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Suggest treatment for persistent diarrhea and blood in stool

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Posted on Wed, 5 Apr 2017
Question: When I have diareha for a few days, a bit of blood and mucus in stools and a bit of blood on toilet paper after antibiotics. after a week of diarhea -( I get a long bout of diareha after antibiotics) My rectum? or anus? feels swollen inside but it goes away back to normal after. This happened twice with different antibiotics. Also sometimes mucus and a bit of blood without antibiotics. I have no known food allergies but will have mucus and blood after eating shellfish. Also, after eating pancakes, I get really bad cramp in stomach but it passes quickly.
I have hx of diverticulitis (colonoscopy following flare up found the neuroendocrine tumor - small well differentiated all removed)
Most days, stools are normal, some days, heavy stools like poridge.
I am 52 year old female 10 lbs overweight, full hysterectomy, gallblader gone, had small neuroendocrite tumor removed from rectum in 2015. No medications.
This winter, when laughing I would get what feels like a stitch below the right side of rib cage, below last rib.
For the past few years, I've had sharp or dull pain on the right side just below the last rib, not severe. This last week, I've had a feeling of fullness there, no pain. Same feeling as when laughing but larger.
I just had a checkup with doctor and blood work is normal, ALT is normal.
I have a history of drinking more than I should but I have not been doing so the last 4 weeks (appx 3 glasses of wine of 6 ounces each night)

Awaiting to see G.I doctor but would like your insight

I should have said, my gallbladder was removed several years ago, they found a large stone.
Also Other than the above symptoms, I feel fine, no fever, nausea, normal appetite, I can exercise, good blood pressure.
doctor
Answered by Dr. Ramesh Kumar (1 hour later)
Brief Answer:
All possibilities discussed in details.

Detailed Answer:
Hello,
Thanks for choosing HealthcareMagic for your query,
I am Dr XXXXXXX and will be answering your query,Going through your details there are three possibilities-
1)Most likely your are having overlapping problems.Fullness and a feeling of uncomfort on right side just below the rib can be because of Postcholecystectomy syndrome,symptoms like dull aches indigestion etc can be encountered many years post removal of gall bladder,As the syndome presents many years post cholecystectomy it can often be missed by clinicians.The chronic condition is diagnosed in approximately 10% of postcholecystectomy cases after few years.
Trials and researches show that approxiamately 50% of cases are due to biliary causes such as remaining stone, biliary injury, dysmotility etc.Takingbjustva low fat diet will relieve the symptoms.
The remaining 50% are due to non-biliary causes due to abdominal causes.Diarrhea in postcholecystectomy syndrome is a type of bile acid diarrhea but it is usually not associated with bleeding.

2)Some amount of mucus in the stool is normal; however, significant amounts of mucus and mucus accompanied by diarrhea, or blood may signify an intestinal condition such as infection or inflammation. It can also occur with cancers of the colon or rectum or with bowel obstruction.You had a neuro endocrine tumourvwhich was removed in 2015.Recurrence rates of neuro endocrinal tumours are bit high.I would initially recommend you to go for a stool routine and microscopy test to rule out the possibility of infection or inflammation in intestinal mucosa(Due to bacterial or protozoal infection).If the test is normal a repeat colonoscopy should be done to rule out possibility of tumour.If colonoscopy is also normal digital rectal examination of rectal canal should be done to rule out hemorrhoids.

3) Very likely due to antibiotic therapy the intestinal flora get depleted.depleted intestinal flora is responsible for bouts of loose stools post antibiotic therapy.Probiotics should be taken for long term to replete the already destroyed flora.Once the good bacterias destroyed by antibiotics are relplenished,Overall digestion will improve and your symptoms will settle down.

Please discuss all three possibilities with your gastroenterologist.
I wish i answered your query well,Feel free to follow up.
Regards.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Ramesh Kumar (8 hours later)
"bile acid diarrhea" - I sometimes (rarely) have this type of diarrhea, frothy, yellow. I thought this was from the missing gallbladder.

