[30F] With chronic watery stools and family history of Crohn's disease

Patient Description

A 30-year-old female has been experiencing consistent watery stools for almost a full month. She has a history of a wheat allergy and lives a gluten-free lifestyle. Over the last two months, her diarrhea has worsened, particularly after catching the flu earlier this month. Despite taking Imodium almost every day, she still experiences 2 to 4 watery stools daily, and without Imodium, she has around 6 watery stools a day. Each episode of watery stools occurs every few minutes to every 20 minutes. She has not noticed any blood in her stools but occasionally sees mucus. She also reports random cramping in her lower abdomen, described as sharp, nerve-like pain. Additionally, she has lost approximately 5 to 6 pounds in the last two weeks. She has not had any fever or chills but has experienced joint pain and no eye inflammation. The patient has a family history of Crohn's disease and is concerned about whether her symptoms might be related to IBD, IBS, or the Opill birth control she started taking last month. Her medical history includes fibromyalgia, diagnosed in March 2021, and ADHD, diagnosed at age 16. She is allergic to amoxicillin, Bactrim, and Haldol. Currently, she is only taking the Opill birth control and occasionally takes Excedrin for migraines.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some potential explanations for your symptoms:

  • Inflammatory Bowel Disease (IBD): Given your family history of Crohn's disease and your symptoms of chronic diarrhea, weight loss, and abdominal cramping, IBD is a possibility. Crohn's disease and ulcerative colitis are the two main types of IBD. They can cause inflammation and ulcers in the digestive tract, leading to symptoms like diarrhea, abdominal pain, and weight loss.

    • Treatment: IBD is typically managed with medications to reduce inflammation and control symptoms. In some cases, surgery may be necessary. A healthcare provider may recommend tests like colonoscopy, endoscopy, or imaging studies to confirm the diagnosis.
  • Irritable Bowel Syndrome (IBS): IBS is a functional gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits, including diarrhea. While IBS does not cause inflammation or damage to the intestines, it can significantly impact quality of life.

    • Treatment: Management of IBS often involves dietary changes, stress management, and medications to control symptoms. A healthcare provider may recommend a low-FODMAP diet or other dietary modifications.
  • Medication Side Effects: The Opill birth control you started taking last month could potentially contribute to gastrointestinal symptoms, although this is less common. Hormonal changes can sometimes affect bowel habits.

    • Treatment: If the birth control pill is suspected to be a contributing factor, a healthcare provider may suggest trying a different form of contraception.
  • Post-Infectious Diarrhea: Since your symptoms worsened after catching the flu, it's possible that a gastrointestinal infection or post-infectious irritable bowel syndrome (PI-IBS) could be contributing to your symptoms.

    • Treatment: Post-infectious diarrhea typically resolves on its own, but supportive care such as hydration and dietary modifications can help. A healthcare provider may recommend stool tests to rule out ongoing infection.

What you can do

While you should seek medical advice for a formal diagnosis and treatment plan, here are some steps you can take in the meantime:

  1. Stay Hydrated: Ensure you drink plenty of fluids to prevent dehydration, especially given the frequency of your watery stools. Oral rehydration solutions can be helpful.
  2. Dietary Modifications: Continue to avoid gluten and lactose as you have been. You might also try a low-FODMAP diet, which can help manage symptoms of IBS.
  3. Monitor Symptoms: Keep a symptom diary to track the frequency and severity of your diarrhea, any associated symptoms, and potential triggers. This information can be valuable for your healthcare provider.
  4. Limit Imodium Use: While Imodium can help manage acute diarrhea, it is not a long-term solution. Overuse can sometimes lead to complications.

What you should look out for

Seek medical attention more urgently if you experience any of the following:

  • Severe Abdominal Pain: If the pain becomes severe or unmanageable.
  • Blood in Stool: If you notice blood in your stool, which could indicate a more serious condition.
  • Fever or Chills: If you develop a fever (temperature over 100.4°F) or chills, which could indicate an infection.
  • Severe Dehydration: Signs of severe dehydration include dizziness, rapid heartbeat, and decreased urine output.

Reminder

Please remember that while this information can help guide you, it is not a substitute for professional medical advice. It's important to consult with a healthcare provider to receive a formal diagnosis and appropriate treatment.

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6 mo ago


People Also Ask


What are the common symptoms of Inflammatory Bowel Disease (IBD)?

Common symptoms of IBD include chronic diarrhea, abdominal pain, weight loss, fatigue, and sometimes blood in the stool. It can also cause inflammation and ulcers in the digestive tract.


Can birth control pills like Opill cause gastrointestinal issues?

While it's less common, birth control pills can sometimes cause gastrointestinal issues such as nausea, bloating, or changes in bowel habits due to hormonal changes.


What is the difference between IBD and IBS?

IBD is a group of inflammatory conditions, including Crohn's disease and ulcerative colitis, that cause inflammation and damage to the digestive tract. IBS, on the other hand, is a functional disorder that affects bowel habits and causes abdominal pain without causing inflammation or damage.


How can I manage chronic diarrhea at home?

To manage chronic diarrhea at home, stay hydrated by drinking plenty of fluids, consider dietary modifications like a low-FODMAP diet, and keep a symptom diary to identify potential triggers. It's also important to consult with a healthcare provider for a proper diagnosis and treatment plan.

1 Comments


Leo#17

6 mo ago

Wow that sounds really uncomfortable! Hope you're consuming lots of fluids and electrolytes. Have you tried Bismuth subsalicylate if Imodium seems not to be doing the trick?

Also, since this picture raises suspicion for Crohn's disease, have you gotten a recent colonsocopy?

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