### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I have severe to moderate cramping for 5 months now. When it does start feeling better, I always have slight cramps that I can feel and a tenderness. I go to the bathroom, not alot, but I go. My bowels are very hard. I take quite a bit of medicine for my bi-polar which some of the side effects are constipation . I will take Lactulose every day but nothing gets rid of this cramping. When it gets severe, I end up in bed with a heating pad . I am almost unable to stand and walk around the pain is so bad. In the last year I have had a colonoscopy - everything was fine except my bowels were really kinky. I just know something is wrong, I feel it. It is always there. I am so tired of this. I also have Hep C . Have had that for 26 years. My ankles, knees and hands have become so swollen and I now have that liver rash all over my ankles and legs. I don t know what to do.

### output:

Hello, clmiltimore, You tell us that you have been diagnosed with Hep-C for 26 years. Only after 1992 we have had good screening tests for Hep-C. Now in the past ten years and more recently, in the past couple of years, we have very effective treatment to cure Hep-C. I am not sure if you are currently being treated for that. On EOF the known side effects of Interferon that is used to treat is depression. If that becomes a major problem then they have to be under care of a psychiatrist to monitor while on treatment for Hep-C. Some antidepressants have side effects and the major is constipation. You tell us that you have been using lactulose still having problems. Lactulose can give more bloating and gas and more so if someone has lactose intolerance. What you could do, is to try MiraLax (Peg solution) or similar and follow the instruction son the label. This works well. When you start having diarrhea, you Cancun back the dosage. Also, make sure you are on a high fiber diet and Chat Doctor. If you have swollen ankles and feet, you may be retaining water. If your abdomen is swollen, you may have fluid in the belly from cirrhosis of the liver from chronic hepatitis. You need to have complete blood tests, including blood count, coagulation studies, liver tests, electrolytes, kidney tests. Also, I recommend that you get a sonogram of the liver and abdomen to look for changes of cirrhosis. You might need aggressive treatment with good close medical supervision. I wish you well.