Could the fullness in the rectum area after too many days of diarrhea be haemorrhoids? I don't get this feeling without several days of diarrhea before.

the pinching or dull pain lower below last right rib, is not always present. The swelling or fullness feeling is new, just started last week. Sometimes I don't feel it, other times I do. Hoping it's just a pulled muscle? but what about that XXXXXXX horse feeling I get there when I laugh?

thank you
doctor
Answered by Dr. Ramesh Kumar (4 hours later)
Brief Answer:
Follow up answer.

Detailed Answer:
Hello again,
As per your query answers are-
1)Yes fullness in rectum can be due to -
*Proctitis is an inflammation of the lining of the rectum. Stool passes through the rectum on its way out of the body. Proctitis can cause rectal pain and the continuous sensation that you need to have a bowel movement or
*It can be Hemorrhoids,Digiyal and proctoscopic examination of patient should be done in physical to rule out the possibility.
*As already adviced Most likely Fullness and a feeling of uncomfort on right side just below the rib can be because of Postcholecystectomy syndrome,However it could just be a muscular sprain also.Take any anti inflammatory muscle relaxant for aday or two if you respond to it ,it can be muscular also.Associated pain with laughing can be a muscular sprain also.

Please discuss all possibilities with your Gastroenterologist.
In case you need any other help feel free to ask.
Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ramesh Kumar (2 days later)
The bleeding in stools seems to follow diarrhea associated antibiotics.
Then, if I have shellfish, that can happen as well just once after.
Or the other day, I jogged, and the next day there was some red blood on mucus in toilet.
Could it be from foods? My bowels habits always vary (for several years) between normal formed and porridge.

I had a colonoscopy in April 2014 (the small neuroendocrine tumor was removed at the time) , then sygmoiscopyanal ultrasound and octreoscan, then another sygmoiscopy in May 2015 with a tattoo

I am going for colonoscopy this spring.
Neurodencorine tumors grow very slowly, this one was Net .65cm ki67 <2
1 mm free margins
Well differentiated
Would one grow back again in this short period of time?
I did not have any polyps in 2015, could a polyp or cancer (except NET) have grown since?
or could certain foods and running cause haemorrhoids or proctitis?

another question.
My initial visit to the ER in 2013 was because of bloating (very bloated) could not pass gas, pain lower right abdomen, cramps, nausea, chills.
At the ER, I was diagnosed with diverticulitis and given proper antibiotics. Then had a CT scan to confirm. Followed by a sygmoiscopy where they found a "polyp" in my rectum. Several months later, I had the colonoscopy (April 2014) where the "polyp" was excised. No other words on diverticulitis, I never even thought of asking. I remember him saying, colon looks good.
Then saw the GI specialist and was told the polyp was a Neuroendocrine tumor,.65cm ki67 <2
1 mm free margins
Well differentiated. So from there, another sygmoiscopy, then another with tattoo on site one year later. liver scan, MRI and Octreoscan. All was well.
Doctor plan on colonoscopy this spring.

Spring 2016, pain in lower right quadrant returned, went to ER and because of previous DX of diverticulitis, given same antibiotics. Tmt was successful but took me 2 months to get my bowels back to normal. I went to my physician who told me blood in stools during diverticulitis is normal. I didn't like it but if it's normal then so be it. Lots of mucus, some bright red blood.

Then, went back to normal.
The odd times, I get mucus, but never like after the antibiotics. Then antibiotics for tooth, different kinds but still, had trouble with bm, diarreha, mucus and blood (a bit) after a week of diarreha. Finally took probiotics, things got better.

My question is: Could a small (smaller then 7mm) Neuroendocrine tumor in the rectum cause diverticulitis symptoms?
Are CAT scans reliable to Dx diverticulitis?
Could all of this be diverticulits and the NET an incidental finding at the time of colonoscopy?

