How to manage chronic bowel issues and abdominal pain?

Question

Hi doctor,

I have been dealing with chronic abdominal pain with alternating constipation and diarrhea that has really affected my daily life. On my better weeks, I mostly have constipation, usually two to three small or narrow stools a day, and I almost always feel like I have not fully emptied my bowels. Even if I pass a normal-looking stool, I still get this lingering sensation that I need to go again, but nothing comes out.

The pain is pretty constant, about a 3 to 4 out of 10, mostly in the lower left side of my abdomen, which feels like the sigmoid colon area. It is worse in the mornings and tends to ease up after I have a bowel movement.

When I have flare-ups, it usually starts with bad cramping and constipation, then flips into diarrhea, which actually relieves the pain. These episodes usually happen if I overeat, have large meals, or eat spicy or fast food.

This all started suddenly after one particular meal. At that time, I also had a lot of anxiety and panic along with the cramping and diarrhea, but the anxiety part has mostly gone away now.

I have noticed that dairy makes me really bloated. I exercise about three times a week, and it makes my abdomen feel lighter and a bit better overall. I am not taking any medications or supplements right now, and probiotics actually made my constipation worse. What should I do?

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

Thank you for this detailed history. Based on the presentation, you have been experiencing chronic lower left quadrant abdominal pain with alternating constipation and diarrhea for the past four years, with constipation being the predominant baseline symptom. The constipation is accompanied by a persistent sensation of incomplete bowel emptying.

Diarrheal episodes occur during flare-ups, often triggered by large meals, spicy foods, or fast food, and are typically preceded by cramping and constipation, followed by diarrhea and relief of pain. The patient also reports that pain is generally worse in the mornings and improves after bowel movements. Additional findings include bloating with dairy, symptomatic relief with regular exercise, and no mention of alarm features such as unintentional weight loss, rectal bleeding, or anemia.

The clinical pattern is highly suggestive of a functional bowel disorder, most likely irritable bowel syndrome (IBS), with a constipation-predominant baseline (IBS-C) and intermittent diarrhea during flare-ups, consistent with the mixed type (IBS-M). Supporting features include the chronic nature of symptoms, their association with bowel movements, the absence of red-flag symptoms, and improvement with defecation.

Thank you.