Irritable Bowel Syndrome vs. Colorectal Cancer Symptoms

Irritable Bowel Syndrome (IBS)? Colorectal Cancer?

Doctor, I have been experiencing a very high frequency of diarrhea recently, especially in the mornings right after I wake up; I almost always have to go.
Sometimes I go several times a day (4-5 times), with the first one or two being more substantial, and the subsequent ones only a little bit.
Even when I'm not having diarrhea, my stools are still somewhat soft and yellowish in color, and I haven't seen any blood.
There is no relevant medical history in my family, and I currently have no stomach pain or loss of appetite.
However, when I do have diarrhea, I feel a strong urgency, and my stomach feels a bit uncomfortable during those times.
I've had digestive issues since childhood, so I initially didn't think much of the diarrhea, but I recently noticed a significant weight loss (though I was intentionally dieting during that time; however, my past experiences with dieting haven't been this effective, losing about 4 kg in two months).
This has made me a bit anxious.
I've returned to a normal diet, and my weight is gradually recovering, but the diarrhea persists.
I have done a fecal occult blood test once, which came back negative, but I have heard that a negative result doesn't necessarily mean everything is fine.
Should I have this test done multiple times?

Nick, 30~39 year old female. Ask Date: 2018/06/02

Dr. Cai Jinji reply Gastroenterology and Hepatology

If diarrhea persists for more than 6 weeks, it is classified as chronic diarrhea.
It is recommended to visit a hospital for examination, as there are many potential causes, including medication, malabsorption, and inflammatory bowel disease.

Reply Date: 2018/06/02

More Info

When considering the symptoms of irritable bowel syndrome (IBS) versus colorectal cancer, it's essential to understand the differences in presentation and underlying mechanisms of these conditions. Your description of frequent diarrhea, particularly in the mornings, along with soft stool and a recent weight loss, raises valid concerns that warrant further evaluation.

Irritable bowel syndrome is a functional gastrointestinal disorder characterized by a group of symptoms, including abdominal pain, bloating, and changes in bowel habits, such as diarrhea or constipation. IBS is often triggered by stress, dietary changes, or gastrointestinal infections. The symptoms can be quite variable and may improve with dietary modifications or stress management techniques. Importantly, IBS does not cause structural changes in the bowel, and it is not associated with an increased risk of colorectal cancer.

On the other hand, colorectal cancer can present with a range of symptoms, including changes in bowel habits (such as diarrhea or constipation), blood in the stool, unexplained weight loss, and abdominal discomfort. The presence of blood in the stool, especially if it is bright red or dark and tarry, is a significant red flag. However, the absence of blood does not rule out colorectal cancer, especially in the context of other concerning symptoms like significant weight loss or changes in bowel habits.

In your case, the fact that you have experienced a notable weight loss, even if it is related to dietary changes, combined with persistent diarrhea and urgency, is concerning. While your initial fecal occult blood test was negative, it is true that a single test may not be definitive. If symptoms persist or worsen, further investigation is warranted. This may include additional stool tests, imaging studies, or even a colonoscopy, especially given your history of gastrointestinal issues.

It is also worth noting that family history plays a crucial role in assessing risk for colorectal cancer. While you mentioned no relevant family history, it is still important to consider your overall risk factors, including age, lifestyle, and any personal history of gastrointestinal disorders.

In summary, while your symptoms could align with IBS, the combination of significant weight loss and persistent changes in bowel habits necessitates a thorough evaluation to rule out more serious conditions, including colorectal cancer. I recommend consulting with a gastroenterologist who can perform a comprehensive assessment and determine the appropriate diagnostic steps. Early detection and intervention are key in managing any potential gastrointestinal issues effectively.

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