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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18772
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Chronic diarrhea. Point pain in 3 spots. Digestive noises

Customer Question

Chronic diarrhea. Point pain in 3 spots. Digestive noises and pain, not frequent but sometimes vomiting. Involuntary weight loss. 1year loss of 30 lbs. Recent diagnosis of Endometriosis on uterin wall and ligaments, bladder wall, and appendix. Recently CT w/contrast had. Small lesion on rt posterior valve of liver, extremely retroverted uterus, large amount of formed stool noted in rt colon, the sigmoid colon is collapsed, there is some peri colonic fat stranding, and a small amount of fluid noted in lower right quadrent. My doctor says this is all normal and we have no answer hear. How is this so?
Submitted: 1 year ago.
Category: Medical
Customer: replied 1 year ago.
Also should add I am 5'4, 120lb, 41 year old. I was feeling healthy until I took a single prescribed Bactrum. Became violently ill and have been sick since.
Expert:  Dr. D. Love replied 1 year ago.

Hello from JustAnswer.

I would not have said that these findings are normal. I usually prefer to use terms that reflect that these changes are not necessarily a sign of significant disease and are common in people with benign conditions or the conditions that you are already known to have, such as IBS or endometriosis. Of these findings, the most worrisome would be the pericolonic fat stranding, which can be a sign of inflammation of the colon, either from a primary inflammatory bowel disease or from diverticulitis. However, if there were either a primary inflammatory bowel disease or diverticulitis, it would have been detected by the colonoscopy. If the colonoscopy did not show any inflammation, then there would not be concern about the fat stranding.

The large amount of stool in the right colon and the collapsed sigmoid colon are common in people with IBS, in which the primary abnormality is altered muscular activity of the gut, and which can be either increased or decreased. Retained stool can develop in areas with decreased muscular activity and an empty or collapsed colon can develop in areas with increased muscular activity.

The small amount of free fluid in the lower right quadrant is a common finding in someone with endometriosis, as these endometrial implants can bleed or otherwise ooze fluid.

The retroverted uterus is not considered a disease process.

Since this started after taking the Bactrim, the other diagnosis to consider would be a bacterial overgrowth in the intestines. This can mimic or occur alongside IBS and can sometimes be difficult to detect. Cultures of the stool cannot identify if there is excessive growth higher in the intestines. A hydrogen breath test may help to detect the problem. The probiotics may help with bacterial overgrowth, but it also may need a course of antibiotics oriented towards the germs that tend to cause the overgrowth, such as rifaximin, levofloxacin, or metronidazole. Some doctors may consider a trial of antibiotics, even if a definitive diagnosis cannot be established.

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Customer: replied 1 year ago.
I should have added that the colonoscopy and endoscopy showed inflammation and spastic behavior. She took biopsies throughout, no polyps, hemerroids were located. Parasite ova testing, H-pylori tested, CDiff tested, Celiac panel also ran. All negative. Blood work shows a minuscule elevation of a/g ratio, and a diminished level alkaline phosphatase
Expert:  Dr. D. Love replied 1 year ago.

Most of this is not worrisome.

What did the biopsy of the area of inflammation show?

Customer: replied 1 year ago.
Clean biopsy. How about the lesion on my liver? I just during all of this found a lump at 10 o'clock on my right breast. Had a ultrasound and mammogram. Results were: due to dense tissue palpable nodule not visible by mammography, but is visible by ultrasound. Found at lateral fold of breast, a small discoid nodule is seen subcutaneous tissues measuring 8x8x2 mm. It is hypoechoic, circumscribed, fairly homogeneous internally and has no abnormal vascularity.
This has been going on for a year thanksgiving.
Customer: replied 1 year ago.
She said the whole area from esophagus to rectum was inflamed and over active. Spastic was the words she used.
Question. Off my right colon is packed full of formed stool and I have only had diarrhea for one year, and part of the trap door (sigmoid colon) is collapsed... How does it clean out?
Expert:  Dr. D. Love replied 1 year ago.

The most common cause of a small lesion of the liver is a simple liver cyst, which occurs in about 5% of the population and is not considered a significant illness.

Spasticity of the colon is common with IBS, which is why another name for the condition is a spastic colon. If there is overt inflammation beyond the spasticity, that could be more of a concern, but the biopsy would identify the specific cause of the inflammation.

Cleaning out the colon when these changes occur from IBS is usually done with fiber, as you have been doing, and it may need higher amounts of fiber, up to 35 grams per day. But if fiber does not work for you, then a stronger medicine to help the stools may be necessary, such as Colace, Miralax, or lactulose.

The abnormality on the breast ultrasound would not be causing any of these changes.