Like many I’m finding trouble getting a diagnosis and managing symptoms.  I’ve gone 57 years of having no intestinal problems to speak of.  At the beginning of January 2025, I had a period of wind mucus urgency diarrhoea which lasted for around 2 weeks then a return to normal. I’ve had a few months of roughly two weeks on and two weeks off.  Over the past couple of months this has changed to being fairly normal with some stools on the constipation end of the scale for days followed by a period of mucus, water, urgency leakage and little diarrhoea (sometimes) which typically last 24/48 hours.  I’ve had good evacuations in the day before these episodes happen  I’ve had all the tests which have shown nothing untoward and thoughts about malabsorption and slow motility have been suggested.  Has anyone suffered this ?  Grateful for any thoughts. Many thanks

I wonder if you had some sort of a virus or bug in January 2025 that started all of this.

Leakage is very distressing and not usual; however, you can have something called overflow diarrhea around periods of constipation which could explain this.

Can you describe which tests you have had?

Hi Jeffrey. Thanks for your response.  Overflow diarrhoea was a possible early diagnosis, then slow motility and constipation, then overload and overflow, then extreme IBS. I feel my symptoms don’t easily fall into these brackets. I have had a course of antibiotics for what could possibly have been an infection in January, but was not prescribed these until July. I have since had recurrent symptoms. 
Tests have included colonoscopy (all clear), CT scan (all clear), various stool tests for campylobacter, cryptosporidium, giardia lambic, salmonella, shigella, and stec (all clear). Liver function, full blood count, urea, coeliac, lactose intolerance, again all clear. There doesn’t seem to be a reason for my symptoms thus far but they still recur regularly approximately every week/10 days. Any thoughts you have would be very gratefully received. Thank you

Thanks for the list of all your tests.

A couple of things worth considering are an overgrowth of Clostridium Difficile. It's highly unlikely given your history and you'll need to submit diarrhea for the C. Difficile stool test. The other thing to look at is elastase level which could point to pancreatic insufficiency. A blood test can look at that.

That's kind of all that I can think of.

Hi Jeffrey. Many thanks for taking the time to respond. I will look into both of your suggestions 

Hi Jeffrey. Thanks for suggestions back in August 25. Both checked and both negative. I had from early August to near end September with no issues at all. Thought I might be at end of it but no ! Then a return of mucus, wind, Pooey mucus, minor occasional diarrhoea, large pellet poo and mucus leakage. That lasted about two weeks. Then normal for a couple of days then back to a more minor version of the symptoms. I’ve been prescribed another course of antibiotics (metronidazole) and to take buscopan (mainly for mucus). I might be wrong but this all doesn’t strike me as typical of IBS. You mentioned before about post viral IBS. Is there a way this can be diagnosed as all tests so far have been negative. Any thoughts about treatment & management if it is ? Any help would be greatly appreciated as I’ve had this now since Jan 25 with no previous history in my 68 yrs. The medical people I’ve been seeing have run out of ideas and think it will go with time ??

You're right. Those symptoms do not strike me as typical IBS. I just went through a flare of my Crohn's disease in my rectum and it always starts as proctitis. Your description of your mucous, pellet poo and leakage completely fits that. I was treated with Uceris (corticosteroid) rectal foam for 2 weeks and it resolved after having symptoms for 8 weeks. I think I might have more inflammation still lingering as the symptoms recurred, but still, nobody has considered that from IBS.

I understand that your colonoscopy was negative for inflammation and sometimes antibiotics are prescribed for IBD patients with inflammation. Since they are out of ideas, I wonder if you can either ask for a rectal corticosteroid foam or rectal mesalamine suppositories. Both are not pleasant, but at least you would put this micro inflammation situation to bed and get it resolved.

Hi Jeffrey. Thank you very much for your speedy response and for your further thoughts. I really appreciate it. Nobody has discussed proctitis and I will certainly be raising it with the medics I’m seeing. I’ve never heard of it. A lot of my symptoms correspond so it’s definitely worth following up. Thanks again

Hope it helps. Although you can have bleeding with proctitis, I have never had that. Proctitis goes hand in hand with tenesmus. That is something that I have.

It's awful that you've been dealing with this for so long.

Thanks again. I’ll be asking the question in the next couple of days

Hi Jeffrey. Following your very helpful suggestions last year, I continue to have the same periodic symptomatic issues (currently a cycle of roughly one week mucus, wind & leakage then no symptoms and one week normal) and further tests have ruled out microscopic collitis and proctitis. After now 15 months, I still have no proper diagnosis or management plan. I do have central and obstructive sleep apnea and use a APAP machine every night. From what I’ve been reading there could be a link between apnea, the use of the machine and some IBS symptoms. I just wondered if you have come across this possible link. Many thanks

Truly sorry to read that you are continuing to be challenged by your symptoms that are alternating between normal and being symptomatic.

There have been a few studies which make a connection between sleep apnea and IBS symptoms; however, I'm not sure I would claim that there is a connection. Inconsistent sleep does appear to affect symptoms related to IBS though I'm not sure anyone has the answers as to why.

Why you have never had any indications for a diagnosis of IBD has anyone suggested trying rectal mesalamine to try and manage your symptoms? It ironically can create more gas, but it might help with leakage and mucus.

Hi Jeffrey. Many thanks for taking the time to respond, I appreciate it. I was clutching at straws about a possible link between apnea and IBS but it was exploring.

I’m talking to my consultant again this week. I think he has run out of ideas so I’ll talk to him about IBD and rectal mesalamine to manage the symptoms. Thanks again.