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Gastroenterology

Expert answers from Gastroenterology physicians on health concerns and treatment options

Questions & Answers

800 articles

Q

What is the treatment for inflammatory bowel disease?

IBD is treated with medications that control inflammation and maintain remission, including aminosalicylates, short-term corticosteroids for flares, immunomodulators, biologic therapies, and newer small-molecule pills; some people also need surgery, which can be curative for ulcerative colitis but not for Crohn’s. Care is individualized and also includes nutrition, lifestyle support, and ongoing monitoring to prevent complications; there are several factors to consider, so see below for key differences by disease type and severity, medication risks, and when to contact a doctor.

Q

Where is IBD pain usually felt?

IBD pain is usually felt in the lower abdomen: Crohn’s often causes pain on the lower right side near the terminal ileum, while ulcerative colitis more often causes lower left and rectal pain; some people also feel central pain or discomfort around the belly button that can spread. There are several factors to consider, including pain outside the abdomen such as in the joints or lower back and symptoms that may need urgent care. See below for important details that can affect which next steps you take in your healthcare journey.

Q

Abdominal cramps and diarrhea: what combinations suggest colitis vs infection?

There are several factors to consider. Colitis is more likely when cramps and diarrhea are chronic or recurrent, include blood or mucus, urgency or nighttime stools, weight loss or joint/skin/eye symptoms, and show elevated fecal calprotectin or lactoferrin. An infection is more likely with sudden onset watery diarrhea, prominent fever, nausea or vomiting after a clear exposure, and improvement within days. See below for key exceptions like C. difficile, red flags that need urgent care, and the tests and treatments that can guide your next steps.

Q

Blood when wiping: hemorrhoids, fissure, or something more serious—how can you tell?

There are several factors to consider. Most bright red blood on the toilet paper is from hemorrhoids or an anal fissure, with fissures causing sharp pain during and after a bowel movement while hemorrhoids are often itchy or painless. Less common but more serious causes include colorectal polyps or cancer, inflammatory bowel disease, diverticular bleeding, and infections; warning signs are heavy or ongoing bleeding, black or tarry stools, new bowel habit changes, weight loss, fever, or severe pain. See the complete guidance below for specific clues, home treatments, and when to seek urgent care so you can choose the right next step.

Q

Blood when wiping… is it “nothing,” or is it a warning sign?

A small smear of bright red blood on toilet paper is often from minor causes like hemorrhoids, anal fissures, or irritation and usually improves with fiber, fluids, gentle cleaning, and sitz baths. There are several factors to consider. See below for important details on causes, self care, tests your doctor may recommend, and red flags like heavier or persistent bleeding, blood mixed with stool, dizziness or fainting, abdominal pain, weight loss, bowel habit changes, a family history of colorectal cancer, or any bleeding if you have cirrhosis.

Q

Bloody diarrhea: what conditions cause it, and what tests usually come next?

Bloody diarrhea most often results from infections such as Salmonella, Shigella, Campylobacter, toxigenic E. coli, C. difficile, or parasites like Entamoeba, but inflammatory bowel disease, ischemic colitis, medication or radiation injury, and colon polyps or cancer are also important, with hemorrhoids, fissures, and portal hypertensive colopathy less common. There are several factors to consider; see below to understand more. Typical next tests include stool studies for bacteria, Shiga toxin, C. difficile, and parasites, inflammatory stool markers, blood work for anemia and inflammation, and when needed imaging and endoscopy such as CT, flexible sigmoidoscopy, or colonoscopy with biopsy, with red flags and timing guidance detailed below.

Q

Can’t stop pooping—what if your gut is stuck in overdrive for a reason?

There are several factors to consider: infections, food intolerances, medications, and chronic conditions like IBS, celiac disease, IBD, or bile acid diarrhea can all push the gut into overdrive; see below for what counts as diarrhea, quick at home relief, and the tests and treatments that match the cause. Seek care promptly for dehydration, blood in stool, high fever, severe abdominal pain, or symptoms lasting beyond two weeks, and review the important details below that could change your next steps.

Q

Cramping before pooping—why does relief after going not always mean IBS?

There are several factors to consider, because cramping that eases after a bowel movement is common in IBS yet not specific, and can also stem from constipation, infections, inflammatory bowel disease, partial obstruction, motility problems, or extraintestinal issues like gallbladder, kidney, or gynecologic conditions. Watch for red flags such as weight loss, bleeding, fever, anemia, severe or persistent pain, onset after 50, or a family history, and know that proper diagnosis may require symptom tracking, labs, stool tests, imaging and endoscopy with tailored treatment, so for key details that can guide your next steps see the complete explanation below.

Q

Cramping before pooping: what does that timing suggest about inflammation vs spasm?

Cramps that peak right before a bowel movement and ease quickly afterward most often indicate an intestinal spasm; pain that begins well before you need to go and does not fully improve after can point to inflammation. There are several factors to consider, and important red flags, triggers, self-care options, and when to seek medical care are outlined below.

Q

Diarrhea after eating: what causes a fast “gastrocolic” response vs a bigger issue?

Diarrhea right after eating is often a normal gastrocolic reflex, especially if mild and linked to triggers like high fat or spicy foods, caffeine, artificial sweeteners, stress, or an exaggerated response in IBS-D. There are several factors to consider: persistent or severe diarrhea, or red flags like weight loss, blood, fever, severe pain, dehydration, or symptoms lasting more than 48 hours can indicate malabsorption, IBD, microscopic colitis, bile acid problems, infections, thyroid or liver disease, or medication effects; see below for important details on when to seek care and what tests and steps may help.

