[18F] Experiencing hot flashes, stomach pain, and rectal prolapse

Patient Description

An 18-year-old female has been experiencing sudden and intense hot flashes during the daytime for the past 2 months, sometimes associated with lightheadedness and a feeling of near fainting. These episodes may be triggered by sugar intake. Concurrently, she reports sharp stomach pain in the lower middle abdomen, rated 8 out of 10 in severity, present for about a year, which is partially alleviated by Bentyl. She also experiences nausea, particularly when she has severe diarrhea, and the smell of food can worsen this symptom. The patient has been dealing with rectal prolapse for approximately a year, which occurs almost every time she has a bowel movement and sometimes requires manual reduction. She has been constipated since around December 2022, which she believes led to the prolapse. The patient also reports watery diarrhea since June, gas, and bleeding between periods. She has a history of Hashimoto's disease and depression, both diagnosed about 4 years ago. Her current medications include levothyroxine, dicyclomine, Linzess, naltrexone, prazosin, and geodone. No known drug allergies have been reported.

Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

Irritable Bowel Syndrome (IBS): This is a common disorder that affects the large intestine and can cause cramping, abdominal pain, bloating, gas, diarrhea, and constipation. The fact that you have both diarrhea and constipation, and that you experience relief from Bentyl (a medication often used to treat IBS) could suggest this condition.
- Treatment for IBS often includes changes in diet and lifestyle, as well as managing stress. In some cases, medication or counseling might be recommended.
Rectal Prolapse: This condition occurs when the rectum (the last part of the large intestine) drops down from its normal position. This can be caused by several factors, including constipation, straining during bowel movements, and weakened pelvic floor muscles. You've mentioned that you've been experiencing rectal prolapse for about a year, which is consistent with this diagnosis.
- Treatment for rectal prolapse usually involves surgery to secure the rectum in place.
Menstrual Irregularities: Bleeding between periods can be caused by a number of factors, including hormonal imbalances, stress, changes in weight, and certain medications. Given your age and the medications you're taking, it's possible that these could be contributing to your irregular bleeding.
- Treatment for menstrual irregularities depends on the underlying cause and may include hormonal therapies or lifestyle modifications.
Hashimoto's Thyroiditis: This is an autoimmune condition that can cause hypothyroidism (underactive thyroid), which can lead to symptoms such as fatigue, weight gain, depression, and sensitivity to cold. You've mentioned that you were diagnosed with Hashimoto's in the 4th grade, so it's possible that some of your symptoms could be related to this condition.
- Treatment for Hashimoto's typically involves taking synthetic thyroid hormone to help restore the body's normal metabolic activity.
Anxiety or Panic Disorder: Sudden, intense hot flashes and feelings of dizziness or near-fainting could potentially be symptoms of a panic attack, which is associated with anxiety disorders. Given your history of depression, it's possible that you could also be experiencing an anxiety disorder.
- Treatment for anxiety disorders often includes a combination of psychotherapy (talk therapy), cognitive behavioral therapy, and medication.

What you can do

Schedule an appointment with your primary care doctor to discuss your symptoms. They may refer you to a specialist, such as a gastroenterologist, for further evaluation.
Keep a symptom diary. Note down when your symptoms occur, what you're doing at the time, and what foods you've eaten. This can help identify any patterns or triggers.
Try to maintain a balanced diet and stay hydrated, especially if you're experiencing diarrhea.
Try to manage stress. Techniques such as deep breathing, yoga, and meditation may help.
Continue taking your prescribed medications. If you're having trouble remembering all of them, consider using a pill organizer or setting reminders on your phone.

What you should look out for

Seek immediate medical attention if you:

Have severe abdominal pain
Notice blood in your stool
Have a fever
Experience severe or worsening rectal prolapse
Have persistent or worsening symptoms despite treatment

Please remember that this advice is intended to be general in nature, and specific causes may not apply to your personal situation. Always consult with a healthcare provider for appropriate examination, testing, and care recommendations.

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1 yr ago

Top picked over-the-counter products for Irritable Bowel Syndrome: American College of Gastroenterology Guidelines