Diarrhea and Constipation: When to Seek Medical Help

Diarrhea and constipation?

Hello, Dr.
Ke.
I apologize for the lengthy message, but I have some concerns regarding my bowel habits.
Firstly, my past dietary habits have primarily consisted of fried foods, often eating items like chicken cutlets and salty crispy chicken, with very little intake of fruits and vegetables.
My bowel habits have frequently included diarrhea, sometimes with mucus, and I rarely have formed stools.
However, since I have been having daily bowel movements, I didn't think much of it.
Around early June, I began to experience dull pain in my lower abdomen.
Initially, I thought it was just gastrointestinal discomfort, so I consulted my family doctor, who diagnosed me with irritable bowel syndrome and prescribed some medications for it.
However, I continued to have diarrhea, but I started to notice some formed stools alongside the diarrhea.
My bowel movements increased from about twice a day to 4-5 times a day.
A few days later, I began to experience a loss of appetite, nausea, and a feeling of needing to have a bowel movement, but I could only pass small stools.
I also lost about 7-8 kilograms over the course of three weeks.
I then went to a Chinese medicine clinic, where the doctor prescribed medication for bloating, anti-nausea medication, and ulcer medication, and I had an X-ray done.
The doctor mentioned mild bloating with no signs of fecal impaction.
A stool occult blood test was negative (other stool parameters were normal).
I asked the doctor about the possibility of colon cancer, and he said it was not certain, but he did not arrange for a colonoscopy, only prescribing medication for two weeks and telling me to take it until finished.
Today, July 10th, I suddenly have not had a bowel movement all day.
I usually have a bowel movement in the morning before work, and even if it’s difficult, I can usually pass a little.
However, today I feel the urge but cannot pass anything.
Additionally, when I wiped with toilet paper, I noticed bright red blood.
Does this indicate possible bleeding from colon cancer? Should I consider paying out of pocket for a colonoscopy?

A-Jun, 20~29 year old female. Ask Date: 2017/07/10

Dr. Ke Fangxu reply Surgery

At the age of 27, the likelihood of developing colorectal cancer is not zero, but generally speaking, it is very, very low.
Based on your description, it seems more like irritable bowel syndrome combined with hemorrhoidal bleeding.
It is recommended to start with a light diet and maintain a good lifestyle.
Spicy, irritating, and greasy foods should be avoided.
If symptoms persist without improvement, you can consult a physician for medication or undergo a colonoscopy.
There is no need for out-of-pocket expenses; as long as there are concerns, you can utilize health insurance coverage.

Reply Date: 2017/07/10

More Info

When it comes to gastrointestinal issues such as diarrhea and constipation, understanding when to seek medical help is crucial, especially given your symptoms and history. Based on your description, you have experienced a range of gastrointestinal symptoms, including frequent diarrhea, abdominal pain, changes in bowel habits, significant weight loss, and now the presence of bright red blood on toilet paper after attempting to have a bowel movement.

Understanding Your Symptoms
1. Diarrhea and Constipation: Your history of frequent diarrhea, sometimes with mucus, followed by a sudden onset of constipation and difficulty passing stool, suggests a possible underlying issue that may need further investigation. The alternating patterns of diarrhea and constipation can be indicative of conditions such as Irritable Bowel Syndrome (IBS), but given your weight loss and the presence of blood, it is essential to consider other possibilities.

2. Weight Loss and Appetite Changes: Losing 7-8 kg in three weeks, along with a decrease in appetite and feelings of nausea, raises concerns. Significant and unexplained weight loss is a red flag that should not be overlooked, as it can indicate a more serious underlying condition.

3. Blood in Stool: The appearance of bright red blood on toilet paper can be alarming. While it may not always indicate a serious condition, it can be associated with hemorrhoids, anal fissures, or more serious issues such as diverticular disease or colorectal cancer, especially given your age and symptoms.

When to Seek Medical Help
Given your symptoms, it is advisable to seek medical attention promptly. Here are some guidelines on when to seek help:
- Persistent Symptoms: If diarrhea persists for more than two days or if constipation lasts for more than three days, it is time to consult a healthcare provider.

- Blood in Stool: Any presence of blood, especially bright red blood, should be evaluated by a physician. This is particularly important if it is accompanied by other symptoms like pain, weight loss, or changes in bowel habits.

- Severe Abdominal Pain: If you experience severe or worsening abdominal pain, this could indicate a more serious condition that requires immediate attention.

- Dehydration Signs: Symptoms such as excessive thirst, dry mouth, dizziness, or decreased urine output can indicate dehydration, which may require urgent care.

Diagnostic Considerations
Given your symptoms and the fact that your doctor did not arrange for a colonoscopy, it may be prudent to advocate for further investigation. A colonoscopy is a valuable tool for diagnosing conditions such as inflammatory bowel disease, polyps, or colorectal cancer. While your doctor may have assessed your symptoms and provided treatment, your concerns about the possibility of colorectal cancer, especially in light of your symptoms, warrant a thorough evaluation.

Conclusion
In summary, your symptoms suggest that you should seek further medical evaluation, particularly a gastroenterologist who can assess your need for a colonoscopy. It is important to communicate your concerns clearly, including your weight loss, changes in bowel habits, and the presence of blood. Early diagnosis and treatment are key to managing gastrointestinal disorders effectively. Don't hesitate to advocate for your health and seek the necessary tests to rule out serious conditions.

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