Gastrointestinal Issues: When to Consider a Colonoscopy

Gastrointestinal issues

Hello Doctor: My diet is normal and I have no bad habits.
I underwent fecal occult blood tests in November last year and July this year due to blood in my stool, but the results were normal.
Recently, for the past half month, I sometimes feel the urge to rush to the bathroom right after eating, and this week I noticed white objects resembling colonic mucosa shedding in my stool.
I went to the hospital for a consultation, and the doctor diagnosed me with irritable bowel syndrome along with internal hemorrhoid bleeding, suggesting that a colonoscopy was unnecessary.
However, after taking medication last night, I experienced high-frequency gurgling sounds in my left abdomen, approximately below the rib cage, which woke me up this morning.
The sounds disappeared when I turned from lying on my back to my side.
After researching online, I found that this is called borborygmi.
I have never experienced this before, and the symptoms are similar to those of colon cancer, which makes me a bit anxious.
I would like to ask the doctor whether I should undergo a colonoscopy in this situation.
Thank you!

C, 20~29 year old female. Ask Date: 2018/09/07

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, your symptoms are likely due to peristalsis causing abdominal sounds, so there's no need to worry.
Changhua Hospital cares about your health.
Chen Shidian.

Reply Date: 2018/09/07

More Info

When it comes to gastrointestinal issues, particularly concerning symptoms like blood in stool, changes in bowel habits, and abdominal discomfort, it is essential to approach the situation with a thorough understanding of the potential underlying causes. Based on your description, it seems you are experiencing a combination of symptoms that could be indicative of several conditions, including irritable bowel syndrome (IBS), hemorrhoids, or even more serious concerns like colorectal cancer.

Firstly, the presence of blood in your stool is a significant symptom that warrants attention. Although you mentioned that previous fecal occult blood tests returned normal results, the fact that you have noticed blood again, along with the recent observation of white objects resembling intestinal mucosa, should not be overlooked. While your doctor has suggested that your symptoms are likely due to IBS and hemorrhoids, the emergence of new symptoms, particularly the white objects in your stool, raises a valid concern.

The sounds you described in your abdomen, often referred to as "borborygmi," can be normal, especially after eating, as they indicate normal intestinal activity. However, if these sounds are accompanied by discomfort or changes in bowel habits, they may suggest an underlying issue that needs further investigation.

In general, a colonoscopy is recommended in the following situations:
1. Age and Family History: If you are over 45 or have a family history of colorectal cancer, screening is advised.

2. Persistent Symptoms: If you experience persistent changes in bowel habits, unexplained weight loss, or abdominal pain that does not resolve, a colonoscopy may be warranted.

3. Blood in Stool: Any new occurrence of blood in the stool should prompt further investigation, especially if it is recurrent.

4. Unexplained Anemia: If you have symptoms of anemia, such as fatigue or weakness, a colonoscopy may be necessary to rule out bleeding sources in the gastrointestinal tract.

Given your symptoms and the recent changes you've experienced, it would be prudent to discuss the possibility of a colonoscopy with your healthcare provider. While your doctor may feel that the symptoms align with IBS and hemorrhoids, your concerns about the potential for colorectal cancer are valid, especially considering the new developments in your condition.

Furthermore, it is important to consider that gastrointestinal symptoms can often overlap, and conditions such as IBS can coexist with other issues, including hemorrhoids or even inflammatory bowel disease (IBD). Therefore, a comprehensive evaluation, including a colonoscopy, could provide clarity and peace of mind.

In conclusion, while your doctor may not see an immediate need for a colonoscopy based on your current symptoms, your concerns are legitimate. It is essential to advocate for your health and ensure that all potential issues are thoroughly investigated. If you continue to experience symptoms or if they worsen, do not hesitate to seek a second opinion or request further testing. Your health is paramount, and understanding the root cause of your gastrointestinal issues is crucial for effective management and treatment.

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