Mucus? IBD vs IBS?

The IBS talk is crap. You are having very mild UC symptoms, farther up than your sigmoidoscopy could see.

I agree with NCOT. It is very possible that it is IBS related. And I wish Gary would stop definitively diagnosing people with the worst case scenario.

One could look at it a little different perhaps:

I went through a similar process over a few months where there was a drastic change in the type of mucus I was having. I went from yellowish, to white, to generally clear then to none at all. Now the only time I have visible mucus is when I eat something my body doesn't agree with and there are very few things now that cause mucus for me. Number one is wheat products, but it takes a fair amount now. This results in a thicker white mucus. and goes away after a day of avoiding the food.

I learned something about mucus a few weeks ago at a lecture - and I think it applies here.

'Yellow mucus' - the yellow colour generally comes from DEAD white blood cells. They have died because they have eaten (phagocytised) a bacteria (or virus/fungi), have degraded it with ROS (Reactive oxygen Species) and then committed suicide - they do this in an effort to prevent the spread of the bacteria.

White mucus is an inflammatory response and a sign of inflammation of the tissues of your colon etc. Basically it thickens up and is expelled when you poop. It's the thickening that gives it the colour and ummm blob like appearance. Water loss in the mucus makes it thick and white'ish.

Clear mucus is self explanatory... you can't really see it or notice it when you poop.

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I think most GI's don't pay attention to mucus. Visually i.e. though a colonoscopy you might look fine but somewhere up there something going on still and most likely something is going on (either inflammation or secondary infection) because you still have Inflammatory Bowel Disease.... and probably not IBS... just as Gary suggests.

In my case my GI says the same crap: well it looks like you may have IBS... Now really, did I manage to cure or drive my IBD into full remission and am left with an inflammatory syndrome? Come on now... this is crap. I still have Inflammatory Bowel Disease (Crohn's-Colitis).

One could argue that 'food antigens' are causing the inflammation and white mucus on my part, which the seem to be. But is this a whole other 'syndrome' IBS? Or just a consequence of still having Crohn's-Coltis... I'm quite sure I still have IBD.

Post Edited (Canada Mark) : 9/28/2015 9:29:20 AM (GMT-6)

I'll never understand why some people are so anti-IBS on this board. If a colonoscopy is visibly and microscopically clear, what else do you want your GI to diagnose you with? Me, I am convinced I have rectal inflammation, but if a flex sig shows no sign of inflammation anywhere I'll accept that. I could go digging around for small bowel disease, but I don't have small bowel symptoms, so I don't think that would yield much fruit.

PS: And IBS is very much a real thing. Vastly more people have IBS than IBD.

I think the actual answer to Dr. Ben's question might be that many people and many of us have had the same experience and there is no answer to anything further than that.

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It's kind of one of those circle arguments really. In IBS the immune system seems to be responding to food antigens. In IBD it appears this is also the same for many. In both cases there is no doubt the barrier is much more permeable than normal people.

So at some point in time something (a large 'food source' peptide or many different peptides) have crossed the barrier or have been picked up by an immune cell and the immune system has singled it out as something it doesn't like. Every time it comes across this it mounts some variation of an immune response, be it inflammatory, or a change in mucus, or diarrhea in an effort to get rid of the offender.

The real question perhaps would be something like: Is a diarrhea or mucus in response to dietary antigens a separate 'syndrome' altogether? Or is it a consequence of having Inflammatory Bowel Disease?

I think everyone, even GI's struggle with this. Why all of a sudden do dietary antigens trigger an immune response?

It get's pretty confusing. If you get rid all all detectable "inflammation" yet still have these responses to food do you still have IBD? Or do you have a "syndrome' that developed because of IBD? or ... well.... it goes in circles I think.

It's interesting to think about though. Like NCOT says a lot more people have IBS, but they don't have tissue visible tissue damage and inflammation etc etc...

At the same time I remember Old Mike dug up a paper that showed that people with IBS actually do have microscopic damage not visible or detectable by colonoscopy. He'd have to dig out that one. It was about a year or two ago. If memory serves they looked at normal, IBS and IBD and the difference was in the amount of 'damage' - something like that. Was an interesting study actually.

Based on my own experiences, I think GIs jump on the IBS dianosis too quickly. It's a diagnosis of exclusion, meaning that they're just calling it a functional problem with no known origin. While IBS exists and definitely occurs in a lot of people with IBD, I would probably want more thorough testing to rule out something else before accepting a sort of catch-all diagnosis.
A colonoscopy with biopsies would tell you more than a flex sig. Did he do blood work to look at your inflammation markers?

As far as what you can do, if it actually is IBS, figuring out your dietary triggers could be helpful. Start keeping a food diary. Some people swear by the SCD and FODMAP diets. If you're already marathon training, trying paleo may be a good place to start. If you can find a nutritionist with experience working with IBD, they can make sure you're getting everything you need nutrition-wise while still eliminating foods like dairy or wheat that commonly cause problems.

Another thing: I'm a runner too, though definitely not marathons! I usually do between 7-10 miles. One thing that I noticed is that I *have* to stick to short distances if I have any inflammation at all. Longer distances + inflammation actually make my colon swell. My belly becomes puffy and tender and I tend to see blood and mucus for a few days afterwards. Maybe try a few days of cross training to see if your symptoms improve.

Actually, that is what the OP was wanting, opinions, because there are not enough facts on his case for even his doctor to declare anything one way or the other. That's why the doctor didn't specifically diagnose IBS and merely said "it sounds like irritable bowel". It is a fact that there is such a thing as IBS and that patients can indeed have it concurrently with IBD but it is also a fact that doctors misdiagnose a patient as having IBS many times when the patient doesn't. Heck, there are several occasions where UC and Crohn's are misdiagnosed as being the other. I agree with DrBen that whether you have IBS or not, our bowels are still "irritable". Nobody can argue with that. Maybe that's the bottom line.