Abnormal Bowel Movements: Causes and Diagnostic Approaches

Abnormal bowel movement examination

Hello Dr.
Chen, I would like to seek your clarification on a few points:
1.
My current bowel habits have changed (loose, mucoid stools, alternating with thin stools, frequent lack of urge to defecate, occasional mucus) and I have lost 6 to 7 kilograms over the past six months.
I have undergone fecal occult blood testing, sigmoidoscopy, and barium enema X-ray, all of which showed normal results.
How does the accuracy of these tests compare to that of a full colonoscopy? Can colorectal cancer and polyp symptoms be ruled out?
2.
I occasionally experience a vague, dull pain in the lower right abdomen, which comes and goes, along with the abnormal bowel movements.
Is there a possibility that this could be inflammatory bowel disease (IBD)? The doctor mentioned that the likelihood of an issue in the cecal area is high, but did not provide further details.
3.
It has been reported that there are now blood screening methods available to check for colorectal cancer and polyps.
Should I pursue further confirmation of this?
4.
If tumors can be ruled out and my weight continues to decrease, which specialty should I consult?
Thank you for taking the time to respond amidst your busy schedule.

Tai, 50~59 year old female. Ask Date: 2016/12/14

Dr. Chen Qifeng reply Gastroenterology and Hepatology

1.
Small polyps cannot be ruled out, but if they are small, they may not necessarily cause the symptoms mentioned above.
2.
Based on the current situation, including the preliminary examination results, it is likely not IBD (Inflammatory Bowel Disease).
3.
Currently, there are no established tests available that can directly detect colorectal cancer and polyps.
4.
Metabolism Department.

Reply Date: 2016/12/14

More Info

Understanding abnormal bowel movements can be a complex issue, especially when accompanied by symptoms such as weight loss and changes in stool consistency. Based on your concerns, let's address each of your questions systematically.

1. Accuracy of Diagnostic Tests: You mentioned undergoing several tests, including a fecal occult blood test, sigmoidoscopy, and barium enema, all of which returned normal results. While these tests can provide valuable information, a full colonoscopy is generally considered the gold standard for evaluating the entire colon. It allows for direct visualization and biopsy of any suspicious lesions. Although sigmoidoscopy can detect issues in the lower part of the colon, it does not assess the entire colon, which means that some conditions, particularly those affecting the proximal colon, could be missed. Therefore, while your tests are reassuring, they do not completely rule out colorectal cancer or polyps, especially if you have risk factors or persistent symptoms.

2. Possibility of Inflammatory Bowel Disease (IBD): Your symptoms, including the alternating stool consistency and weight loss, could potentially indicate an inflammatory bowel disease such as Crohn's disease or ulcerative colitis. These conditions can cause intermittent abdominal pain, changes in bowel habits, and weight loss. The right lower quadrant pain you described could be related to inflammation in the ileocecal region, which is commonly affected in Crohn's disease. If your doctor suspects IBD, further evaluation, such as a colonoscopy with biopsies or imaging studies like an MRI or CT scan, may be warranted to confirm the diagnosis.

3. Blood Tests for Colorectal Cancer: There are indeed blood tests available that can help screen for colorectal cancer, such as the CEA (carcinoembryonic antigen) test, which can be elevated in certain cancers. However, these tests are not definitive and should not replace standard screening methods like colonoscopy. If you have ongoing concerns about colorectal cancer, discussing the appropriateness of these tests with your healthcare provider is essential.

4. Addressing Weight Loss: Continuous weight loss, especially when unexplained, warrants further investigation. If malignancy has been ruled out, you might consider consulting a gastroenterologist who specializes in functional gastrointestinal disorders. Conditions like irritable bowel syndrome (IBS) or malabsorption syndromes could contribute to your symptoms and weight loss. Additionally, a dietitian could help assess your dietary habits and nutritional intake, which may also play a role in your weight changes.

In summary, while your current tests are reassuring, they do not entirely exclude the possibility of significant gastrointestinal pathology, especially given your symptoms. It would be prudent to follow up with your healthcare provider to discuss the need for further evaluation, particularly a full colonoscopy if not already performed, and to explore the possibility of IBD or other gastrointestinal disorders. Keeping a detailed record of your symptoms, dietary habits, and any other changes can also be beneficial in guiding your healthcare provider in making an accurate diagnosis and treatment plan.

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