I was initially diagnosed with ulcerative colitis 2 years ago after suffering painful and bloody diarrhea for 24 hours. I was admitted to the hospital for one day.
Since then, I have had only two separate flare-ups that included a small amount of blood in my stool. However, I have had crampy diarrhea episodes at least 2-3 times a month.
I recently went to a renown specialist, who after administering a colonoscopy and heard my symptoms, concluded that I had a "non-descript" colitis and was suffering mostly from IBS. Because I had no blood in my stool and no inflammation in my rectum, he concluded that it was not ulcerative colitis as initially diagnosed by my previous doctor.
However, two weeks ago, I had blood in my stool again, accompanied by diarrhea. My symptoms are largely those of a person with IBS; i.e., I have frequent constipation and diarrhea, cramps, acute pain in my left lower abdomen, and mucus in my stool. My question to you is: is it possible to have IBS and get accompanying blood? The two times I had blood after the first hospital stay, the blood was minute, and not much to speak of. Could the blood be coming from the inflammation my doctor is calling "non-descript" colitis? Or could the blood be coming from somewhere else like hemorrhoids?
My new doctor recommended that I get off the Pentasa I have been on for two years to see if my initial symptoms recur. Do you think this is a good idea?
Please advise.
REPLY:
Bleeding per se is definitely not part of IBS. When patients with IBS report bleeding it needs to be explained whether it is from an anal fissure, hemorrhoids, or some other source.
Did your doctor review your hospital record from your first episode? I would like to know if after reviewing that record and re-examining actual biopsies, colonoscopy reports, x-rays, etc. the diagnosis of ulcerative colitis still seems valid. Other conditions including some infectious diseases of the colon can mimic ulcerative colitis. Perhaps you never had ulcerative colitis in the true sense at all.
It may be that you did have ulcerative colitis then and have it now but it is under very good control and the colon doesn't show any sign of it on colonoscopy. Did your new doctor take a biopsy of the normal looking colon? Sometimes patients in remission have a very normal looking colon but biopsies show significant colitis and in these patients I am unwilling to stop their medication since a relapse may occur.
Nevertheless, a trial off of medication is reasonable if your doctor is willing to see you if your symptoms act up and take another look in your colon to see if there are signs of inflammatory bowel disease either visibly or on biopsy.
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Bruce Sckolnick, M.D.
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