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A complex case - what do you think guys?

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Posted 4/30/2014 1:08 PM (GMT 0)

Hi Guys

I wish you all good health by the grace of God.

I haven't been on here for ages because I have been in remission for several years from Non Specific Colitis. I am now confused as I again have rectal bleeding and if you don't mind I was wondering if I could tell you my story and see whether you can help me?

FYI: I am a hypochondria which I find is the main trigger if I ever have a flare.

Here is a brief history:

• August 2007 I had rectal bleeding which was diagnosed as Non-Specific Colitis + Hemmorhoids

• October 2007 on a 2nd Opinion I had rectal bleeding which was diagnosed as Non-Specific Colitis; prescibed Asacol and it cleared up.

• September 2008 did a Sigmidoscopy and took me off all meds saying I only have IBS and Piles

• September 2009 when I had rectal bleeding who diagnosed Chrohn’s Disease. It cleared up with Pentasa and Chrohns diagnosis questionned.

• I have stayed in remission for 4 years using 1000mg Pentase x 2 a day and VSL 3 once a day.

Here is the crux of my issues:

1. I do not diarrhoea with my colitis
2. I have internal haemorrhoids and a fissure
3. Each incidence happens when I have a serious stressful event in my life – my hypochondria and IBS then takes over and I start bleeding after several visits to the toilet and straining.

I do not have abdominal pain, or bloody diarrhoea or any suggestions in my blood tests of inflammation - they are always normal and HB is over 17. I get bright red blood on toilet tissue and streaks on the stool. In addition the colonoscopy sometimes shows mild inflammation on the right sided cecum and in lower part of my bowel – (patchy and mild inflammation) with no urgency or diarrhoea.

What I want to investigate is whether this patchy inflammation is IBD or something different given my very mild symptons, whether the current bright red bleeding is my haemorrhoids or something else more sinister - I do not have any other symptoms apart from an sore bum.

I feel totally fine, except for the bright red blood on stool and on tissue which now comes on occasions after a disappearance of some 4 years!

Is this complex investigation something you peeps can help me with? The anxiety is driving me insane.

LondonRed
Colitis since 2007, aged 40.

Posted 4/30/2014 1:34 PM (GMT 0)
My personal opinion is that the bright red blood is from your hemmies. That happens with me. Even though you seem to be doing fairly well I question how good your docs are since their diagnosis seem to be all over the board. I think they are making it a complex case when it really isn't.
Posted 4/30/2014 1:37 PM (GMT 0)
Thanks Gary - I too also think that - the original GI said just that but my anxiety made me get a 2nd opinion and they found inflammation.

The question is all inflammation from IBD? Secondly, does there need to be diarrhea for it to be IBD?

God willing, I hope you're right.
Posted 4/30/2014 1:45 PM (GMT 0)
Just because you have inflammation doesn't necessarily mean you have IBD. IBD is a chronic lifelong autoimmune disease with periods of flares and periods of remissions. You can have temporary inflammation causing colitis, which is not IBD. Diarrhea seems to go hand in hand with IBD but I have UC and have had formed stools for a couple of years now, although it started with diarrhea. My main and only real problem now is frequency. There have been a few who visited here recently claiming they were diagnosed with UC but had constipation and no diarrhea. This sounds more like IBS to me but they claim to have been diagnosed with UC.
Posted 4/30/2014 1:49 PM (GMT 0)
I think frequency is related to anxiety in that most people IBD probably also have IBS. IBS can cause piles and other bleeding symptoms like from fissures. It's a vicious cycle. I really need to understand the word inflammation and IBD. Not all colitis is IBD although all docs diagnose IBD when they see inflammation with bleeding.
Posted 4/30/2014 2:04 PM (GMT 0)
Have you had biopsies taken when you have been scoped?
Posted 4/30/2014 2:09 PM (GMT 0)
Yes biopsies were taken of course. The first time I got Colitis the biopsies were "Non Specific Colitis" and not IBD. Subsequently I have had them done and they have said the same thing. One said "Chrohn's" but there is some doubt on that given my symptoms. It has left me massively confused. It goes to show there isn't much consistency with GI docs - they just don't know this disease.

IBS and Piles mimics IBD, Inflammation and bleeding does so too - but neither could be IBD. Its confusing.
Posted 4/30/2014 2:10 PM (GMT 0)
Blood in stool can be caused by a variety of things such as hemorrhoids, uc/chron's inflammation, or by overgrowth of pathogens (CDIFF, food poisoning due to salmonella or something). The only way to tell for sure which it is, is to have an examination in a GIs office (a flexible endoscope or colonoscopy) and stool tests in the case of pathogens.

If your diagnosis is all over the place, then I would schedule a second opinion with a leading gastroenterologist. Your local GI might be good, but not as good as one of the bigger names in a nearby large city. Do some research, find out who is one of the better GIs and have him/her examine you and look at your case history (results of past exams you've had, whatever information you can bring along).
Posted 4/30/2014 2:11 PM (GMT 0)
iPoop - I have done all of that - my GI is a leading one from a famous hospital in UK.
Posted 4/30/2014 2:34 PM (GMT 0)
Hmm sounds like you've done your homework and even got an expert baffled. Not sure how much more I can advise then...
Posted 4/30/2014 2:46 PM (GMT 0)
To make it a little easier and less complex you said "I feel totally fine, except for the bright red blood on stool and on tissue which now comes on occasions after a disappearance of some 4 years!"

You note you have hemmies, anxiety and most likely IBS. That's probably the most important things I see. Previously dx'd with Non-specific Colitis, and I would forget about the Crohns thing for the moment.

