Dear Dr Nina: Are cramps before bowel movements normal?
Ask the doctor
Recently, I have had a change in my bowel movements. First thing in the morning, I get stomach cramps and when I go to the toilet, my stools are rather loose. I haven't had any change to my diet and my stress levels etc have remained the same. What could this be?
Answer: Most of the nutrients we eat get absorbed in the stomach and small intestine. Undigested material enters the colon and travels through here, resulting in the absorption of water and the production of solid stool. If there is inflammation or irritation of the gut, or if cramping or infection are causing rapid transit of food through the intestines, fluid may not be absorbed as well as usual and loose stool may occur.
Eating food or drinking fluids (especially caffeine) can stimulate movement in the gut so many will find they may need to pass a bowel motion after eating breakfast or having their morning tea or coffee. Cramps before bowel motions are not considered normal. They may be simply due to trapped wind, but cramping followed by loose stool or diarrhoea can be a sign of infection or inflammation.
Gastrointestinal viruses can cause abdominal pain, nausea, vomiting and altered bowels or diarrhoea.There may also be an associated fever, headache or body aches and pains. Most cases are short lived, and recovery occurs within one to three days. Worrying signs include dark or reduced urine, dry mouth and lips, dizziness when standing, headache, and unusual tiredness as these are tell-tale signs that the body's fluid reserves are low.
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Viral gastroenteritis is extremely contagious and spreads easily among those in close contact. Although the infection itself may only last days, some people suffer a post-infectious irritable bowel syndrome (IBS) which may go on for some time. The exact cause isn't clear, but it is thought to be a combination of ongoing inflammation and changes in gut microbes and permeability. The risk of post-infectious IBS also correlates with the severity of the initial illness, increasing two-fold if diarrhoea lasted more than a week.
Post-infectious lactose intolerance is well documented and so in those with ongoing gastrointestinal upset, it may be worth trying a low-lactose diet to see if this helps. There are no other specific dietary recommendations but if diarrhoea predominates, a lower residue diet may help. Coeliac disease should always be ruled out in someone with prolonged loose stool.
If you are passing blood in your bowel motions, have weight loss, nausea or a feeling that you are not emptying your bowel properly, you should seek further medical care. This may indicate a more serious medical cause and warrants onward specialist referral.
Anyone over 50 who has altered bowel motions going on more than a few weeks should see a doctor for examination and advice.
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