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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29553
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have a bleeding problem from my colon. In September, 2011,

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I have a bleeding problem from my colon. In September, 2011, I was hospitalized for a similar problem. The two events started a little differently but here is what happened in September in order to set up what is happening now.

My illness began with severe diarrhea and progressed on to just water. I tred Immodiam and several other remedies. Made an appt with gastro doc and got colonscopy. Results some problems in colon, not very specific. He prescribed several meds which I could not take orally because by that time I could not eat at all, except maybe a bite of filet of beef or something like that. Still the diarrhea, blood, protein was flowing from my body. The doc did test to see why my feet were swelled and they were inconclusive. My illness progressed. I reported to the doctor my unsuccess with the meds and I kept all the appt. that he suggested I do. Sometimes I talked with his nurse practitioner but nothing ever came of any of the appts except more time and money spent and sickness increasing. I changed grastro docs. He walked into the room with the form for a colonoscopy, and an insulting attitude. I said "wait, doctor, I wish to talk with you". He you must first have a colonoscopy. I tried to tell him I had one recently and asked him why my knuckles were swelled. He said, You have RA... I looked him in the eye and NO, I DO NOT have RA. He just threw the papers at me. I looked at my husband and let's get out of here. We left.

Meanwhile, I just got sicker until I finally was lead to go to my old family doctor back in a little country town in Alabama. He is a genius and owns medicine in his area. He took one look at me and said 'You look like hell'.. He told me my legs were swelled due to lack of protein which had been escaping with all the blood, which was heavy by this time and other things I was loosing.

This country Doc told me that if I had been given a colonoscopy at that time, the report would not have been accurate. He built up my system before having a gastro doctor do a scope on my stomach and a colonoscopy at the same time. I stayed in the hospital 8 days, receiving Flaggil, fluids, blood, potassium, and other meds, which included Medimucil. The test took a long time to analysize because theys studied every ulcer I had in depth.. I would have died except for God and that country doctor.

I am having similar problems now. I went to a gastro doc yesterday. He was rude and just wanted to do a colonoscopy without much history on me and actually said, "This will go fine unless I cut you." Wow, this was a well known doctor at a Presbyterian Hospital near Charlotte, NC. I took the paperwork and left having made an appt for the prodecure. This last night, it occurred to me that perhaps gastro docs are there just to do the test and I need another doc for treatment.

I am too far away to go back to the Alabama doctor because my husband has been been in treatment for cancer and heart failure here in Charlotte and I must be with him while he finishes his treatments.

This time the blood started earlier without as much diarrea. I have had considerable lose of blood, my blood count going down 2 pts in one week. I don't the time or money to run all over the place going to docs. What would be your suggestion for the colonoscopy and the following treatment? I know I am asking a somewhat basic question to you but to me it is serious and just a pat answer will not satisfy me.

Thank you for your time and expertise in my behalf.

PS If I carefully watch what I eat so as not to produce gas in my lower parts, I do much better. Sometime I am suprised with erruptions and rapid trips to the bathroom. I am experimenting with my diet.
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 year ago.

Greetings Ben / Ann.

I am sorry that your question was unanswered for long.

With your symptoms, before the colonoscopy (which I agree would be required in evaluation and you may need a biopsy of colon during the scopy), there are other investigations too, which should be done like stool exam, stool culture, blood work etc. The initial evaluation of diarrhea (and blood in bowel motion) is on these characteristic;

 

a) stool volume,

b) frequency,

c) consistency, and

d) gross appearance.

 

with or without bleeding.

 

Stool volume can give an idea of disease location and underlying mechanism.

 

a) Large-volume stools (more than one liter per day) would point to small bowel disease and secretory diarrhea.

b) Small-volume stools (less than 300 ml per day) suggest large intestine diseases and functional gastrointestinal disorders like IBS.

 

Stool consistency can be varied ranging from formed to watery, and correlates with the rate of intestinal transit.

 

a) Secretory diarrheas are liquid.

b) Functional diarrheas are soft or semi-solid.

c) Stool floating will be indicative of if being filled with gas from fermentation of mal absorbed carbohydrates.

d) Mucus can point to both inflammatory and noninflammatory diarrheas, such as ulcerative colitis and IBS.

 

Stool appearance helps to classify diarrhea as;

 

a) Watery diarrhea is caused by carbohydrate malabsorption, medications, bile acid malabsorption, Crohn's disease, microscopic colitis, chronic mesenteric ischemia, post surgical diarrhea, hyperthyroidism, colonic adenomas and carcinomas, alcohol induced diarrhea, laxative abuse, and hormone-secreting tumors.

b) Steatorrhea or fatty diarrhea is greasy, oily, foul smelling, bulky, or voluminous stools that are often difficult to flush, might contain undigested food particles, and sometimes leaves an oily stain in the toilet bowl. These characteristics suggest pancreatic disease, short bowel syndrome, celiac disease, giardiasis, and small bowel bacterial overgrowth (SBBO).

c) Bloody diarrhea suggests Ulcerative colitis, Crohn's colitis, cancer and chronic infections.

