Painful digestive condition - causes?

July 4, 2012 8:23 AM

Embarrassing, uncomfortable digestive condition - what the heck is it? I regularly experience pain, constipation, bloating, and flatulence. I also get rashes regularly. I eat healthy and drink lots of water. Bread seems to trigger it - is it IBS, celiac, or something else?

Hello everyone,

I'm 21, male, and about to be a senior in college.

For the past few years, I have been dealing with a very irritating digestive condition. It really flared up when I started college (bad roommate and a whole new level of stress).

What happens is that I will get constipated for a few days, with bloating and discomfort in the abdomen. Sometimes, it feels like there is hot lava in there. I feel the urge to have a bowel movement several times a day, but all I will get is a small amount of pellet stool that doesn't come out very easily.

Then, at some point (often after I eat a lot of fiber), I have to rush to the bathroom and I have diarrhea or loose stool. As soon as I step out of the bathroom, I find myself having to go again!

The diarrhea or loose stool is sometimes accompanied by a bad taste in my mouth.

I don't remember having problems to this extent when I was younger, though I often had excessive gas.

I remember having more bowel movements per day as I got older. However, I first really noticed this cycle about four years ago, the summer before senior year of high school, when I studied for three weeks in a country with "contaminated" water. I remember having to run to the bathroom with diarrhea almost every day in the middle of class!

My senior year of high school, I was OK for the most part, but when I got to college, with its added levels of stress, the condition became worse than ever.

I had a full endoscopy/colonoscopy/sigmoidoscopy done last year. Nothing was found except for a small polyp that was cut out. What else could it be?


Also, this condition (especially in the constipation "phase") can flare up as I am ready to go to sleep, and probably has caused me to lose sleep many times. Drinking water soothes the discomfort and can help it "advance" to the diarrhea phase (the diarrhea is actually less painful than the constipation, not that it is in any way pleasant).

IBS-C is where the diagnosis stands - for now. However, IBS is ONLY based on symptoms, not on causes - hence, why I feel this needs to be investigated. I need to find the root of the problem.

I forgot to add: I get terrible rashes on my hands (wrists, top of hands, and thumbs). They are worst in the winter, but can return at any time of year. Corticosteroids help; however, I don't know what causes them in the first place. They are ugly, itchy, and bleed easily. Are they related? I have seen reports of rashes in certain digestive disorders.

I remember getting a similar rash around my lips starting from when I was ~ 12 years old. It would come back regularly, and various creams were prescribed. I haven't had it for two or so years (knock on wood), but of course, that's when the hand rash started.

Now that I think of it, I remember getting constipated often as a child along with the aforementioned excessive, embarrassing gas. My parents had to give me laxatives of various types.

Fiber/water can only help so much. They make it easier to "go", as they should, but only in relative terms. The pain and bloating don't go away easily.

Bread seems to trigger the condition. Is it gluten? High fructose corn syrup?

I remember a few years ago, I went for a blood test for food allergies. They tested milk, wheat, tree nuts, etc., with completely negative results; however, I'm not sure if this tested for celiac (sprue) or intolerances. Should I ask my doctor if the aforementioned conditions should be tested for? Any others?

posted by Seeking Direction to health & fitness (28 answers total)

IBS-C is where the diagnosis stands - for now. However, IBS is ONLY based on symptoms, not on causes - hence, why I feel this needs to be investigated. I need to find the root of the problem.

Stress can certainly be a cause in itself. I know because I had IBS symptoms and had everything checked out. After dealing with the stress, the symptoms went away. And you sound worried about this in a way that may be exacerbating it.

That said, as long as you're checking things out, also check your thyroid levels. Hyperthyroidism can cause stress and IBS in itself.
posted by vacapinta at 8:40 AM on July 4, 2012

My understanding is the only really reliable way to test for celiac is via a biopsy, which you would remember. It does sound like that's probably a decent next step for you.
posted by restless_nomad at 8:43 AM on July 4, 2012

Get a blood test for Celiac. I know you had the endoscopy but it's not always accurate. Did they specifically look for Celiac? I would suggest giving up gluten for at least a month as a trial. One can be gluten intolerant without having Celiac and there are no lab tests to show it - the only way to know is to entirely stop eating it and see if you feel better. If that doesn't do it you might contemplate a really rigorous elimination diet while keeping a log in order to figure out what foods are causing your woes. It's a long, tedious experiment but it's often the only useful way to fix this sort of woe.

