u/GlitteringMostBanana

I’ve been dealing with gut issues for around 5 years now, and I’m still trying to figure out whether this is IBS, bile acid malabsorption/diarrhea, fast transit, food intolerance, gut dysbiosis, or some combination.
My main symptoms are:
Right-sided abdominal/rib-area discomfort, and pain sometimes wrapping from back to front
Gas, bloating, and pressure
Urgency, especially when it feels like my body suddenly “dumps” bile or food
Loose yellow/orange stools at times
Mucus in stool
Foamy/bubbly stool, especially after sugar or sugar alternatives
Stool that can fall apart in water, look fatty/oily, and stain the toilet orange
Sometimes I can see partially undigested food come out fast — around 8 hours from eating to seeing it in stool
Symptoms often improve after a bowel movement or passing gas
Triggers seem to include sweets, sugar alternatives, dairy + sugar combinations, high-fat meals, bread/carbs, coffee/green tea, and protein shakes.
I’ve had a lot of testing done over the years. Colon evaluation was normal, inflammatory stool markers were normal, infection testing was negative, pancreatic elastase was normal, no parasites, celiac testing was negative, and imaging has not shown anything serious structurally with the liver, gallbladder, pancreas, or intestines. My gallbladder and bile ducts looked normal on imaging.
One notable result was borderline elevated fecal bile acids. My GI mentioned this could fit bile acid-related diarrhea and offered bile acid sequestrants as a treatment option.
I also did a small gut microbiome kit. It showed a pattern of gut dysbiosis with Enterobacteriaceae dominance, including high E. coli / Shigella-type bacteria and some Klebsiella, with lower beneficial bacteria like Bifidobacterium and Akkermansia. I know these home microbiome tests are not the same as a medical diagnosis, but it did seem to match the “fermentation/gas/irritation” pattern I feel.
I tried colesevelam, and it does seem to help when I take it, but I don’t take it consistently because I’m afraid it will slow my stool too much or cause constipation. So I’m stuck between “this helps” and “I’m nervous to take it regularly.”
The frustrating part is that my symptoms can come and go. Sometimes stool normalizes and the side pain disappears, then after certain foods or drinks it can flare again for days or weeks.

Not sure what to do and how to treat it. Any similar experience and if you were able to figure out would be appreciated.
Thank you

I’ve been dealing with gut issues for around 5 years now, and I’m still trying to figure out whether this is IBS, bile acid malabsorption/diarrhea, fast transit, food intolerance, gut dysbiosis, or some combination.
My main symptoms are:
Right-sided abdominal/rib-area discomfort, and pain sometimes wrapping from back to front
Gas, bloating, and pressure
Urgency, especially when it feels like my body suddenly “dumps” bile or food
Loose yellow/orange stools at times
Mucus in stool
Foamy/bubbly stool, especially after sugar or sugar alternatives
Stool that can fall apart in water, look fatty/oily, and stain the toilet orange
Sometimes I can see partially undigested food come out fast — around 8 hours from eating to seeing it in stool
Symptoms often improve after a bowel movement or passing gas
Triggers seem to include sweets, sugar alternatives, dairy + sugar combinations, high-fat meals, bread/carbs, coffee/green tea, and protein shakes.
I’ve had a lot of testing done over the years. Colon evaluation was normal, inflammatory stool markers were normal, infection testing was negative, pancreatic elastase was normal, no parasites, celiac testing was negative, and imaging has not shown anything serious structurally with the liver, gallbladder, pancreas, or intestines. My gallbladder and bile ducts looked normal on imaging.
One notable result was borderline elevated fecal bile acids. My GI mentioned this could fit bile acid-related diarrhea and offered bile acid sequestrants as a treatment option.
I also did a small gut microbiome kit. It showed a pattern of gut dysbiosis with Enterobacteriaceae dominance, including high E. coli / Shigella-type bacteria and some Klebsiella, with lower beneficial bacteria like Bifidobacterium and Akkermansia. I know these home microbiome tests are not the same as a medical diagnosis, but it did seem to match the “fermentation/gas/irritation” pattern I feel.
I tried colesevelam, and it does seem to help when I take it, but I don’t take it consistently because I’m afraid it will slow my stool too much or cause constipation. So I’m stuck between “this helps” and “I’m nervous to take it regularly.”
The frustrating part is that my symptoms can come and go. Sometimes stool normalizes and the side pain disappears, then after certain foods or drinks it can flare again for days or weeks.

Not sure what to do and how to treat it. Any similar experience and if you were able to figure out would be appreciated.
Thank you