I am 28, male. Why do I have cramps and bloody stools?

Question

Hello doctor,

I am a 28-year-old man who has been dealing with increasingly severe digestive problems for the past year, and they are seriously affecting my quality of life. I have urgent, bloody diarrhea up to 12 times a day, often with mucus, and the cramping in my lower left abdomen is so intense that it doubles me over in pain. I have lost about 25 pounds without trying, and I feel constantly exhausted and have low-grade fevers. The symptoms seem to come in waves; I feel I have a few better days when I think I am improving, then it gets worse again.

I am afraid to eat certain foods or go anywhere without knowing where the nearest bathroom is. This has made me cancel social plans and avoid dating. My doctor first thought it was food poisoning or stress from my job, but several rounds of antibiotics have not helped. What concerns me is that I sometimes see bright red blood in the toilet, and I have been having night sweats. Could these ongoing bloody stools and abdominal cramping be a sign of an inflammatory bowel disease, such as ulcerative colitis?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Based on what you have described, frequent, urgent, bloody diarrhea with mucus, severe cramping, unintentional weight loss, fatigue, low-grade fevers, and night sweats, this clinical picture strongly suggests inflammatory bowel disease (IBD), most likely ulcerative colitis, though Crohn’s disease is also a possible cause, especially if the small intestine is involved.

Ulcerative colitis usually affects the large intestine, beginning in the rectum and often spreading in a continuous pattern. The bright red blood, mucus, and left-sided abdominal cramping you are experiencing are classic signs, especially when they happen along with symptoms at night and weight loss. These symptoms are not common in stress-related or functional digestive conditions like IBS (irritable bowel syndrome). The pattern of symptoms improving and worsening that you mentioned is also typical of inflammatory bowel disease flare-ups.

The fact that several rounds of antibiotics have not helped further supports the idea that this is not a simple infection or bacterial overgrowth. Although stress can make any digestive condition worse, your whole-body symptoms, such as fevers, weight loss, and night sweats, go well beyond what stress alone can cause.

At this stage, I would suggest the following investigations: A colonoscopy with biopsies is the most accurate way to diagnose inflammatory bowel disease.

Get stool tests to rule out infections and blood tests to check for anemia, inflammation (C-reactive protein or erythrocyte sedimentation rate), and vitamin or mineral deficiencies.

If ulcerative colitis is confirmed, treatment usually includes:

Anti-inflammatory medications like Mesalamine.
For moderate to severe disease, corticosteroids, immunomodulators such as Azathioprine, or biologic therapies like Infliximab or Adalimumab.
Nutritional support and possibly Iron or Vitamin B12 (Cyanocobalamin) if there is anemia.

Your quality of life is being affected. The physical symptoms, fear of eating or leaving home, and emotional impacts, such as avoiding social activities or dating, can all be improved with proper treatment. The good news is that there are very effective treatments available now for inflammatory bowel disease. These can reduce flare-ups, bring the disease into remission, and help you live much more comfortably and with confidence.

This situation is urgent. While it may not be life-threatening right now, the symptoms you are having could lead to serious problems, such as severe anemia, dehydration, or damage to your large intestine, if not treated.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.