Also while checking your thyroid is definitely a good idea the symptoms you mention would be more likely to indicate hypo-thyroid than hyper - under not over-active.
posted by leslies at 8:46 AM on July 4, 2012 [2 favorites]

Get the celiac blood test while you are still eating gluten.
posted by Max Power at 8:50 AM on July 4, 2012

Anecdotally, I've known a couple of people whose digestive systems never recovered, after time spent in developing countries where they were exposed to some particularly exotic and tenacious pathogen. Make sure you tell any investigating physician about the trip you took.
posted by fingersandtoes at 8:53 AM on July 4, 2012 [2 favorites]

The simplest way to check if you're gluten intolerant (Celiac or otherwise) is to stop eating gluten entirely and see how you feel.

If your symptoms vanish then you have your answer. You don't necessarily need to get a biopsy to prove it -- if cutting out gluten works it works.
posted by imagineerit at 8:56 AM on July 4, 2012

If you are thinking celiac/gluten, don't forget that beer has gluten. You are at the age where maybe you have just started drinking beer, so I thought I would point that out.
posted by CathyG at 8:56 AM on July 4, 2012 [1 favorite]

Oh and I wanted to add that eating totally gluten-free can be challenging, as their are lots of products that you wouldn't expect to have gluten that do, and lots of products that are produced in facilities that use gluten and someone whom is very sensitive to it could still be affected.

So read those labels!
posted by imagineerit at 8:57 AM on July 4, 2012

I have IBS but not Celiac. I've been unable to find a particular food that causes the symptoms, unfortunately. But you have some evidence that gluten could be an issue, so do what everyone is saying and get tested for Celiac.

If you're not already keeping a food diary, you should do that as well. If it's not Celiac, knowing what you've eaten and what symptoms you've had can help you better understand what foods you might want to avoid.
posted by tommasz at 8:59 AM on July 4, 2012

When you say fibre helps, what kind of fibre are you using? If it's not already psyllium husk, a dessertspoon of that with every breakfast might settle things down a lot.
posted by flabdablet at 9:14 AM on July 4, 2012

My husband has Celiac and gets rashes and constipation when he's glutened. We actually have not found it that difficult to eat gluten free (and he's a pizza and beer lover!). There are SO many products on the market these days that your average supermarket will probably have a good GF section.

But I'd get tested. Best to know for sure.
posted by PhoBWanKenobi at 9:38 AM on July 4, 2012

Are there any daily medications that you take? Including supplements and/or vitamins? There might be something that's contributing to this condition unexpectedly.
posted by blaneyphoto at 9:40 AM on July 4, 2012

Wow, sounds like my wife before we nuked grains, wheat, etc.

She also can't eat peppers.

Consider a bone density test. And forget about drinking beer ever again.
posted by rr at 9:57 AM on July 4, 2012

GI food-related diseases can be pretty darn tricky to diagnose and pharmaceutical treatment is not terrifically helpful (as you've found). Most effective treatment is generally eliminating the offending food products. If you find that eliminating gluten produces benefits, getting a biopsy and an official diagnosis won't change that or the treatment. So why not give it a shot and see what happens? If you want to be very safe about it, try this elimination diet and see where symptoms start popping up again:

1) No milk, no carb sources that aren't non-starchy vegetables (i.e. only tomatoes, spinach, greens, carrots, cucumbers, etc)
2) Add in non-starchy fruits (e.g. berries, oranges)
3) Add in starchy vegetables (sweet potatoes, yams, parsnips, etc--but not white potatoes)
4) Add in starchy fruits (bananas, mangoes, etc)
5) Add in white potatoes/red potatoes
6) Add in non-gluten carb sources (rice, gluten-free oats--careful with the oats, some oats are processed in facilities that process gluten)
7) Add in milk products
8) Add in gluten products

Celiac is sometimes used as a catch-all term to cover a variety of food allergies, so if you follow the above steps you're pretty guaranteed to find out at what point your body starts reacting to the most common GI stressors to people with your types of symptoms. You may also want to lay off the fiber supplements and replace them with extra vegetable intake until you're sure they aren't exacerbating the issue.


