Bowel Pain After Drugs, Passing Stool Investigation

SallyCG Asked :

I have been suffering with IBS (irritable bowel syndrome) for decades now and the symptoms became worse after I was put on medication for high blood pressure. While my doctor did not tell me the final diagnosis, I know I was on an ACE-inhibitor and the symptoms match intestinal angioedema.

It’s been over 3 months now since I changed my BP meds and the bowel pain has gone down but comes after passing stool – I do get some pain with straining but then I get these waves of pain that are in the lower abdomen and buttocks. It can last up to an hour, sometimes two. Eating food does not seem to trigger the pain.

My doctor referred me to a gastroenterologist who told me that an endoscopy and colonoscopy would be necessary for him to make a final diagnosis. He advised a capsule endoscopy over the usual endoscopy for a number of reasons. The procedure is quite expensive and I have not got in as yet. I am wondering if it could just be the intestinal angioedema that is persisting?

This question was posted under the Intestinal Angioedema – Causes, Symptoms, Diagnosis, Treatment article.

Any response by the Health Hype team does not constitute a medical consultation and the advice should be viewed purely as a guide. Always consult with your doctor before making any changes to your current treatment program. The information provided in this article is not an authoritative resource on the subject matter and solely intends to guide the reader based on the questions asked and information provided.

Dr. Chris Answered :

If it was present at the time, intestinal angioedema in your case was drug-induced. The swelling of the intestinal wall would settle down after stopping the medication, sometimes as soon as 24 hours afterwards. At 3 months, the swelling should most definitely have resolved provided that it was intestinal angioedema and that it was caused by the ACE-inhibitor. Remember that intestinal angioedema is not a very common condition.

It is important that you tell your gasteroenterologist about the suspected case of intestinal angioedema. If it is still present, maybe due to acquired or hereditary angioedema (Types of Angioedema), then a capsule endoscopy would not be advisable. The stricture caused by this type of intestinal swelling could mean that the capsule will be retained within the bowels.

There are other options for an endoscopy, namely an upper gastrointestinal (GI) endoscopy and the double balloon endoscopy.  An upper GI endoscopy will only go as far as the first part of the small intestine (duodenum) while the double balloon endoscopy will  reach the last part of the small intestine (ileum). This will mean that you still need to have a colonoscopy.

If your bowel pain after passing stool is not due to drug-induced intestinal angioedema, then you can have a C1-INH (C1 inhibitor) blood test to diagnose acquired or hereditary angioedema. If these levels are low then it could be indicative of acquired or hereditary angioedema. It is not often where intestinal angioedema would persist for this period of time with no other signs or  symptoms.

There are other reasons for bowel pain after passing stool and IBS is one of the possible causes. Colon/rectal cancer, colitis, diverticulitis, polyps or even hemorrhoids may also be responsible. At times the cause may not be related to the gastrointestinal tract and pelvic inflammatory disease, ovarian cysts or trauma are other possibilities. Your gastroenterologist is conducting routine investigations to confirm or exclude any diagnosis that was made upon clinical evaluation. You should speak to your doctor and the gastroenterlogist about your concerns and they will assist you with finding an affordable and viable alternative.

Refer to this article on Abdominal Pain for further information on your symptoms.

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