Colonoscopy: When to Seek Testing for Digestive Issues

Colonoscopy

Hello, I have been struggling with chronic constipation, sometimes going 5 to 6 days without a bowel movement.
Usually, my stools are hard.
However, a year ago, my bowel habits changed, and I would have a bowel movement every 3 to 4 days, but they were loose and unformed.
I often feel like I can't fully empty my bowels, and my stools are sometimes thin and long, resulting in difficulty cleaning myself afterward.
Occasionally, I experience abdominal bloating, and my symptoms resemble those associated with colorectal cancer.
I want to go directly to the hospital for a colonoscopy, but the doctors insist that I first undergo a fecal occult blood test.
Given my irregular bowel habits and the time constraints of visiting the hospital, is it really necessary to do the fecal occult blood test before proceeding with the colonoscopy?

Qiu Xiaojie, 0~9 year old female. Ask Date: 2017/06/04

Dr. Yang Zhichao reply Gastroenterology and Hepatology

Hello Ms.
Chiu, the tests are arranged after an evaluation by the physician, not based on your personal preference for what tests to schedule.
Some conditions cannot be detected by a colonoscopy alone, so the physician's recommendation for specific tests is made with a purpose.
Changhua Hospital cares about your health.

Reply Date: 2017/06/04

More Info

When it comes to digestive issues, particularly concerning symptoms like constipation, changes in stool consistency, and the presence of blood in stool, it is essential to understand when to seek further testing, such as a colonoscopy. Your concerns about long-term constipation, irregular bowel movements, and the potential for serious conditions like colorectal cancer are valid and warrant careful consideration.

Understanding Your Symptoms
From your description, it appears that you have been experiencing significant bowel irregularities, including prolonged periods without bowel movements, followed by episodes of diarrhea, and the sensation of incomplete evacuation. These symptoms can indeed be distressing and may lead to concerns about underlying conditions, including colorectal cancer.

When to Seek Testing
Colonoscopy is a valuable diagnostic tool that allows physicians to visualize the interior of the colon and rectum. It is typically recommended in the following scenarios:
1. Persistent Changes in Bowel Habits: If you have experienced a significant change in your bowel habits that lasts for more than a few weeks, such as prolonged constipation followed by diarrhea, this is a reason to seek further evaluation.

2. Presence of Blood in Stool: Any instance of blood in the stool, whether visible or detected through a fecal occult blood test, should be taken seriously. It can indicate various conditions, ranging from hemorrhoids to more serious issues like polyps or cancer.

3. Age and Risk Factors: If you are over the age of 45 or have a family history of colorectal cancer, the recommendation for screening becomes even more critical.

4. Associated Symptoms: Symptoms such as significant abdominal pain, unexplained weight loss, or changes in appetite alongside bowel changes should prompt immediate medical evaluation.

The Role of Fecal Occult Blood Testing (FOBT)
While it may seem frustrating to be required to undergo a fecal occult blood test before a colonoscopy, this is a common practice. The FOBT can help identify hidden blood in the stool, which is an important indicator of potential issues in the gastrointestinal tract. If the test is positive, it typically leads to a recommendation for a colonoscopy to investigate further.

Your Concerns About Timing and Logistics
You mentioned concerns about the time required to undergo testing and the inconvenience of multiple visits to the hospital. It is understandable that managing your health can be challenging, especially with a busy schedule. However, it is crucial to prioritize your health and address these symptoms appropriately.
If you feel that your symptoms are severe or worsening, you should not hesitate to seek a second opinion or request a more immediate evaluation. Some healthcare providers may allow for direct referrals to a gastroenterologist for a colonoscopy based on your symptoms, especially if there is a concern for serious underlying conditions.

Conclusion
In summary, while it may be necessary to perform a fecal occult blood test before proceeding with a colonoscopy, your symptoms warrant thorough evaluation. If you continue to experience significant discomfort, changes in bowel habits, or any alarming symptoms, it is essential to advocate for your health and seek the appropriate testing. Early detection and intervention are key in managing digestive issues and preventing potential complications. Always communicate openly with your healthcare provider about your concerns and the urgency of your symptoms.

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