(Re: contaminated water--I'm going to assume you were checked out and treated for any possible parasites? If so and you're clear, then keep in mind that sometimes allergy issues stay relatively dormant until the immune system becomes sensitized due to an outside infection or irritation. That is, your body was relatively OK with your food allergies, but then you came in contact with outside contamination, that got your immune system riled up, and led to it being reactive towards your allergens to a degree it wasn't in the past.)
posted by schroedinger at 10:01 AM on July 4, 2012 [1 favorite]

Er, rr's post reminds me that sometimes people have issues with the so-called "nightshades" as well--peppers, tomatoes, eggplant. So perhaps Step (1) is eliminating those as well, and add those in before you add in the non-starchy fruits.
posted by schroedinger at 10:03 AM on July 4, 2012

When I had some allergy tests a few years ago, The allergist said not all foods will test positive, so they recommended an elimination diet.

On preview, schroedinger just suggested this.
posted by annsunny at 10:03 AM on July 4, 2012

I had similar symptoms and after several doctors and endless tests that showed nothing, tried an elimination diet. The problem for me ended up being gluten. You can do several of the above suggestions - get the blood test for Celiac disease while you are still eating gluten, get the biopsy to confirm if you want, and then try the elimination diet. I chose to just do the elimination diet and within weeks of quitting gluten I stopped having the gas, bloating, and constant swinging between constipation and loose stools. At the very least, an elimination diet is worth a try, since it's pretty easy to do.
posted by bedhead at 10:13 AM on July 4, 2012

You describe symptoms that I suffered with for 20 years until I quit the gluten. Go get the anti-body test now while you still have gluten in your system.
posted by humboldt32 at 10:14 AM on July 4, 2012

Sounds like chronic giardiasis:

Manifestation of infection
...
Colonization of the gut results in inflammation and villous atrophy, reducing the gut's absorptive capability. In humans, infection is symptomatic only about 50% of the time, and protocol for treating asymptomatic individuals is controversial.[4] Symptoms of infection include (in order of frequency) diarrhea, malaise, excessive gas (often flatulence or a foul or sulphuric-tasting belch, which has been known to be so nauseating in taste that it can cause the infected person to vomit), steatorrhoea (pale, foul smelling, greasy stools), epigastric pain, bloating, nausea, diminished interest in food, possible (but rare) vomiting which is often violent, and weight loss.[4] Pus, mucus and blood are occasionally present in the stool. It usually causes "explosive diarrhea" and while unpleasant, is not fatal. In healthy individuals, the condition is usually self-limiting, although the infection can be prolonged in patients who are immunocompromised, or who have decreased gastric acid secretion.[4]

People with recurring Giardia infections, particularly those with a lack of the Immunoglobulin A antibody, may develop chronic disease.

Lactase deficiency may develop in an infection with Giardia, however this usually does not persist for more than a few weeks, and a full recovery is the norm.[citation needed]

Some studies have shown that giardiasis should be considered as a cause of vitamin B12 deficiency, this a result of the problems caused within the intestinal absorption system.[9]

Note the celiac-like villous atrophy and the occasional foul taste in the mouth.
posted by jamjam at 10:19 AM on July 4, 2012 [2 favorites]

One other simple thing to try is a probiotic. I swear by Culturelle. I always use it when I travel, I've been several places with questionable water where others have succumb, and I manged to be ok.

It won't help with an "real" underlying condition so keep getting tested, but it will help to populate your gut with "good" bacteria and might help the recovery...

One final note, the gut is slow to heal and sometimes slow to react - so if you eat something in the morning on Tuesday it might not be until late night Wednesday when you get the reaction...so when you are having a flare up, the food causing the problem may have already left your system...
posted by NoDef at 10:27 AM on July 4, 2012

Hey buddy, I really feel for you. I have a digestive condition (colitis), that is thankfully diagnosed and appropriately medicated, but - like you - getting there was a very, very long journey.

The rashes interest me because I, too, suffer from eczema, and it was one of the first things my gastroenterologist asked me even before they turned me into human fingercuffs.

Hy specialist said, yeah, it's all auto-immune errors where your body perceives something to be a threat that isn't a threat. My colitis seems to have been exacerbated by an episode of food poisoning (like you) that never went away.

Now, given you've had the colon/endoscopy, it's unlikely you have colitis as they would have found it there. However, whilst the medication has certainly helped I still need to practice good "stomach hygiene", if you know what I mean.

Number one on the list is stress. Stress is so very bad for me and my stomach, it's not funny. I have to proactively take a lot of steps in my life to eliminate as much stress as possible. Obviously my diet is constrained in some respects too.

