[34F] Experiencing rectal bleeding and gastrointestinal symptoms

Patient Description

A 34-year-old female presents with a two-week history of excessive bright red rectal bleeding, described as enough to saturate a pad. She also reports chronic diarrhea, which has been present for two years following gallbladder removal, and fluctuated between constipation and diarrhea prior to surgery. The patient describes her stools as mushy, occurring 3-5 times daily, with difficulty passing and associated with cramping and gurgling. Bloating has been a long-term issue, notably higher in the stomach, and is somewhat relieved by gas relief medication. Stomach soreness is reported, exacerbated by pressure or touch. The patient has a history of ADHD diagnosed at 7 years old, asthma diagnosed at 5 years old, and is anemic. She is currently taking Symbicort, an albuterol inhaler, Prilosec for heartburn, which she has managed for nearly a decade, and melatonin. She experiences heartburn severity at a level 6, particularly when lying down. The patient has a known allergy to sulfa-based drugs. No recent travel, fever, or chills have been reported.

Arora's Assessment

What might be happening

Based on the information you've provided, here are a few possibilities:

Irritable Bowel Syndrome (IBS): This is a common disorder that affects the large intestine. Signs and symptoms include cramping, abdominal pain, bloating, gas, diarrhea or constipation, or both. IBS is a chronic condition that you'll need to manage long term.
- Treatment usually focuses on relieving symptoms so that you can live as normally as possible.
Inflammatory Bowel Disease (IBD): This term covers conditions that cause inflammation in the lining of your intestinal tract. This can cause abdominal pain, diarrhea, rectal bleeding, and other symptoms. The two most common types are Crohn's disease and ulcerative colitis.
- Treatment for IBD usually involves drug therapy or, in certain cases, surgery.
Gastroesophageal Reflux Disease (GERD): This is a chronic condition where stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus and cause heartburn.
- Treatment typically involves lifestyle changes and over-the-counter medications. In severe cases, prescription medication or surgery might be needed.
Gallbladder Removal (Cholecystectomy) Side Effects: Diarrhea is a common side effect of gallbladder removal. This is because your gallbladder is not present to regulate the release of bile into your intestines, which can result in a faster transit time.
- Treatment typically involves dietary adjustments, such as a low-fat diet, to help manage this symptom.
Hemorrhoids or Anal Fissures: These are common causes of rectal bleeding, especially bright red blood. Hemorrhoids are swollen blood vessels in the rectum or anus, while an anal fissure is a small tear in the thin, moist tissue that lines the anus.
- Treatment typically involves over-the-counter creams or ointments, or in more severe cases, surgery.

Please note that these are just possibilities and not a definitive diagnosis. It's important to consult with a healthcare provider who can evaluate your symptoms and medical history in a comprehensive manner.

What you can do

Dietary Changes: Try to identify any foods that trigger your symptoms and avoid them. Common triggers include alcohol, caffeine, carbonated drinks, chocolate, artificial sweeteners, fried or fatty foods, and high-fiber foods.
Stress Management: Stress can exacerbate symptoms of IBS and GERD. Techniques such as deep breathing, meditation, or yoga may help reduce your stress levels.
Regular Exercise: Regular physical activity can help reduce symptoms of IBS and GERD. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.
Over-the-Counter Medications: Over-the-counter medications can help manage symptoms of IBS, GERD, and hemorrhoids. Always follow the instructions on the package, and consult with a healthcare provider if you have any questions.

What you should look out for

Seek immediate medical attention if you experience:

Severe abdominal pain
Persistent or worsening rectal bleeding
Unintentional weight loss
Signs of dehydration, such as dark urine, dry skin, or feeling lightheaded
Difficulty swallowing
Chest pain, especially if it's accompanied by shortness of breath or arm or jaw pain

Remember, while I strive to provide accurate information, I'm not a doctor. Please consult with a healthcare provider for a formal diagnosis and treatment.

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11 mo ago

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