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

Answered by
Dr. Arbab Muhammad Kashif Khan
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Apr 23, 2020 and last reviewed on: May 04, 2020

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.

Dr. Arbab Muhammad Kashif Khan

Medical Gastroenterology
#

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 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.


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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.

Dr. Arbab Muhammad Kashif Khan

Medical Gastroenterology
#

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.


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