Brief Answer:
IBS, chronic constipation, management options

Detailed Answer:
Hello and Welcome

I appreciate your concern

The descriptions indicates IBS ( irritable Bowel syndrome) which can present with abdominal pain or cramping with alternating diarrhea or constipation. Usually the pain is relieved after defecation. However , due to straining during defecation, the pain can persist or worsen afterwards. Stool for routine exam plus ova/parasite and culture can be advised. DRE (Digital rectal exam) can also be done. If the stool are hard then Miralax and sodium picosulfate should be prescribed to see for improvement. Sucralfate and rifaximin or eucarbon are the options to treat IBS. They are usually advised for at least 3 to 4 weeks initially and can then be continued according to the response.

I would empirically recommend a two week course of a course of A PPI like Esomeprazole and a prokinetic like itopride to see for improvement, if symptoms persist then this combination can be alternated with Eucarbon and sucralfate. Mebeverine and hyoscine can be used if spasmodic pain episodes recur at a greater frequency. You may discuss these options with your doctor. Please consult your doctor before starting any medication.

For the accompanying GERD and bloating which is a common occurrence both with chronic constipation and IBS, a PPI like Esomeprazole with a pro kinetic like domeperidone can be added in consult with your doctor. Hyoscine butylbromide can be used for the spasmodic pain episodes. Please consult your doctor before starting any medication.

A high fiber diet, regular exercise , stress management, avoiding smoking ,soft cola and alcoholic beverages will also help as part of life style changes. If the symptoms persist despite the above intervention then a colonoscopy can be considered, in consult with a Gastroeneterologist to rule out malignancy and inflammatory bowel disease.


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Dr. M.S. Khalil

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