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Dr. Andrew Rynne

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Hey doctor, Recently last week I came back from Bali

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Dr. Antoneta Zotaj

General & Family Physician

Practicing since :2004

Answered : 1740 Questions

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Posted on Sat, 12 Jan 2019 in Digestion and Bowels
Question: Hey doctor,

Recently last week I came back from Bali and I had a few stomach issues mainly pain in my upper gut. However the last two days I’ve had pain in my lower bowels and I haven’t been able to pass a stool I just get really sharp pains down there whenever I need to pee and I can’t pass anything. Usually I go two-three times a day and I’ve has IBS for a number of years after a clear gastroscopy/colonoscopy last year but I’ve never had constipation before and it’s quite painful. Can certain bugs or parasites cause constipation like symptoms it’s very unsual for me and the opposite of what i am usually like. I don’t eat a lot of junk food either my diet mainly consists of lean meats, fruits and vegetables and I have a daily gut supplement that has a lot of fibre, slippery elm, tumeric so it’s very odd that I am having these symptoms and I can only relate it to visiting Bali last week. What can I do for this is there any tests I should get done?
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Follow up: Dr. Antoneta Zotaj 0 minute later
Hey doctor,

Recently last week I came back from Bali and I had a few stomach issues mainly pain in my upper gut. However the last two days I’ve had pain in my lower bowels and I haven’t been able to pass a stool I just get really sharp pains down there whenever I need to pee and I can’t pass anything. Usually I go two-three times a day and I’ve has IBS for a number of years after a clear gastroscopy/colonoscopy last year but I’ve never had constipation before and it’s quite painful. Can certain bugs or parasites cause constipation like symptoms it’s very unsual for me and the opposite of what i am usually like. I don’t eat a lot of junk food either my diet mainly consists of lean meats, fruits and vegetables and I have a daily gut supplement that has a lot of fibre, slippery elm, tumeric so it’s very odd that I am having these symptoms and I can only relate it to visiting Bali last week. What can I do for this is there any tests I should get done?
doctor
Answered by Dr. Antoneta Zotaj 6 hours later
Brief Answer:
Possible causes and detailed advises for treatment given below

Detailed Answer:
Hello XXXXXXX

Stomach upset can happen in patients that travel and it is most of the time due to viruses and rarely from bacteria or parasites.

Sometimes due to dehydration (loss of fluids) or due to side effects of medication (if you have used anything that has Imodium or so-called Loperamide) or if you are not eating well, there might be constipation happening after a stomach upset starts to settle.

To help with the symptoms I would recommend you to continue taking the fibre supplements and sometimes you can add a lactulose syrup 2 tablespoons a day. This generally should make you pass stools within 24 hours (you might take more then 2 tablespoons a day if it is not helping enough). Meanwhile, try to take plenty of fluids.

It is salmonella infection (important bacterial infection) that can cause constipation with gastrointestinal upset. In this case, the patient has also fever and might have general malaise. Stool cultures are the test to diagnose it but generally may come out negative (they don't show the infection the first week) when constipation is the clinical symptom so it needs to be repeated. Giardia (a parasite infection) is another possible cause of the combination of stomach upset with constipation but it is considered only after the first 10 days with symptoms (after viral infection is ruled out). Stool for ova and parasite and stool antigen for giardia can be used to diagnose it.

To conclude:
- very likely you are having a viral stomach upset and you need to drink plenty, continue with the fibre and take some lactulose syrup to help with the bowel.

- if you have been using Immodium (loperamide) this may be the cause of constipation so please make sure you avoid it.

- If you have fever and general malaise (or you noticed blood with stools) then salmonella typhi can be considered and a visit with your doctor and stool culture sensitivity can be considered.

- If you are having the symptoms for longer then 10 days then giardia infection can be considered and stool for ova and parasite with stool antigen for giardia can be done.
- if you have constipation (not passing any stools) and are not able to pass any gas either and you have nausea and vomiting and your tummy is extending (bloating and getting bigger) then an emergency can be considered (like ileus for example) and in this case you will need to see your doctor urgently to rule it out.

Hope I have answered your question but please let me know if I can assist you further.

Regards,
Dr Antoneta Zotaj
General and Family Physician

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Antoneta Zotaj 0 minute later
Brief Answer:
Possible causes and detailed advises for treatment given below

Detailed Answer:
Hello XXXXXXX

Stomach upset can happen in patients that travel and it is most of the time due to viruses and rarely from bacteria or parasites.

Sometimes due to dehydration (loss of fluids) or due to side effects of medication (if you have used anything that has Imodium or so-called Loperamide) or if you are not eating well, there might be constipation happening after a stomach upset starts to settle.

To help with the symptoms I would recommend you to continue taking the fibre supplements and sometimes you can add a lactulose syrup 2 tablespoons a day. This generally should make you pass stools within 24 hours (you might take more then 2 tablespoons a day if it is not helping enough). Meanwhile, try to take plenty of fluids.

It is salmonella infection (important bacterial infection) that can cause constipation with gastrointestinal upset. In this case, the patient has also fever and might have general malaise. Stool cultures are the test to diagnose it but generally may come out negative (they don't show the infection the first week) when constipation is the clinical symptom so it needs to be repeated. Giardia (a parasite infection) is another possible cause of the combination of stomach upset with constipation but it is considered only after the first 10 days with symptoms (after viral infection is ruled out). Stool for ova and parasite and stool antigen for giardia can be used to diagnose it.

