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Constipation with no bowel movement, intense pain in mid abdomen, later diarrhea, normal colonscopy and endoscopy report. Suggestion?

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Hi, I'm a 36 yr old caucasian male - 6'0 tall, 180lbs, don't smoke, a glass of wine a few times a week, not on any meds. I've had these symptoms for 3 years now: i'll be constipated with no bowel movements at all for about a week, a ton of pressure will build up in my entire abdomen, to the point where my movement is restricted because it feels like something will burst. Then i'll have a day of intense pain in my mid-to-upper abdomen, and then i'll have diarrhea for hours, in which it feels like all the waste is "emptied" at once. Then, the cycle starts again. Lately it's been getting worse, to the point where I can barely stand the pain and pressure i've had a colonoscopy and endoscopy which both dr's said looked normal. They suggested it's probably IBS and I should eat more fiber - which, by the way, does absolutely nothing to help. I've tried every probiotic under the sun but for some reason I have a reaction to them. I'll get a fever w/extreme fatigue until I stop the probiotics, and, they don't help anyway. I've tried miralax, but the only thing that happens is i'll have a bowel movement w/a small amount of water - nothing solid. I've also had my thyroid checked several times and always normal. I've tried eliminating dairy and gluten to no avail. In fact, i've tried eating nothing but rice and water for 2 weeks straight and still the same problems. I've been tested for allergies but nothing showed up. Only thing out of the ordinary was a "fatty liver" which my dr said was from "genetics" Sorry to be so graphic but I'm at my wits end.
Posted Sat, 5 May 2012 in Digestion and Bowels
Answered by Dr. Poorna Chandra K.S 31 hours later

Thank you for the query.

Constipation is usually secondary to the following reasons. I will also let you know how to rule each one of them out with various investigations.

- Mechanical obstruction - At your age and with a normal colonoscopy may be secondary to bands or intusussception / volvulus. It requires a contrast CT (Computed Tomography) with enterography to rule this out.

- Slow transit constipation - Primarily an inherent problem with gut muscles and nerves. It is usually associated with lack of urge for defecation; investigated by motility studies and special stains on biopsy. Hypothyroidism is one of the causes of slow transit constipation. Serum level of Calcium and phosphate say about hyperparathyroidism.

- Idiopathic variant & a diagnosis of exclusion. Hence labelled only after ruling out common and rare causes.

- Constipation variant IBS (Irritable Bowel Syndrome) - The abdominal discomfort rather than the constipation is the predominant symptom. I may agree with your doctor on IBS, has a potential to cause such symptoms. Although I think the investigations have to be thorough before the diagnosis.

Based on the clinical profile I would first suggest a contrast CT abdomen and pelvis with CT enterography along with repeated stool examination as the first line of investigation. Rest can be planned in discussion with your Gastroenterologist.

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