Do I Need a Colonoscopy After Years of IBS Symptoms?

Hello, I have been diagnosed with irritable bowel syndrome for many years. Do I need to undergo a colonoscopy?

Hello Doctor: When I was 23-24 years old, I traveled abroad and ate too much, which led to gastric bleeding and black stools.
I was quite anxious at that time, which was around 1998.
After returning home, the black stools disappeared, but I then experienced alternating diarrhea and pellet-like stools, along with mucus.
I went to a large hospital, but they didn't perform any blood tests or other examinations; the doctor directly diagnosed me with irritable bowel syndrome (IBS).
Now, about 8-9 years later (without continuous treatment), my stool has not changed much; it is mostly loose, with very few pellet-like stools.
There is often yellow mucus on the toilet paper, and occasionally I have normal-shaped stools (about the size of a 5-10 NT dollar coin), which have less mucus on the paper.
During this period, I have not lost weight; instead, I have gained 10 kg.
A fecal occult blood test was done at the hospital 4-5 years ago, which was negative.
In the past two years, I have also used home test strips for occult blood, and they have all been negative (I just tested last week).
I often feel a sensation of something being stuck or constricted in my left lower abdomen near the iliac bone, but it is not painful.
This has persisted for many years.
Recently, I have started to feel a similar sensation on the right side, but sometimes it is not present at all.
I am curious if IBS can cause this kind of sensation, or if it is due to my obesity (weighing 92 kg).
As for flatulence and bowel movements, I don't feel any particular relief as mentioned online; it feels quite normal.
Recently, due to taking strong antibiotics, I have had watery stools for a month.
I have started taking probiotics, and this morning my first stool was in multiple pieces, and by noon, I had a small bowel movement (but it wasn't as watery).
I feel like I have forgotten what healthy, well-formed stools look like.
My company health checks in 2011 and 2014 showed normal blood indices with no signs of anemia.
In 2014, I also had gastrointestinal cancer markers tested, and all values were normal (CEA, CA 19-9, etc.).
I apologize for the lengthy description.
Do you think there is an urgent need for a colonoscopy? (I am quite concerned about the procedure.) Recently, I have also been experiencing muscle tension in my neck and shoulders, leading to myofascial pain, and my lower back sometimes feels sore due to my sitting posture, along with my intestinal issues.
I feel like my body is in pain all over.
Thank you for taking the time to address my concerns.

Niming, 30~39 year old female. Ask Date: 2017/04/18

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Anonymous / 33 years old / Male
1.
It is urgent and difficult to discuss certain cancers.
Tumor markers are not elevated; some people develop polyps, which are benign.
After removal, they will not turn into cancer, which is a good outcome.
2.
There is a painless colonoscopy available that requires anesthesia.
You can choose this option.
Wishing you good health,
Taoyuan Hospital
Dr.
Chen Sih-Rong

Reply Date: 2017/04/18

More Info

Based on your description, it seems you have been experiencing symptoms consistent with Irritable Bowel Syndrome (IBS) for several years, including alternating diarrhea and constipation, mucus in your stool, and abdominal discomfort. Given your history and the fact that you have not had a colonoscopy, it is understandable to be concerned about whether you should undergo this procedure.

First, it’s important to note that IBS is a functional gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, and changes in bowel habits. While IBS itself is not associated with an increased risk of colorectal cancer, it is crucial to rule out other potential causes of your symptoms, especially given the duration and nature of your complaints.

You mentioned that you have had normal blood tests and tumor markers in the past, which is reassuring. However, the presence of mucus in your stool and the ongoing changes in your bowel habits warrant further investigation. While IBS can cause mucus in the stool, it is essential to ensure that there are no other underlying conditions, such as inflammatory bowel disease (IBD) or colorectal polyps, which could present with similar symptoms.

A colonoscopy is a valuable diagnostic tool that allows for direct visualization of the colon and rectum. It can help identify any abnormalities such as polyps, inflammation, or other structural issues that may not be apparent through imaging or blood tests. Given that you have been experiencing these symptoms for nearly a decade without significant improvement, a colonoscopy could provide clarity and peace of mind.

In your case, the following factors suggest that a colonoscopy may be warranted:
1. Duration of Symptoms: You have had persistent symptoms for 8-9 years, which is longer than the typical duration for IBS without significant changes. This raises the possibility of other underlying conditions.

2. Change in Bowel Habits: The alternating patterns of diarrhea and constipation, along with the presence of mucus, could indicate a need for further evaluation.

3. Abdominal Discomfort: The "stuck" feeling you describe in your lower abdomen, although not painful, is concerning enough to warrant further investigation.

4. Family History and Risk Factors: If there is any family history of colorectal cancer or other gastrointestinal diseases, this would further support the need for a colonoscopy.

5. Age Consideration: While you are relatively young, it is important to remember that colorectal cancer can occur in younger individuals, especially if there are risk factors present.

While the thought of undergoing a colonoscopy can be daunting, it is a routine procedure that is generally safe and well-tolerated. Many facilities offer sedation options to minimize discomfort during the procedure. The benefits of obtaining a clear diagnosis and ruling out serious conditions far outweigh the temporary discomfort associated with the procedure.

In conclusion, based on your symptoms and medical history, it would be prudent to discuss the option of a colonoscopy with your healthcare provider. They can help you weigh the risks and benefits and determine the best course of action for your situation. It is essential to address your gastrointestinal symptoms comprehensively to ensure your overall health and well-being.

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