To conclude:
- very likely you are having a viral stomach upset and you need to drink plenty, continue with the fibre and take some lactulose syrup to help with the bowel.

- if you have been using Immodium (loperamide) this may be the cause of constipation so please make sure you avoid it.

- If you have fever and general malaise (or you noticed blood with stools) then salmonella typhi can be considered and a visit with your doctor and stool culture sensitivity can be considered.

- If you are having the symptoms for longer then 10 days then giardia infection can be considered and stool for ova and parasite with stool antigen for giardia can be done.
- if you have constipation (not passing any stools) and are not able to pass any gas either and you have nausea and vomiting and your tummy is extending (bloating and getting bigger) then an emergency can be considered (like ileus for example) and in this case you will need to see your doctor urgently to rule it out.

Hope I have answered your question but please let me know if I can assist you further.

Regards,
Dr Antoneta Zotaj
General and Family Physician

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Antoneta Zotaj 28 hours later
Hey doctor just a follow up I had my stool complex come back and it was all normal no signs of any inscopious bacteria or parasites. Can the stool tests sometimes miss it though depending on the sample provided? I haven’t really been able to pass anything yet I’ve been drinking a lot of water and eating more fibre but no luck as of yet I have however have been passing a lot of gas which I assume is a good sign? I was also prescribed Lactulose 10ml daily to help but I haven’t had a chance to try it. I did try drink some prune juice last night but it hasn’t helped me go I just woke up with a lot of gas and some bowel pains from it. What else can I do to help and is there any other tests or reasoning why this is happening especially since my normal bowel habit is 2-3 times a day?
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Follow up: Dr. Antoneta Zotaj 0 minute later
Hey doctor just a follow up I had my stool complex come back and it was all normal no signs of any inscopious bacteria or parasites. Can the stool tests sometimes miss it though depending on the sample provided? I haven’t really been able to pass anything yet I’ve been drinking a lot of water and eating more fibre but no luck as of yet I have however have been passing a lot of gas which I assume is a good sign? I was also prescribed Lactulose 10ml daily to help but I haven’t had a chance to try it. I did try drink some prune juice last night but it hasn’t helped me go I just woke up with a lot of gas and some bowel pains from it. What else can I do to help and is there any other tests or reasoning why this is happening especially since my normal bowel habit is 2-3 times a day?
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Follow up: Dr. Antoneta Zotaj 5 hours later
Just an update I finally was able to pass a stool but it was quite painful and hard and I also noticed there was a blood streaks in some the stools which has got me a little worried. I did however have a colonoscopy in November last year which came out completely clear so could it possibly be related more so to me being backed up and the hard stool causing inflammation?
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Follow up: Dr. Antoneta Zotaj 0 minute later
Just an update I finally was able to pass a stool but it was quite painful and hard and I also noticed there was a blood streaks in some the stools which has got me a little worried. I did however have a colonoscopy in November last year which came out completely clear so could it possibly be related more so to me being backed up and the hard stool causing inflammation?
doctor
Answered by Dr. Antoneta Zotaj 2 hours later
Brief Answer:
Detailed answer below

Detailed Answer:
Hello,

Thank you for the update. By what you explain very likely you are having constipation. It is normal with constipation to get hard stools and these may scratch the anal mucosa and cause some thin stripes of blood. It is good you are taking water, fiber, prunes, these might help but sometimes when it is so hard to pass stools you will need stool softeners like lactulose. I would say 10 ml is a bit small dose, you need 1-2 tablespoons a day now which is 15-30 ml a day but to better help I would say is best 30 ml. Lactulose is not absorbed in the body, it all stays in the bowel and does not cause problems generally, even though sometimes bloating gas and cramps can happen.

I don't think you have high chance of bacterial or parasite infection at the moment and passing gas and having a bowel movement reduces risks for ileus as well so there is nothing to worry at the moment, just do a good treatment for the constipation.

I hope I have answered your question. Let me know if I can assist you further.

Regards,
Dr. Antoneta Zotaj, General and Family Physician
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Antoneta Zotaj 0 minute later
Brief Answer:
Detailed answer below

Detailed Answer:
Hello,

Thank you for the update. By what you explain very likely you are having constipation. It is normal with constipation to get hard stools and these may scratch the anal mucosa and cause some thin stripes of blood. It is good you are taking water, fiber, prunes, these might help but sometimes when it is so hard to pass stools you will need stool softeners like lactulose. I would say 10 ml is a bit small dose, you need 1-2 tablespoons a day now which is 15-30 ml a day but to better help I would say is best 30 ml. Lactulose is not absorbed in the body, it all stays in the bowel and does not cause problems generally, even though sometimes bloating gas and cramps can happen.

I don't think you have high chance of bacterial or parasite infection at the moment and passing gas and having a bowel movement reduces risks for ileus as well so there is nothing to worry at the moment, just do a good treatment for the constipation.

I hope I have answered your question. Let me know if I can assist you further.

Regards,
Dr. Antoneta Zotaj, General and Family Physician
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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