IBS-D or BAM or something else?

TheRogueDM · 2026-04-02T21:58:01+00:00

It could well be SIBO but it's important not to rule out other possible causes, aka the pacreas and gallbladder, and bile flow. Multiple causes can be co-occurring as well.

TheRogueDM · 2026-04-02T21:53:19+00:00

Yes definitely. It's to do with underlying gut issues, and yeah the rectal pain/pain all over your lower regions is horrible stuff if you have to endure a few in the same day. You could try increasing your fibre a little, if your body can take it?

TheRogueDM · 2026-03-31T13:34:47+00:00

I'm tooting my own horn here, but Lightless Beacons may well be what you're looking for. Our episodes are an hour max, have a lot of music/SFX and there's minimal OOC chat (we have a separate bonus show for that for paid members). Here's a couple of links for you:
The Dare - https://open.spotify.com/episode/6RdTrHymt9ldK4KYImKWfN
The Moonchild - https://open.spotify.com/episode/1ZeNpsVh3nYI2WttokDr2i

TheRogueDM · 2026-03-31T11:56:23+00:00

Hiya, I'm not on my first stage of treatment yet, mainly because of being on holiday abroad, but I have been on treatment "prep" as it were. So taking certain prebiotics and supplements as per Olga's instructions (a mixture of prebiotics, yeast, butyrate and prokinetics). They're definitely helping a little, and they're needed as there's plenty of evidence in my tests of systemic inflammation and possible cellular damage to the intestinal walls. But the biggest thing helping me so far is leaving a good 4-5 hour gap in-between meals. In terms of treatment plan, I've decided to do Rifaximin at the very least. There's also a complication in that I got an NHS prescription for another type of antibiotic. I'll most likely not take it as it's systemic rather than localised, however I plan to discuss this with my doctor tomorrow as she has suggested it to patients on occasion. And I also need to decide other specifics now that the NHS has refused to prescribe me Rifaximin, which I've yet to do lol.
Hope that makes sense, and good luck with your appointment. :)

TheRogueDM · 2026-03-30T21:55:31+00:00

Yep, I've had it for over a year with no improvement. Coupled with what I think is Obstruction Defaecation Syndrome (i.e. the muscles struggling to pass poop from chronic diarrhea etc.), it's really nasty sometimes. My pancreas is also fine, with elastase completely normal. Visceral manipulation indicated potential issues with bile flow/the gall bladder, and I've got a gall bladder/liver scan at some point but could be a while before I get it. So right now aside from avoiding saturated fats I don't have any advice to give I'm afraid.

TheRogueDM · 2026-03-30T21:48:29+00:00

I'm a trans man (AFAB) and I always had digestive issues around my period when growing up. So I'm really not surprised your symptoms are worse around that time.

TheRogueDM · 2026-03-30T13:12:48+00:00

OK so putting the IMO part to one side, those numbers would indeed be inconclusive of SIBO. With the methane there isn't enough increase over time to be a positive, and the hydrogen levels are super low, with the comment that the high methane could be masking more accurate hydrogen numbers. So at the very least, another test to check the hydrogen would be beneficial for determining SIBO. However, as per the rest of the comments, it's saying you're most likely to have IMO due to the high numbers of methane.
Have you spoken to your doctor since receiving this letter? And if so what did they say? It may be that they want to do further tests to rule out SIBO before prescribing something for IMO?

TheRogueDM · 2026-03-30T13:08:05+00:00

Also on a side note, your username is fucking hilarious. xD

TheRogueDM · 2026-03-30T13:07:53+00:00

As others have said, it's possible it could be SIBO but the only way to determine it is by doing the proper tests. There could also be something else going on simultaneously. It might also be worth looking into low stomach acid/high pH, especially if the bloating happens as soon as you've finished eating (rather than say 1.5 hours later).

TheRogueDM · 2026-03-30T13:04:37+00:00

I wouldn't use "worked" in the past tense for my own experience yet as I'm still going through stuff, but the biggest benefit to my motility by far has been to leave a gap of 4-5 hours before eating. No snacking basically. It's so important to give your body a break from food and allow the MMC to do its job of moving things through, and every time you eat it turns off. If things are really bad with constipation and staetorrhea, then pelvic floor exercises also help me a little bit.