Or could the pain, cramps, chills symptoms be related to the small tumor?
The antibiotics made things better.
So many questions, no easy access to specialist
Thank you

and can diverticulitis be missed on a colonoscopy?

My mistake, pain was in the lower left side of abdomen. Sorry for confusion
doctor
Answered by Dr. Ramesh Kumar (13 hours later)
Brief Answer:
Follow up answers!

Detailed Answer:
Hello again,
As per your query allergy to a paricular food is usually not associated with bleeding.Presence of blood in stool means that some where in the gastro intestinal tract mucosa is breached and capillaries are ruptured.
Neuroendrocrine tumour grow slowly in general but it's not mandatory that they always take years to grow back,In some cases even they grow back in few months post removal.
Running or allergy to certain food can aggrevate the symptoms of already occuring Hemorrhoids or proctitis.
For example over oily and spicy food and increase symptoms of Hemorrhoids.

1 year is more then enough time for a polyp or cancer to develop,Best way to rule out possibility is colonoscopy.

Diverticulitis is an inflammation due to infection in one or more small pouches in the digestive tract.Colon contains small pouches called divericula when they get infected by bacteria or protozoa condition is called diverticulitis.I don't thing that rectal tumour has any thing to do with diverticulitis,Both are different entities.

Yes CT scan is gold standard test to rule out diverticulitis.
Chills are usually there when there is some infection in body.So if cramps were associated with chills it can likely be infection(Diverticulitis),Relief on taking antibiotic also favours the symptoms to be likely because of diverticulitis.

Tumour usually don't cause chills.So yes it can be an accidental finding.

Yes diverticulitis can be missed in colonoscopy.Investigation of choice for diverticulitis is CT scan and not Colonoscopy.

Thanks!

Above answer was peer-reviewed by : Dr. Remy Koshy
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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2844 Questions

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Suggest treatment for persistent diarrhea and blood in stool

Brief Answer: All possibilities discussed in details. Detailed Answer: Hello, Thanks for choosing HealthcareMagic for your query, I am Dr XXXXXXX and will be answering your query,Going through your details there are three possibilities- 1)Most likely your are having overlapping problems.Fullness and a feeling of uncomfort on right side just below the rib can be because of Postcholecystectomy syndrome,symptoms like dull aches indigestion etc can be encountered many years post removal of gall bladder,As the syndome presents many years post cholecystectomy it can often be missed by clinicians.The chronic condition is diagnosed in approximately 10% of postcholecystectomy cases after few years. Trials and researches show that approxiamately 50% of cases are due to biliary causes such as remaining stone, biliary injury, dysmotility etc.Takingbjustva low fat diet will relieve the symptoms. The remaining 50% are due to non-biliary causes due to abdominal causes.Diarrhea in postcholecystectomy syndrome is a type of bile acid diarrhea but it is usually not associated with bleeding. 2)Some amount of mucus in the stool is normal; however, significant amounts of mucus and mucus accompanied by diarrhea, or blood may signify an intestinal condition such as infection or inflammation. It can also occur with cancers of the colon or rectum or with bowel obstruction.You had a neuro endocrine tumourvwhich was removed in 2015.Recurrence rates of neuro endocrinal tumours are bit high.I would initially recommend you to go for a stool routine and microscopy test to rule out the possibility of infection or inflammation in intestinal mucosa(Due to bacterial or protozoal infection).If the test is normal a repeat colonoscopy should be done to rule out possibility of tumour.If colonoscopy is also normal digital rectal examination of rectal canal should be done to rule out hemorrhoids. 3) Very likely due to antibiotic therapy the intestinal flora get depleted.depleted intestinal flora is responsible for bouts of loose stools post antibiotic therapy.Probiotics should be taken for long term to replete the already destroyed flora.Once the good bacterias destroyed by antibiotics are relplenished,Overall digestion will improve and your symptoms will settle down. Please discuss all three possibilities with your gastroenterologist. I wish i answered your query well,Feel free to follow up. Regards.