OpenHealth Q&A

Constipation or Another Issue?

Greetings everyone, I’m a 16-year-old female, standing at 178 cm and weighing 100 kg. Let me clarify my medical background and medications I'm currently using. I have type one diabetes, managed with an insulin pump, and my blood glucose levels are stable. Additionally, I take metformin to address insulin resistance. I also deal with depression and anxiety, for which I take Escitalopram at a dosage of 20 mg and occasionally melatonin. Although I have a diagnosis of Borderline Personality Disorder (BPD), it's not the focus here. Now, regarding my family health history: My father was recently diagnosed with celiac disease, and there are several other cases of celiac disease in his family, including an aunt and some cousins. On my mother’s side, there is a history of type one diabetes, and my cousin is frequently hospitalized with what is suspected to be Crohn's disease. Here's my timeline: I became lactose intolerant at the end of November last year. In April, I contracted a campylobacter infection, which required antibiotics for about three weeks, leading to a complete resolution of symptoms. However, about six weeks ago, I started experiencing severe stomach pain and nausea alongside constipation, alternating with diarrhea, and noticed blood in my stool—both after wiping and in the toilet bowl. Additionally, I’ve developed itchy rashes on my legs and hands, along with mouth ulcers, and have been experiencing frequent nosebleeds. The stomach pain is constant, particularly after meals, and it is localized in the lower left quadrant of my abdomen. Results from my blood tests indicate a negative result for celiac disease, with an elevated ESR at 42, a CRP of 8.0, and a fecal calprotectin level of 48, which I understand to be within normal limits. My general practitioner suspected IBD or Crohn's disease (this assumption was made before we received the fecal calprotectin results) and recommended that I see a gastroenterologist. Moreover, my GP indicated that I would likely need an endoscopy to further investigate celiac disease and a colonoscopy for IBD evaluation. During my visit with the gastroenterologist, he reviewed my previous tests and examined my abdomen, concluding that my issues stemmed from constipation. He instructed me to use laxatives, suggesting that this would address the blood in my stool. However, he made no remarks about addressing my excruciating pain, which significantly affects my daily life. Unfortunately, his manner was rather off-putting, and he preferred to communicate with my mother rather than speaking directly with me—likely due to his specialization in pediatrics and limited experience with older adolescents. All things considered, while I understand he is a medical specialist, I’m contemplating whether it might be prudent to seek a second opinion. I'm not entirely convinced that my issues are solely related to constipation. Furthermore, based on the blood test results, particularly the fecal calprotectin, it seems that I might not have any underlying conditions, but I would appreciate any advice on this matter.

Answers (1)

8/8/2025, 11:50:53 AM

OpenHealth AI

It sounds like you're going through a complex and concerning set of gastrointestinal issues, and it's completely valid that you're seeking clarity and reassurance regarding your symptoms. Your experience of abdominal pain, changes in bowel habits, and associated symptoms is important to address, especially with your family history and existing medical conditions.

Summary of Your Situation:

• You are experiencing severe stomach pain, nausea, constipation alternating with diarrhea, blood in your stool, itchy rashes, mouth ulcers, and frequent nosebleeds.
• You have a significant family history of celiac disease and inflammatory bowel disease (IBD), and your blood tests have shown an elevated ESR and CRP, suggesting inflammation, albeit with a normal fecal calprotectin.
• Your gastroenterologist attributed your issues primarily to constipation and suggested laxatives without fully addressing your pain or other symptoms.

Explanation:

Constipation can certainly contribute to complications like pain and blood in the stool, but your array of symptoms—especially the localization of pain, rashes, and ulcers—may indicate more complex conditions like IBD, even if initial tests seem normal. Persistent pain, especially after meals, is significant and may not solely result from constipation. The elevated inflammatory markers could suggest ongoing inflammation that warrants further investigation.

Next Steps:

1. Track Your Symptoms: Keep a detailed diary of your symptoms, noting the intensity of pain, bowel habits (including amounts and characteristics), and other symptoms like rashes and ulcers. This can help both you and any healthcare provider understand the situation better.

2. Consider a Second Opinion: Given your concerns about the initial evaluation and management by the gastroenterologist, seeking a second opinion is advisable. Look for a gastroenterologist who specializes in adolescent care or IBD and who is willing to take the time to communicate directly with you.

3. Address Pain Management: Discuss with your healthcare provider how to better manage your pain since it significantly impacts your daily life. There may be dietary changes, pain relief strategies, or medications that can help alongside any laxatives that may be prescribed.

4. Stay Informed and Proactive: Given your family history of celiac disease and IBD, it's essential to remain proactive about follow-up testing and discussions with healthcare providers. If your symptoms worsen or you experience new symptoms, such as more significant bleeding or unmanageable pain, seek immediate medical attention.

5. Consult on Dietary Changes: While you are already lactose intolerant, consulting a dietitian knowledgeable about gastrointestinal disorders might help tailor a diet that minimizes symptoms and promotes gut health.

Remember, your health and comfort are paramount, and it's okay to seek support and clarity about your condition. Don't hesitate to advocate for yourself when communicating with healthcare professionals.