SO confused

Hey guys,

I've been knocking around a few different forums trying to get somewhere but I always end up back at square one - confused. I'll try to be as brief as possible and hopefully one of you kind people might have some insight :)

From the start: I'm 27 and I developed agoraphobia/anxiety/panic disorder about 3-4 years ago, then a year or so after started having slightly harder stool and a bit of mucus. Then after a while I noticed a little bit of blood as well, the amount of blood has never changed since this started (I'd say less than a teaspoon, bright red and mixed in with mucus or on paper when wiping), but I have no idea how much blood is usual for anyone with any inflammation? I went to my GP who said I might possibly have an IBD so he performed a proctoscopy which didn't give him any clear answers so he referred me to a colorectal surgeon who then did a sigmoidoscopy and noted nothing abnormal except a fissure (which I had never had any pain with but which maybe might explain the occasional blood?). Biopsies taken were also normal and showed no crohns or UC. The colorectal surgeon stated it was his job to look for anything serious and since he didn't find it he would refer me to gastroenterology. Gastro doc said he thought IBS so tried me on amitriptyline for 3 months, which appeared to cure me completely for about 2 of those months after which point the hard stool sneaked back followed by mucus and the tinges of blood again (I also noticed a little bit of anxiety coming back). It always seems to go in this order, the softer the stool the less mucus and blood appears.

At this point the panic/anxiety is I'd say 90% gone and my weight has increased by one kilo. I have had blood tests, stool tests for all kinds of viruses/infections/diseases and the only thing that's ever come back slightly abnormal is the fecal calprotectin. Now, my FC when last checked was 120 and the gastro doc said this was slightly raised (even could be this way if I'd taken any NSAIDs which I do from time to time) and that he might want to perform a camera endoscopy if things don't improve again in the next 6 months just in case there is some inflammation in the small bowel that we cannot see with a scope. He said a blatant case of UC or Crohns might have a calprotectin level of 700+ which obviously I am nowhere near. We also are exploring whether my chronic rhinitis (and tonsilitis) may be contributing to this raised calprotectin level. His final comment was essentially that he would be very surprised to see anything in my small bowel and his gut instinct (for lack of a better expression!) was IBS because of the comorbidity with anxiety/panic and the fact that amitriptyline helped me so much. I definitely notice more mucus when I'm nervous.

Basically I don't know what to think. My doctors cant agree with each other either because although the colorectal surgeon saw a fissure, my GP said since I don't have pain I don't have a fissure. Occasionally I have an ache in the rectal area after a bm and maybe this is it? I seem to only have blood when I have a BM, its occasional and I've never had diarrhoea at any point. The "constipation" I have is very slight - the longest I ever go without a movement is 2-3 days and once things start moving I'll have 1-2 a day as if its trying to catch up! Even then no loose stools, mostly normal if occasionally slightly dense or hard. I also very rarely have any abdominal pain, discomfort or bloating which seems to be the case with IBSers (and also with food intolerance). The amitriptyline also cured the heartburn and indigestion I suffered a lot from previously! Additionally I have no family history whatsoever of any bowel problem, if anything we tend to be a lot more upper GI (cases of ulcers, H. pylori etc and my grandfather died of oesophageal cancer)

I'd go along with IBS if not for the traces of blood and raised FC which are unexplained, but also I've met many people with IBD and their symptoms are SO much more serious than mine which makes me think its not IBD either. It's also strange that its not really got worse over this time, which I'd maybe expect if it was inflammatory.

I apologise for the fact that this story is all over the place! That's just kind of what my life has been like recently. I fully acknowledge that my symptoms are not serious and cause me very little hassle in themselves, its more the idea that there might be something more chronic or serious behind it which makes me worry. I just wondered if anyone here had any ideas or suggestions since you all are most likely much more informed that I am!

Thanks :)

It sounds more like IBS and a fissure to me. I would lean towards trusting the CR surgeon more than the GI with regards to the fissure. Make sure you are drinking plenty of fluids.

Sometimes things like this are "warning signs" for IBD but happen long before Crohn's actually comes into play, if that makes sense. I had a fissure 3-4 years before I even began to have Crohn's.