Disorders involving the function of the digestive system, such as irritable bowel syndrome (IBS), chronic constipation (CC), or Cyclic Vomiting Syndrome (CVS) are diagnosed by a careful discussion between the patient and healthcare provider, a physical examination, and with selected testing.
Accurate diagnosis depends upon how accurately the individual describes his or her symptoms, and how skillfully the doctor interprets them.
The following are examples of symptoms often described due to gastrointestinal (GI) disease or dysfunction that can be confusing.
Gas has many sources and explanations. Everyone’s GI tract contains gas that sometimes escapes from the mouth or anus. Someone who feels “full of gas” may also describe feeling “bloated” or “distended.”
Another person suffering from the release of gas from the anus may describe this as “farting,” “passing gas,” “breaking wind,” or “flatulence.” Fortunately, few of these gas indications are signs of serious disease. Even so, they can be embarrassing and uncomfortable.
It is important that a healthcare provider knows exactly how the gas is occurring. This offers the best chance for a provider to explain and help manage it. Gas and fluid moving through the intestines sometimes causes a gurgling noise described by the word borborygmi.
Even doctors have difficulty defining constipation. Going to the bathroom to have a bowel movement less often may occur in some but not all patients who report being constipated. Some people with constipation may also report straining to pass a bowel movement, hard or lumpy bowel movements, a sense of not passing all of a bowel movement, and the need to use fingers to help to pass a bowel movement. Hard or lumpy bowel movements suggest that the movement of material through the gut may be slowed.
It is important to describe bowel movement habits thoroughly with your healthcare provider. Such details can help your doctor choose the best treatment for you.
Diarrhea has many causes and may occur occasionally or long-term. Diarrhea is present when the bowel movements are loose or watery. The frequent passage of hard bowel movements is not diarrhea. Diarrhea stools are often passed urgently. People may report “accidents” due to failure to find a toilet in time. Diarrhea that occurs suddenly and/or often should be discussed with a healthcare provider. Even short-term cases of diarrhea can cause dehydration.
If you experience any signs of bleeding from your anus, it is important to talk about this with your healthcare provider. Be sure to accurately describe the blood seen in your bowel movements. This may help the provider decide where to look for the source.
Important things to mention are:
- large versus small amounts of blood
- bright red blood on the toilet paper only
- blood mixed in with the bowel movement
- blood associated with diarrhea
- blood associated with painful bowel movements
As mentioned above, urgency can accompany diarrhea. Some people with chronic diarrhea begin to fear sudden bowel movements. As a result, urgency can cause them to reduce social and professional functioning. It is important to discuss with your healthcare provider if your disease is impacting you in this way.
Incontinence or Soiling
Accidental bowel leakage (incontinence, or “accidents”) is understandably distressing to many. This can be especially hard to discuss. They are more likely to occur with loose bowel movements. This occurs especially if the muscle surrounding the anal opening is weak or damaged. It is important that your doctor understands the full details. This
will allow them to track down the cause and recommend the right treatment.
Important things to mention are:
- Is the bowel movement loose and watery?
- How often does it occur?
- Is there any warning?
- Have you sustained any pelvic injury, such as in childbirth?
- How much stool is lost?
- Do you experience staining of the underwear/pad (soiling) or full loss of control?
Straining during a bowel movement usually involves using the abdominal muscles and diaphragm to push down and expel the bowel movement. The diaphragm is a muscle used in breathing located below the lungs. Straining often occurs while holding your breath. Even if the bowel movement is soft, straining may still occur. This may happen due to lack of full control of the muscles which control bowel movements. It is possible to retrain these muscles.
Explaining this symptom fully to your healthcare provider can begin a conversation about the tests available and possible treatments.
Pain in anal area or anus is common. An accurate description is vital to help quickly identify the cause.
Anal fissures are a small tear, often like a “paper cut” in the anal canal. The exposed nerves are very sensitive, and the passage of a bowel movement will cause significant pain and often rectal bleeding. Fissures sometimes accompany the hard bowel movements and straining found with constipation. They typically improve when the constipation is treated.
Hemorrhoids are swollen veins in your lower rectum. If they are outside the anal opening, they can cause severe pain.
Rectal abscess is a hole filled with pus in the anus. It causes extreme rectal pain, passage of pus, and sometimes fever. A rectal abscess rarely goes away on its own. These should be discussed with your provider as soon as symptoms begin to develop.
Proctalgia fugax is sudden, severe pain in the area around the anus. The pain is unpredictable and can begin without warning. It occurs unexpectedly, like a “charley horse,” is very painful, but fortunately lasts only a few minutes. In a few individuals this anal pain can be chronic and difficult to manage.
Gut symptoms may be embarrassing to discuss but paying attention to and sharing these details with your healthcare provider is important to arrive at a correct and timely diagnosis.
Adapted from IFFGD publication #179- Difficult to Interpret Intestinal Symptoms By: Shanti Eswaran MD, Associate Professor, Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, MI; Adapted from an article by: W. Grant Thompson MD, FRCPC, FACG, Professor Emeritus, Faculty of Medicine, University of Ottawa, Ontario, Canada; Edited by: William D. Chey, MD, AGAF, FACG, FACP, RFF Nostrant Collegiate Professor, University of Michigan, Ann Arbor, MI