Q

Diarrhea for 2 weeks: what are the most likely explanations, medically?

There are several factors to consider: diarrhea lasting 2 weeks is persistent and is most often due to lingering infection like Giardia or C. difficile or post-infectious changes, but also IBS-D, inflammatory bowel disease, malabsorption such as celiac or lactose intolerance, medication effects, bile acid diarrhea, thyroid disease, and microscopic colitis. See below for how clinicians sort this out with targeted stool and blood tests, which at-home steps may help, and the red flags like fever, blood in stool, weight loss, or dehydration that mean you should seek care promptly.

Q

Diarrhea with blood: what diagnoses are most commonly considered?

The most commonly considered causes include infectious colitis (such as Campylobacter, Salmonella, Shigella, toxigenic E. coli, C. difficile, or Entamoeba), inflammatory bowel disease (ulcerative colitis or Crohn's), ischemic colitis, and medication or radiation related colitis, with less common but important possibilities like colorectal cancer, vascular malformations, and anorectal sources. There are several factors to consider. See below for key red flags, which exposures and medications matter, and how doctors test and treat these conditions so you can choose the right next steps and know when urgent care is needed.

Q

Do I have Crohn’s—or am I about to keep dismissing a real problem?

There are several factors to consider: Crohn’s often causes ongoing abdominal pain, urgent diarrhea, weight loss, fatigue, fevers, mouth sores, or perianal issues; below you’ll find how to recognize patterns, what serious warning signs look like, and exactly how doctors test for Crohn’s. If symptoms persist over 4 weeks or include bleeding, significant weight loss, high fevers, severe pain, dehydration, or joint, skin, or eye inflammation, seek care promptly, since only proper testing with stool, blood, scopes, and imaging can confirm Crohn’s and early treatment prevents complications; see below for a free symptom check, self-care tips, and when to go to the ER.

Q

Do I have ulcerative colitis: what symptoms make it more likely?

Ulcerative colitis is more likely if you have blood in your stool, persistent diarrhea with urgency or a feeling of incomplete evacuation, crampy lower left abdominal pain that eases after a bowel movement, mucus in stool, and unintended weight loss or fatigue; joint pain, red painful eyes, or tender skin bumps together with bowel symptoms raise suspicion further. There are several factors to consider. See below for key risk factors like family history and age peaks, conditions that can mimic it, red flags that need urgent care, and the tests doctors use to confirm the diagnosis, plus a free online symptom check to guide next steps.

Q

Fecal calprotectin test: what does it measure, and when is it useful?

The fecal calprotectin test measures calprotectin, a neutrophil protein, in stool to estimate inflammation in the gastrointestinal tract. It is most useful to differentiate inflammatory bowel disease from irritable bowel syndrome, to triage chronic GI symptoms, and to monitor known IBD and guide the need for colonoscopy. There are several factors to consider, including result cutoffs, when to repeat testing, and potential false positives from infections or NSAIDs; see the complete answer below for details and next steps.

Q

Frequent bowel movements—what if your “normal” isn’t normal?

A noticeable increase from your usual bathroom pattern especially more than three times a day with loose, urgent stools that lasts over four weeks can indicate chronic diarrhea, with causes that range from diet and infections to IBS, IBD, malabsorption, medications, thyroid problems, and bile acid issues. There are several factors to consider. Red flags like blood or black stools, weight loss, fever, severe abdominal pain, dehydration, or symptoms after antibiotics warrant prompt care, and the complete answer below explains which tests, treatments, and special considerations like liver disease can guide your next steps.

Q

IBS or IBD—what’s the one symptom that should make you stop guessing?

Rectal bleeding is the one symptom that should make you stop guessing and see a doctor. There are several factors to consider, including other red flags like weight loss, fever, anemia, and nighttime symptoms, plus guidance on stool, blood, and endoscopic tests such as fecal calprotectin and colonoscopy; see below for details that can affect your next steps.

Q

IBS or IBD: what symptoms help tell them apart before testing?

There are several factors to consider; see below to understand more, including red flags and next steps. IBS more often causes crampy pain that improves after a bowel movement with bowel habit changes linked to meals or stress, and typically lacks blood in the stool, weight loss, fever, or nighttime symptoms. IBD is more likely with blood or mucus in stool, nocturnal diarrhea, unintended weight loss, persistent pain not relieved by defecation, fever, fatigue, urgency, or family history, which should prompt timely medical evaluation.

Q

Left lower abdominal pain and diarrhea—could this point to the colon specifically?

Left lower abdominal pain with diarrhea often points to the colon, commonly from IBS-D, diverticulitis, infectious colitis, or inflammatory bowel disease, and less often ischemic colitis or neoplasia; seek prompt care for fever, blood in stool, severe or persistent pain, dehydration, or weight loss. There are several factors to consider, including non-colon causes and what evaluations and treatments are appropriate. See below for specifics on red flags, when to seek care, how doctors diagnose it, and safe at-home steps that could shape your next move.

Q

Left lower abdominal pain and diarrhea: what conditions commonly cause this pairing?

Left lower abdominal pain with diarrhea most often comes from diverticulitis, ulcerative colitis, infectious colitis, irritable bowel syndrome, ischemic colitis, medication effects, or gynecologic causes in women. There are several factors to consider, including red flags like fever, severe or sudden pain, or bloody stools, as well as how doctors evaluate and what you can safely try at home; see the complete guidance below to understand the key details that can shape your next steps.

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