OpenHealth Q&A

Exploring the Causes of My Gastrointestinal Issues: Seeking Guidance

For the past half-year, I have been enduring chronic constipation that has led to a small fissure and hemorrhoids, along with persistent abdominal bloating. Regardless of what I consume, I experience significant distension, leaving me looking as if I am pregnant. This bloating occurs immediately after eating, and even when I don’t eat, I still feel some level of discomfort, albeit less intense. Despite attempting a gluten-free and dairy-free diet, I noticed little improvement. My symptoms also include frequent burping, an overwhelming sense of fullness after minimal meals, and a general fatigue that clouds my daily life. Additionally, I am experiencing mood fluctuations, increased hair shedding, shallow breathing, and very noticeable dark circles under my eyes. I have a constant itch in my throat, dust allergies, and my dermatitis has flared up recently, though it remains manageable. Six months ago, I also dealt with Eustachian Tube Dysfunction (ETD). In terms of blood work, my ferritin level is at 18, vitamin B12 is 178, hemoglobin (HB) is 13.5, and vitamin D is measured at 35. My typical diet consists of two varieties of vegetables, two types of fruits, nuts, dates, egg whites, chicken or fish, and either rice or wheat. Despite this seemingly balanced intake, my nutrient levels remain low. I'm left pondering whether I could have methane-dominant SIBO. After consulting with two separate gastroenterologists, SIBO was never mentioned as a possibility. Being from India, I also question whether local healthcare facilities test for this condition. I often wonder if I am simply overthinking my health issues and experiencing heightened anxiety. The results from an endoscopy indicated antral gastritis, and the colonoscopy showed terminal ileitis; the biopsy confirmed chronic ileitis. Unfortunately, nothing has alleviated the bloating, and the only effective combination for regular bowel movements has been a laxative, Lactifibre, and Purease. The treatment plan from my gastroenterologist included three months of proton pump inhibitors (PPIs), Purease, two weeks of digestive enzymes, one week of Rifagut, probiotics, Lactifibre, and a laxative. My doctor stated that my symptoms are attributed to mild inflammation, suggesting that I should incorporate more vegetables into my diet after the third month of treatment. Ironically, even though I love vegetables and consumed them abundantly before my bloating began, they often exacerbate my symptoms. While I experienced hope on the first two days of Rifagut, from day three onward, the bloating returned. The only inquiry from my gastroenterologist was regarding my anxiety levels. My job isn’t particularly stressful, and outside of these gastrointestinal issues, I don’t currently face major anxieties. I had a period of depression between 2020 and 2022, but I’ve returned to my usual self, despite occasional mood swings. I sought a second opinion from another gastroenterologist, who concluded that nothing seemed wrong, and they were unsure about the source of the inflammation, suggesting it could be tied to psychological factors. They recommended exercise, weight loss, and a diet rich in probiotics—changes I have rigorously adhered to for the past four months, yet my symptoms persist unabated. In general, I maintain a healthy lifestyle, consuming whole foods and avoiding junk food, while hydrating with 2-3 liters of water and engaging in strength training and cardio sessions four to five times a week. As a bit of background, I have polycystic ovary syndrome (PCOS), which predisposes me to quick weight gain if I cease working out. I consistently exercised for two years, shedding 22 pounds, but upon taking a break, I regained all that weight within six months. Recently, I have resumed a regular gym routine for the last four months. I apologize for the lengthy account; I was uncertain about what details to leave out. Thank you in advance for any insights you may have.

Answers (1)

7/27/2025, 7:01:53 PM

OpenHealth AI

Thank you for sharing such a detailed account of your gastrointestinal issues. It sounds like you’re facing a complex set of symptoms that significantly affect your daily life. I’ll focus on your primary concerns about chronic constipation, bloating, and the associated discomfort, while also considering the other symptoms you described.

Main Points:

1. Chronic Constipation and Bloating: These could indicate underlying issues like SIBO, dietary intolerances, or inflammatory conditions.
2. Nutritional Deficiencies: Your blood work suggests low ferritin and vitamin B12 levels, which could contribute to fatigue and other symptoms.
3. Psychological Factors: Both anxiety and previous depression could play a role, but the persistence of your physical symptoms warrants attention beyond psychological aspects.

Explanation:

• Chronic Constipation and Bloating: Conditions like SIBO (small intestinal bacterial overgrowth) can cause constipation and bloating. This is often characterized by excess gas production, leading to the sensations you're experiencing.
• Nutritional Absorption Issues: Your low ferritin and B12 could indicate malabsorption or inadequate dietary intake. The changes in your gastrointestinal function, including gastritis and ileitis, could affect how your body absorbs nutrients.
• Role of Diet and Exercise: While you're committed to a healthy lifestyle, some foods (even those generally healthy, like certain vegetables) may exacerbate your symptoms. It’s crucial to identify these triggers.

Next Steps:

1. Keep a Symptom Diary: Track what you eat and your symptoms to identify potential food triggers. This can help isolate items that may be causing bloating or discomfort.

2. Consider a Low-FODMAP Diet: This dietary approach can help manage bloating and constipation. FODMAPs are certain types of carbohydrates that some people find difficult to digest. Following this for a few weeks may help clarify your triggers.

3. Reassess Supplementation: Given your low levels of ferritin and B12, it might be worthwhile to discuss with a healthcare professional the possibility of supplementation, particularly vitamin B12 injections or iron-rich foods/supplements.

4. Explore SIBO Testing: If you suspect SIBO, inquire specifically about a breath test for methane and hydrogen, which can confirm the condition. Although it may not be commonly discussed, you deserve clarity on this potential issue.

5. Maintain Regular Follow-ups: Continue your digestive health management with your healthcare providers, and don’t hesitate to express that your symptoms are persistent. Having a proactive discussion about your ongoing bloating and gastrointestinal discomfort is important.

6. Stress Management and Support: Consider stress-reduction techniques like mindfulness or connecting with a mental health professional to explore anxiety, as physical and mental health are interconnected.

7. Hydration and Fiber: Ensure that hydration and fiber intake are balanced. Sometimes, increased water intake and fiber from the right sources (consider varying types, such as soluble fiber) can contribute to better gut health but be cautious not to overload your system.

Your symptoms are valid, and while you’ve tried many approaches, it’s essential to persist in seeking answers and understanding how each aspect of your health interacts. Please remember that managing health issues can be a journey, and I wish you the best as you seek resolution and improvement.