weight loss.

I took Trimebutine and Mebeverine for over four weeks (I have IBS), also I am taking probiotics and digestive enzymes. What is concerning me the most are the large white balls in the stool that are not mucus (they are quite firm) and the weight loss. Due to COVID-19, I want to avoid physically seeing a doctor, so please suggest a possible cause and treatment.

Hello,

Welcome to icliniq.com.

Yes, you might be having IBS (irritable bowel syndrome) and you might have developed small intestinal bacterial overgrowth (SIBO), with IBS which can occur commonly. In SIBO (small intestinal bacterial overgrowth) you get fat malabsorption which can lead to white stools. Can you please tell me whether you get greasy stools and bloating or not? Let me tell you that greasy stools are identified by a foul smell and floating on top of commode water. Also, share how much weight have you lost in how much time? I will start you on the treatment of SIBO, but meanwhile, we have to investigate and rule out other diagnoses whenever feasible for you.

The Probable causes

SIBO.

Investigations to be done

CBC (complete blood count). C-reactive protein. TSH (thyroid-stimulating hormone). Stool routine, examination, and culture. Stool for fat content. Stool for reducing substances. Colonoscopy or Sigmoidoscopy if needed in the future.

Differential diagnosis

Pseudomembranous colitis.

Treatment plan

Tablet Rifaximine 550 mg thrice a day for 14 days, Mebeverine thrice a day.

Preventive measures

Oral rehydration solution. Exercise.

Regarding follow up

After two weeks.

Patient's Query

Thank you doctor,

Sometimes, I do get greasy stools, especially when I have diarrhea. Sometimes I have bloating as well (at least once a week). I have lost 3 kg in one and a half months.

Hi,

Welcome back to icliniq.com.

So you are most probably having SIBO. Your weight loss is not significant but looking into past history of clostridium difficile and your recent antibiotic use, I will definitely want to rule out pseudomembranous colitis (caused by clostridium) if your symptoms do not subside.

The good thing about Rifaximine (already suggested in treatment) is that it can work both in SIBO and pseudomembranous colitis. Please start it and do tell me about the response.

The Probable causes

SIBO.

Differential diagnosis

Pseudomembranous colitis.

Treatment plan

Tablet Rifaximine 550 mg thrice a day for 14 days, and Mebeverine thrice a day.

Regarding follow up

After 14 days.

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

Dr. Arbab Muhammad Kashif Khan
Dr. Arbab Muhammad Kashif Khan

Medical Gastroenterology

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