The other thing you should do - which I didn't - is get some blood work done. I'm quite confident that due to my condition I was getting pretty seriously malnutritioned at one stage. I was down to 52kgs, and for a dude who's about 180cm (5, 11"), that's getting pretty lean. Best of luck.
posted by smoke at 3:31 PM on July 4, 2012 [1 favorite]

Did you have your colonoscopy/endoscopy performed during a period of time when you were having symptoms? It's theoretically possible that you could be dealing with a colitis type issue but if you were scoped during remission, your colon could have looked healthy and normal. Unlikely but possible.

I would try a strict Whole30 and see where you stand in a month, symptom wise. If it turns out that you can control this thing through diet, then that's 1000x more pleasant than going out and trying to get a real diagnosis of IBD (believe me).
posted by telegraph at 4:18 PM on July 4, 2012

Man, I feel your pain. I went through something similar for years. A few thoughts:

- Quit gluten for a month. Even if you're not a celiac, you might be gluten intolerant, or wheat intolerant, or just have a sensitive system that reacts to it poorly. And don't mess around. Be serious about it. There's lots of options and advice on the net. Make yourself a plan and stick to it.

- If that doesn't help, quit dairy too. Again, you might just have taxed your gut, and so now it's sensitive.

- You really, really, really need to get tested for parasites. Go to a GI, and do it now while you're in college and have access to health care. Do a complete stool test and see what comes back. Remember to have them test for Blastocystis hominis, even if they've never heard about it. It's a fairly common parasite that they used to think was symptomatic, but are now discovering its awful for people with weakened immune systems, as from Celiac or stress.

- Are you stressed? Is there anything in your life you're not confronting? Turn and face it, and deal with it now, because it's not going to get any easier. Figure out systems and ways of coping that allow you to feel healthy and in control.

- If none of this works, ask your GI about a bacteria breath test and possibly something like Nortriptyline, which cools your gut out at night.

Most importantly, keep looking for answers. There's something messing you up, and you can find it. This question is a solid first step. Keep going. Me-mail me if there's anything I can do.
posted by vecchio at 8:39 PM on July 4, 2012

OK, I should clarify about the diarrhea "phase": it is not explosive or watery, but rather soft, poorly formed stool in large quantities. The last time I had "explosive" or "watery" diarrhea was on the aforementioned trip four years ago.

My problem is constipation for the overwhelming majority of the time.

I will be seeing a doctor and getting some blood tests soon.

I should also mention that I suffer from an anxiety disorder and ADHD. I know I need to treat the anxiety - it is no fun at all - but I really don't want to start with SSRI's.

Thanks everyone!
posted by Seeking Direction at 11:31 AM on July 5, 2012

OK, I should clarify about the diarrhea "phase": it is not explosive or watery, but rather soft, poorly formed stool in large quantities. The last time I had "explosive" or "watery" diarrhea was on the aforementioned trip four years ago.

My problem is constipation for the overwhelming majority of the time.

Explosive diarrhea is associated with the acute stage.

As a chronic condition:

Chronic diarrheal illness

* Diarrhea: Stools are often greasy, foul smelling, yellowish, and may alternate between diarrhea and constipation.

* Abdominal pain worsens with eating

* Occasional headaches

* Weight loss

Giardiasis is also associated with a rash. The Google snippet for the linked site mentions "A reddish, scaly rash often located over the surfaces of the elbows, knees, ...", but glancing over the 18 pages devoted to giardiasis, I didn't find that, and can't guarantee it even refers to giardiasis, if it exists at all.

Giardia can also give you a kind of arthritis referred to as "reactive arthritis."

I'd imagine the most effective test for chronic giardiasis would be the antigen test performed on stool (not the test where they look for oocysts), but I'm not sure.

As for the negative endoscopy, note that giardiasis is a disease of the small intestine.
posted by jamjam at 12:39 PM on July 5, 2012

Nope, very likely not giardiasis. The GI doc looked in the small intestine, and I had specifically told him to look for parasites because of my travel to the country in question, but none were found.

Besides, I emphatically do NOT have chronic diarrhea. It is chronic constipation that OCCASIONALLY attempts to relieve itself with loose, mucus-containing stool.
posted by Seeking Direction at 12:49 PM on July 7, 2012

Thanks for the advice, anyway, and my efforts to find the cause of this frustration continue.
posted by Seeking Direction at 12:50 PM on July 7, 2012

However, there is still a chance it's giardiasis - the GI will continue to investigate and order further tests.
posted by Seeking Direction at 1:00 PM on July 7, 2012