Bright red blood on tissue is most likely going to be from hemmies and the straining you are talking about. I sound like a broken record on this but loading up on fiber may help. Would help with the straining. You may have mild UC too which has been kept in check with those meds.
Posted 4/30/2014 2:55 PM (GMT 0)
Thanks Dr-A.

I should also say I take Lanzoprazole for reflux and this can often give me diarrhea.

I just had my first BM of the day after breakfast. It was diarrhea (I rarely get it) and I could see some mucus and specs of red in the water - the IBS from anxiety is now kicking in I fear! However, there was no blood on the tissue on wiping which was weird - maybe the harder stool and straining is what is causing the blood after all? Andd maybe the redness in stool could well be either blood from further up or food?

This disease is making us into detectives :)

Post Edited (LondonRed) : 4/30/2014 9:00:55 AM (GMT-6)

Posted 4/30/2014 3:02 PM (GMT 0)
I know we are not allows to give names on here but would be great if I had the name of a really good investigative GI in England.
Posted 4/30/2014 5:13 PM (GMT 0)
I just does not sound like you have IBD, and facilitating a 3rd (or is it 4th) opinion might not be a kind thing for a hypochondriac.

Treat the IBS. Work to avoid hard stool.
Posted 4/30/2014 5:20 PM (GMT 0)
Very good advice DBwithUC - I don't think I will be getting a 4th opinion on this as they all seem to say something different. I guess what I am really scared of is a sinister disease that get's missed because they put the bleeding down to piles and a fissues.

They have also seen inflammation before and I guess it is this inflammation that needs evaluating. My GI looked up me with a proctoscope 4 weeks ago and he said there was ZERO inflammation but saw the piles. I had bled bright red blood a few days earlier so that should have shown!
Posted 4/30/2014 5:41 PM (GMT 0)
Hemmies have a history of coming and going, bleeding or not bleeding.
Posted 4/30/2014 7:42 PM (GMT 0)
Really Gary? So one time no blood on tissue and then the next one blood, and vice versa is perfectly normal for hemmies?
Posted 4/30/2014 7:47 PM (GMT 0)
Happens to me all the time. I have hemmies. One morning bunch of bright red blood, later in the same day, nothing.
Posted 4/30/2014 8:57 PM (GMT 0)
I think my anxiety is brining on inflammation today in me. I was "perfect" 3 weeks ago on a proctoscope; and normal even 2 days ago - but since seeing blood I am finding I am running to the toilet to check if there is blood!

I have been to the toilet twice already today and have only been up 8 hours. First one was red specs on loose stools but no blood on tissue.

The second BM looked like left over residue from the first one as the blood had gone maroonish but was bright on the tissue wipe and the stools looked sand like - and of very small volume.

Can hemmie blood from a previous BM pool up inside our butt? The blood isn't loads though, maybe only a teaspoon.

I am at the end of my tether but my GI keeps saying wait until my appointment on Saturday and mutters something about IBS and hemmies/ fissure.

Arrghhhhh The anxiety! And I have a 9 hour flight today.

Post Edited (LondonRed) : 4/30/2014 3:00:54 PM (GMT-6)

Posted 4/30/2014 9:11 PM (GMT 0)
hemorrhoids can be from yeast as well.... dont over look that.. See if your guy in england can check into that
Im 41 and had hemorrhoids starting at 5 years old.... I heard it all about straining. Ive had 5 surgeries for them and all they did was come back. I had ulcer colitis and crohns two years ago. ever since I worked on lowering my yeast... there now GONE like the wind.. and my wind has no blood..

I took some drugs thou and nystatin and diflucan as well suppliments and ate low carb/ paleo
I also used great plans lab.. check out this link below
May be missing looking at this
heres a good article on colitis http://jpp.krakow.pl/journal/archive/03_09/pdf/107_03_09_article.pdf

your in the UK but great plans does international testing.. aswell the test is 645.00 dollars but with the uk pound strong i would be alot cheaper for you.

look in theres two OAT test and comp stool test
http://www.greatplainslaboratory.com/home/eng/full_oat.asp
http://www.greatplainslaboratory.com/home/eng/stool.asp

alot of peoples hemorrhoids are linked to yeast.... look at a babys butt when there a baby, they get the red rash ( yeast) in there crack....

Im sure you GI guy is looking for yeast/fungus
Posted 4/30/2014 9:21 PM (GMT 0)
Nobody has said I have IBD yet, lol - I wish that were 100% true - how I would celebrate. Did anyone read my last post?
Posted 4/30/2014 9:22 PM (GMT 0)
I also had a fissure and a fistula which im guessing my hemorrhoids leaded to. today all is good..
Posted 4/30/2014 11:59 PM (GMT 0)

Garylouisville said...
There have been a few who visited here recently claiming they were diagnosed with UC but had constipation and no diarrhea. This sounds more like IBS to me but they claim to have been diagnosed with UC.

Oh for heaven's sake.... YES, you can be diagnosed with ulcerative proctitis with symptoms that include constipation, not diarrhea. That was the case for me, with diagnosis based on BIOPSY RESULTS, not on some random hunch of the doctor or patient.
Posted 5/1/2014 1:07 AM (GMT 0)
I guess there is always different scenarios and possibilities. What does everyone think about my possibilities?

What should be scared of on Saturday with the GI?
Posted 5/1/2014 11:16 AM (GMT 0)
Just got off a 10 hour flight sitting down all the way. I just had one bowel movement on the plane which makes it 2 for the whole day.

Good news: Normal stools. No urgency. No blood on toilet tissue.

Bad News: Some dark blood streaks on outside of stools (right side blood?). Feel sore down there.

I feel totally well and normal. No abdominal pain. But worried about the location of the bleed. It's confusing me and scaring me.
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