What to do about GI concerns

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?

— Clueless

Dear Clueless,

These certainly sound like unpleasant symptoms. It can be very difficult to feel so uncomfortable and not have a diagnosis. If you have the option, it may be beneficial to seek a second opinion from a specialist, such as a gastroenterologist, or visit with your doctor again and explain that your symptoms are back and that you need to pursue other treatments. You mentioned you're concerned about your doctor being too young to make a diagnosis. In order to be a practicing physician, your doctor would have had to complete many years of intensive schooling that would prepare them to make a diagnosis. While an older health care provider may have more experience and have seen more cases, a younger health care provider may be more up to date on their current knowledge of the field. You can't tell how proficient a health care provider will be just by their age, whether they're older or younger. That being said, if you're uncomfortable with what your health care provider has done so far, seeking out a second opinion could be helpful to you. Unfortunately, sometimes finding the appropriate diagnosis and treatment takes some trial and error and a whole lot of patience.

Though your initial gastrointestinal (GI) tests came back with no abnormalities detected, GI diseases can manifest in various ways. Most of the time, nausea and constipation aren’t related to an illness or digestive disorder and often go away on their own. It may be useful to consider managing these symptoms through changes in lifestyle including:

  • Increasing daily fiber intake: Getting the recommended 25 to 30 grams of fiber each day will help to soften stool.
  • Increasing water consumption: This prevents stool from getting dry and, therefore, remains easier to pass.
  • Getting more physical activity: This promotes muscle contractions, including those in the bowel wall.
  • Going when you feel the urge: Having a bowel movement immediately following the urge helps to reinforce the nerve reflex involved.
  • Being mindful of schedule changes: Traveling often interferes with your normal meal and subsequent bowel movement schedule.
  • Taking caution when using laxatives: Though they may be useful to improve temporary symptoms of constipation, they may make the condition worse long-term.
  • Reassessing current medications: Anti-nausea medications and side effects of some prescription medications may unfortunately be contributing to the constipation. Discuss these concerns with a medical provider before changing your medicinal regimen.

A small number of patients with constipation have a more serious underlying medical problem such as irritable bowel disease (IBD), intestinal obstruction, ulcers, diverticulitis, or colorectal cancer. For this reason, it may be useful to pursue a second opinion and further testing. For your next appointment, it may also be useful to track your daily habits including diet, physical activity, water intake, sleep, stress, and any noticeable changes to your stool. This way, the next provider will have a more in-depth description of your condition and could possibly offer a better treatment plan. Second opinions are considered standard for diagnosing conditions such as cancer, infections, and rare diseases. Often, even if the tests come up negative, a second opinion helps to give the patient some peace of mind. Most providers won’t hesitate to pass along your medical records because they understand the practicality of the situation. Hopefully visiting with the same, or different provider, will help clear up some of what’s got you blocked up.

Wishing you stomach relief,

Last updated May 20, 2022
Originally published Jan 27, 1995

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