[24F] With painful lower abdominal bloating, cramping, and fatigue

Patient Description

A 24-year-old female presents with extremely painful lower abdominal bloating and cramping, fatigue, increased hair loss, and severe gas. The symptoms have been present for a few weeks and are constant and daily. The bloating and gas worsen with eating any food and are somewhat relieved by sleeping. The patient reports a history of Clostridioides difficile (C. diff) infection several months ago and has noticed a significant increase in hair loss over the last few weeks, particularly after showering. She also experiences occasional mucus in her stool, nausea, heartburn, and increased constipation. The patient follows a vegan diet and takes paroxetine, mirtazapine, creatine, vitamin B12, and melatonin. There is a family history of breast cancer, appendectomy, and gallbladder issues. The patient has not undergone any diagnostic tests such as a breath test for Small Intestinal Bacterial Overgrowth (SIBO) or stool tests since the onset of these symptoms.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

  • Post-Infectious Irritable Bowel Syndrome (IBS): This condition can develop after an infection like C. diff. Symptoms include bloating, gas, abdominal pain, and changes in bowel habits (constipation and diarrhea). The exact cause is not well understood, but it is thought to involve changes in gut flora and gut-brain interactions.

    • Treatment: Management typically includes dietary changes (like a low FODMAP diet), stress management, and sometimes medications to manage symptoms.
  • Small Intestinal Bacterial Overgrowth (SIBO): This condition occurs when there is an abnormal increase in the number of bacteria in the small intestine. Symptoms include bloating, gas, diarrhea, and abdominal pain. Antibiotic use can disrupt the normal balance of gut bacteria, potentially leading to SIBO.

    • Treatment: Diagnosis is usually confirmed with a breath test. Treatment often involves antibiotics to reduce bacterial overgrowth and dietary changes to manage symptoms.
  • Food Intolerances: Given your vegan diet, you might be consuming high amounts of certain fermentable carbohydrates (FODMAPs) that can cause bloating and gas. Common culprits include beans, lentils, and certain vegetables.

    • Treatment: Identifying and eliminating trigger foods can help. A dietitian can assist with an elimination diet to pinpoint specific intolerances.
  • Nutrient Deficiencies: Hair loss and fatigue can be signs of nutrient deficiencies, which might be more common in a vegan diet if not well-balanced.

    • Treatment: Blood tests can check for deficiencies in iron, vitamin B12, and other essential nutrients. Supplements or dietary adjustments may be necessary.

What you can do

While you should consult a healthcare provider for a formal diagnosis and treatment plan, here are some steps you can take in the meantime:

  1. Dietary Adjustments:

    • Consider trying a low FODMAP diet to see if it alleviates your bloating and gas.
    • Ensure you are getting a balanced vegan diet rich in essential nutrients. You might want to consult a dietitian for personalized advice.
  2. Symptom Tracking:

    • Use MDandMe to journal your symptoms, track your progress, and get insights. This can help you and your healthcare provider identify patterns and potential triggers.
    • Record your food intake, symptoms, and any other relevant factors (like stress levels) to share with your provider.
  3. Hydration and Fiber:

    • Stay well-hydrated and consume a balanced amount of fiber to help manage constipation and diarrhea. Gradually increase fiber intake to avoid worsening bloating.
  4. Probiotics:

    • Consider taking a probiotic supplement to help restore the balance of good bacteria in your gut. Consult your healthcare provider for recommendations.

What you should look out for

Reasons to seek medical attention more urgently include:

  • Severe Symptoms: If you experience severe abdominal pain, significant weight loss, or blood in your stool, seek medical attention promptly.
  • Persistent Symptoms: If your symptoms do not improve with dietary changes or other self-care measures, consult your healthcare provider for further evaluation.
  • Nutrient Deficiencies: If you suspect nutrient deficiencies (e.g., due to hair loss and fatigue), ask your healthcare provider for blood tests to check your levels.

Remember, while these suggestions can help manage your symptoms, it is important to consult a healthcare provider for a formal diagnosis and personalized treatment plan.

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3 mo ago


People Also Ask


What is Post-Infectious Irritable Bowel Syndrome (IBS) and how is it treated?

Post-Infectious IBS is a type of IBS that can develop after a gastrointestinal infection, such as C. diff. It is characterized by symptoms like bloating, gas, abdominal pain, and changes in bowel habits. Treatment often includes dietary changes, stress management, and sometimes medications to manage symptoms.


What are the symptoms and treatment options for Small Intestinal Bacterial Overgrowth (SIBO)?

SIBO occurs when there is an excessive growth of bacteria in the small intestine, leading to symptoms like bloating, gas, diarrhea, and abdominal pain. It is often diagnosed with a breath test and treated with antibiotics and dietary changes to manage symptoms.


How can a vegan diet contribute to nutrient deficiencies and what can be done to prevent them?

A vegan diet can sometimes lead to deficiencies in nutrients like vitamin B12, iron, and omega-3 fatty acids if not well-balanced. To prevent deficiencies, it's important to consume fortified foods, take supplements if necessary, and ensure a varied diet. Consulting a dietitian can help tailor a diet to meet nutritional needs.


What dietary changes can help alleviate symptoms of bloating and gas?

To alleviate bloating and gas, consider following a low FODMAP diet, which involves reducing intake of certain fermentable carbohydrates. Identifying and eliminating specific trigger foods with the help of a dietitian can also be beneficial.


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