Dear Alice-

I am a male, in relatively good health and with no history of serious illness or injury. About 2 months ago, I visited my doctor due to periodic nausea and constipation that I experienced during the preceding 4-6 weeks. I never vomited, but felt like it. The constipation was pretty severe, having a bowel movement every 5-7 days and not producing a normal amount. My diet and sleep patterns were normal before and during this period.

I had both an upper and lower GI (with air) and results indicated no abnormality in colon or bowel. (I assume the intestines would normally be checked during these tests, too, aren't they?). A complete blood workup was performed, again showing no cause for concern. Also, my abdomen was palpitated by the doctor to detect any unusual growths. Shortly after the GI test, my BM returned to normal, and my nausea subsided. But this past weekend the nausea has returned (again, no vomiting occurred). My BMs are slightly off kilter; I have not been able to see a daily pattern to them.

I know this forum is not for diagnosis, but to help us solve some of the questions we have. My one worry is that my doctor is too young to make a diagnosis. Should I seek another doctor? Is this something to worry about? Any clue to what next should be checked?


 Dear Clueless,

These certainly sound like unpleasant symptoms. It can be very difficult to feel so uncomfortable without having a clear answer from your health care provider about the cause. You ask if you should get a second opinion and certainly, if you have that option, it couldn’t hurt to do so. You may want to visit a specialist, a gastroenterologist who may be able to run tests and suggest treatments that your previous health care provider may not have thought of. If this is not an option, you could also try to visit your health care provider a second time and explain that you are still suffering from your symptoms and need additional tests.

It is possible that you are suffering from Irritable Bowel Syndrome (IBS), though that condition isn’t usually accompanied by nausea. However, IBS often does involve feeling gassy and bloated and some people experience this as nausea. IBS can cause either diarrhea or constipation and the cause of IBS is not clear, but the symptoms come and go as you describe. They can be brought on by stress, sadness, certain foods, or the symptoms can seem to appear randomly, with no clear cause.

It may be worth taking note of your diet, level of exercise, stress level, medications, and emotional state, when these bouts of constipation occur. Does the constipation and nausea correlate with any particular stressors? Does it occur around any hormonal cycles? Are your eating or exercise habits ever different during these times? And is your constipation and nausea responsive to over-the-counter medication? Some anti-nausea medications (such as Pepto Bismol for example) can contribute to constipation. If you are using this, it may be more helpful to switch to something gentler on the digestive system, such as liquid antacid. Have you tried fiber, Metamucil, prunes, or other constipation “home remedies?” If none of these have worked, it may certainly be worth a visit to a different health care provider if you continue to have periods of 5-7 days with no bowel movements. If you are a Columbia student, you can make an appointment with a health care provider at Medical Services (Morningside) or the Student Health Service (CUMC).

Besides IBS, there are other possible explanations for your stomach pains and it’s hard to tell from the tests you describe if all of them would have been detectable. Gastroenteritis is an inflammation of the lining of your stomach that is typically caused by a viral infection or bacteria from contaminated food or water. It usually will cause nausea and vomiting, and sometimes diarrhea and cramps.

Ulcers are another possible cause, as are some medications (e.g. some antibiotics can cause upset stomach). More serious issues, like diabetes, liver problems, or kidney problems, can also cause upset stomach. Try to notice as much as you can about the bouts of nausea and constipation (again, your eating exercise, stress, sleep patterns, etc.). Write down whatever you notice and bring this information with you the next time you visit a health care provider.

Wishing you stomach relief,


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