Chronic diarrhea, is defined as the production of loose stools with or without increased stool frequency for more than 4 weeks. The main causes of the chronic diarrhea are following;

 

1) Irritable bowel syndrome; it is a sort of functional diarrhea in which no abnormality is found.

 

2) Inflammatory bowel disease (IBD); this is auto immune mediated type of diarrhea and it can involve other organs in the body. The biopsy of colon and small intestines need to be taken to establish the diagnosis with investigations like CRP, ANA, HLA B 27 etc. There are two type of IBD;

 

a) Crohn's disease

b) Ulcerative colitis

 

3) Microscopic colitis; Microscopic colitis is characterized by chronic watery (secretory) diarrhea without bleeding. It usually occurs in middle-aged patients. Two different types of microscopic colitis have been generally recognized:

 

a) Lymphocytic colitis

b) Collagenous colitis without lymphocytic infiltration of the surface epithelium

 

Collagenous and lymphocytic colitis produce a similar clinical picture characterized by non bloody chronic watery (secretory) diarrhea of up to two liters daily. So total amount of stools per day has to ascertained.

 

4) Malabsorption syndromes; The classic manifestations of malabsorption are pale, greasy, voluminous, foul-smelling stools and weight loss despite adequate food intake.

 

5) Chronic infections; Some persisting infections (C. difficile, Aeromonas, Plesiomonas, Camyplobacter, Giardia, Amebae, etc.) can be associated with chronic diarrhea.

 

You should be investigated for IBD, chronic infections or for secretory diarrhea (by estimating total amount of stools per 24 hours). Looking for the carcinoid tumor also may be considered. Gastrinoma and VIPoma also should be considered for prolonged secretory diarrhea and an high index of suspicion is required. Secretory diarrhea characteristically continues despite fasting, is associated with stool volumes more than 1 liter/day. Selective testing for plasma peptides such as gastrin, calcitonin, vasoactive intestinal polypeptide, and somatostatin, as well as urine excretion of 5-hydroxyindole acetic acid, metanephrine, or histamine and other tests of endocrine function, such as measurement of thyroid-stimulating hormone and serum thyroxine levels or an adrenocorticotropin-stimulation test for adrenal insufficiency, can be considered by your physician. An aspirate of small bowel contents for quantitative culture or breath tests with glucose or isotopically labeled xylose can be used to establish the presence of small bowel bacterial overgrowth.

 

A diarrhea with blood need to be ruled out for (especially in age group above 60);

1) cancer
2) ulcerative colitis
3) Crohn's disease
4) infections
5) parasite
6) bleeding in intestine due to some oozing blood vessel (blood vessel abnormality).

So apart from colonoscopy mesenteric arteriography, stool culture would also be important. Gastro doctors may start with the colonoscopy in your age group but you may ask them to do the other tests first,

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

 

We have recently implemented a new rating and feedback system. Please be aware that you are rating my courtesy and service as a professional. If you have any questions whatsoever, or there is anything I can clarify for you, please temporarily bypass the rating system by clicking “Continue the Conversation” or "Reply."

Clicking either of the lowest two options reflects poorly on me so please reply to me if there is anything else I can do to help before choosing those options. I appreciate your patience while we work out the kinks. It's important to me that you are 100% satisfied with the service I have provided you. Thank you.

Customer: replied 1 year ago.

Sorry I did not reply last night but had a visitor come by.
Today I went to church.


 


Thank you for your extremely detailed and painstakingly prepared answer. I do have different type stools. Some are only brown mucus that falls to bottom of commode. Some are many small formed stools a day, not particularly odiferous, some are mostly blood, if I have eaten something that produced gas. Two lately have been a soft diarra because I ate the wrong thing. The first was Chinese food. It exited within 15 minutes of eating and smelled exactly like burned chinese food. The second one was small and seemed to be cause by excess gas possibly linked to two glasses of milk I drank the night before because it happened shortly after I got up in the morning.


 


I plan to print out your observations and give them to the doctor that I will see if I have your permission.


 


Again, I am so grateful to learn what you have written about the possibilities of what is wrong with me. That makes me feel more in control of the situation. I was concerned that I did not where to turn or who to go to.

Expert:  Dr. Arun Phophalia replied 1 year ago.

You are very welcome, Ann.

Please feel free to print my previous answer. Your changing stools can be due to;

1) polyp (benign tumors)
2) diverticulosis and diverticulitis
3) a bleeding blood vessel.

Your doctor may get a CT scan or MRI of the abdomen, as the initial investigative tool for the assessment.

It is privilege assisting you.

 

Please rate excellent / good, if this interaction has been satisfactory. Only a positive rating gives us credit for the work and expertize. You can ask follow up questions, even after rating.

Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29553
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Dr. Arun Phophalia and 10 other Health Specialists are ready to help you
Customer: replied 1 year ago.

Doctor, I do not believe I have diverticulitis or diverticulosis but I could have a polyp or bleeding vessel. I know that polyps are removed during colonoscopy but what is the possible treatment for bleeding blood vessel?


 

Expert:  Dr. Arun Phophalia replied 1 year ago.
Ann,

A bleeding vessel would be cauterized during colonoscopy. Occasionally that segment of the intestine may need removal surgically if cauterization is not effective.

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