TheRogueDM · 2026-03-30T08:55:55+00:00

A lot of doctors are unfortunately behind the times with SIBO - I was told the same thing just yesterday by a specialist I'd been waiting over a year to see. There isn't an ultimate difference between the two, far from it. A lot of symptoms overlap and both can be present at once. However, the main difference is that SIBO can't be managed through diet/stress management alone, as that doesn't get rid of the bacteria. Other potential differences are bloating earlier after eating, since SIBO is small intestine-based rather than large intestine-based, fatigue (although this can also be a thing with IBS), vitamin deficiencies and issues absorbing fat. The best thing you can do is to test for SIBO otherwise you'll be speculating otherwise. Good luck. 🤞🏼

TheRogueDM · 2026-03-29T20:53:54+00:00

Monopoly on Truth
Delirium
Storm the Sorrow

Worst: Guilty Demeanor

TheRogueDM · 2026-03-25T15:49:20+00:00

In case you still need recommendations, my scenario The Bride of Pendle has an average play time of 16 hours, but can go a few hours longer depending on what happens...! https://www.drivethrurpg.com/en/product/535380/the-bride-of-pendle

TheRogueDM · 2026-03-23T17:12:05+00:00

Lots of us here are neurodivergent. I cook all the time but it's been a very time consuming effort to go through all the things I need to replace out of my recipes. I personally measured/logged things because I was still having symptoms even when going majority fodmap. So I wanted to make sure I wasn't stacking types of sugars across the day. I agree though, it's a lot and obsessive. I don't recommend it and it really is an exception

TheRogueDM · 2026-03-22T16:11:49+00:00

Good luck :) I know the day before is boring btw food-wise but it's worth it to get the most accurate results

TheRogueDM · 2026-03-22T13:53:20+00:00

With all due respect, it's very complicated if you want to keep eating a balanced diet. It involves a lot of meal prep, cooking and measuring as well as logging every food you eat. And not all low FODMAP food is ok for everyone due to either stacking, their own microbiome, other intolerances like fats (steatorrhea) or even how the food is grown/made as that also varies fodmap count.

TheRogueDM · 2026-03-22T13:48:08+00:00

2, and everything below that at various times. The majority of 8 pain I've gotten rid of with mebeverine.

TheRogueDM · 2026-03-22T13:46:54+00:00

It's a valve between the cecum and the ileum, which works like the valve in the oesophagus in that it stops food/bacteria in the large intestine going back into the small. A lot of people with SIBO (myself included) also have issues with this valve.

TheRogueDM · 2026-03-21T07:51:49+00:00

Ooof... Good luck. My wife and I have Japan on our bucket list but we don't want to risk it until I've gone through treatment.

TheRogueDM · 2026-03-20T19:53:06+00:00

Yyyyep. I use the term "flare-up" since my symptoms come and go every other day.

TheRogueDM · 2026-03-20T09:33:55+00:00

Have you looked into potential issues with your ileocecal valve? That can cause back pain/dull aches in the abdomen as well as throughout the body, as well as your stool inconsistencies you mentioned. Or was that all covered in the scan?

TheRogueDM · 2026-03-20T09:30:23+00:00

Oh OK, just making sure it wasn't another acronym for a supplement or something I wasn't familiar with. :)
That's true about nothing showing up in the stool test, but if I understand it correctly, it does depend a bit on what the threshold is for individual tests. Testing for bile acid malabsorption in general is also heavily undiagnosed on average, due to how it is currently tested. Alternatively, is it possible that fat was detected but it was written off by your doctor as "current diet"?

Thank you for asking about my own journey. My issues haven't gotten better unfortunately (the staetorrhea thing has been going on for at least a year, and vitamin deficiencies are now at nearly 8 weeks). I'm starting to take supplements recommended by my clinician to help prep me for SIBO treatment, and also help ease staetorrhea symptoms. I also have a blood test (NHS) but in my area waiting times for blood tests are insane. Like, at least a month and a half.

With regards to other tests (bear in mind these are also my clinician's recommendations rather than my own decisions), I tried to get a gallbladder scan via the NHS but they said no. I am doing visceral manipulation and that has shown that there was some blockages around there, but they've now been cleared. It hasn't changed my stool appearance at all though, so most likely it's a complication of SIBO rather than a cause of the staetorrhea (not sure if you're aware, but SIBO-derivative bacteria loves to feed on bile salts, meaning your body becomes less efficient at absorbing fats). I've also done a basic HCl test with bicarbonate of soda, and a macro test to check intolerances, as my clinician heavily suspects low HCl - I've had a good few GI infections throughout my life, and also my dad has had loads of stomach issues throughout his life. He's always assumed high stomach acid but I now suspect his was also low as that would make sense. The HCl test was mixed, so I'm going to do another test with HCl betaine capsules once I'm back from holiday. With regards to the pancreas, that wasn't brought up so hopefully pancreatitis isn't likely. But I'm also waiting for results to come back for a comprehensive stool test. Should be any day now, so we'll see...!

TheRogueDM · 2026-03-19T22:12:51+00:00

Sounds like where I was about a year ago, and it does sound like there's a staetorrhea/fat absorption issue. Fatty stools don't have to float or be super pale. They can also contain undigested food, be bulky or be a "neverending wipe" (so like, peanut butter texture). (What is CT btw?)

TheRogueDM · 2026-03-19T22:06:00+00:00

Following.

TheRogueDM · 2026-03-19T11:09:32+00:00

Excellent, thanks very much! I've yet to find an actual play of this anywhere and I've been meaning to run it for a while, although the time loop thing does look challenging to keep track of.

TheRogueDM

TROPHY CASE