[64F] With severe lower abdominal and rectal pain, diarrhea

Patient Description

A 64-year-old female has been experiencing severe lower abdominal pain and rectal pain for the past 8 hours. The pain feels boring and creates a sensation of needing to push. She has had diarrhea for the same duration, with loose bowel movements occurring about 8 times in the past 8 hours. Her stool appears brown, sometimes with mucus, and looks like narrowing ribbons. She feels a bit better after going to the bathroom, but the pain and urge to defecate return shortly after. The patient was hospitalized a few weeks ago with rectal bleeding and was diagnosed with gastritis. Since then, there have been no changes in her diet or medications. She has not experienced any nausea, vomiting, weight loss, or loss of appetite. There have been no fever, chills, or recent antibiotic use. No recent changes in bowel habits or blood in stool since the hospitalization. Family history includes colon cancer (father). Past medical history includes fibromyalgia (diagnosed 15 years ago) and hypertension (diagnosed 20 years ago). Current medications include Neurontin (400mg 3 times a day) and Norvasc (10mg once a day). No known allergies or adverse reactions to medications.

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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:

  • Irritable Bowel Syndrome (IBS): IBS is a common disorder that affects the large intestine. Symptoms often include cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both. The feeling of needing to defecate and the relief after doing so are typical of IBS.

    • Treatment: Management of IBS often involves dietary changes, stress management, and sometimes medications to manage symptoms. Fiber supplements, antidiarrheal medications, and antispasmodics may be recommended.
  • Colorectal Cancer: Given your family history of colon cancer and the presence of ribbon-like stools, it is important to consider this possibility. Colorectal cancer can cause changes in bowel habits, abdominal pain, and rectal bleeding.

    • Treatment: If colorectal cancer is suspected, a colonoscopy would be necessary for diagnosis. Treatment options include surgery, chemotherapy, and radiation therapy, depending on the stage of the cancer.
  • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause chronic inflammation of the gastrointestinal tract, leading to symptoms like abdominal pain, diarrhea, and mucus in the stool.

    • Treatment: Treatment for IBD often involves medications to reduce inflammation and manage symptoms. In some cases, surgery may be necessary.
  • Rectal Prolapse: This condition occurs when part of the rectum protrudes through the anus. It can cause a feeling of needing to defecate, pain, and mucus discharge.

    • Treatment: Treatment may involve lifestyle changes, pelvic floor exercises, or surgery in severe cases.

What you can do

While it's important to consult a healthcare professional for a formal diagnosis and treatment plan, here are some steps you can take in the meantime:

  1. Dietary Changes: Try to identify and avoid foods that may trigger your symptoms. Keeping a food diary can help you track what you eat and how it affects your symptoms.
  2. Stay Hydrated: Drink plenty of fluids to stay hydrated, especially if you are experiencing diarrhea.
  3. Over-the-Counter Medications: Consider using over-the-counter medications like antidiarrheals to manage your symptoms temporarily.
  4. Stress Management: Stress can exacerbate gastrointestinal symptoms. Practice relaxation techniques such as deep breathing, meditation, or yoga.
  5. Use MDandMe: You can use MDandMe to journal your symptoms, track your progress, get insights, and share longitudinal medical notes with your healthcare provider.

What you should look out for

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

  • Severe or worsening pain: If your pain becomes unbearable or significantly worsens.
  • Blood in stool: If you notice any blood in your stool, especially given your family history of colon cancer.
  • Fever or chills: If you develop a fever or chills, which could indicate an infection.
  • Inability to pass stool or gas: If you are unable to pass stool or gas, which could indicate a bowel obstruction.

Remember, while this information can be helpful, it is not a substitute for professional medical advice. Please consult a healthcare provider for a thorough evaluation and appropriate treatment.

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3 mo ago


People Also Ask


What are the common symptoms of Irritable Bowel Syndrome (IBS)?

Common symptoms of IBS include cramping, abdominal pain, bloating, gas, and diarrhea or constipation. The sensation of needing to defecate and feeling relief after doing so are also typical.


How does a family history of colon cancer affect my risk?

A family history of colon cancer can increase your risk of developing the disease. It's important to discuss this with your healthcare provider, who may recommend regular screenings like colonoscopies.


What are the differences between IBS and Inflammatory Bowel Disease (IBD)?

IBS is a functional disorder with symptoms like pain and altered bowel habits, but without visible inflammation. IBD, such as Crohn's disease or ulcerative colitis, involves chronic inflammation of the gastrointestinal tract and can lead to more severe complications.


What should I do if I notice blood in my stool?

If you notice blood in your stool, it's important to seek medical attention promptly, especially with a family history of colon cancer. This could be a sign of a serious condition that needs evaluation by a healthcare professional.

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