Changes in Bowel Habits: Frequency and Shape Concerns

Q: Changes in Bowel Habits: Frequency and Shape Concerns

Hello： Hard and bulky stools may be related to not having a bowel movement for several days. <br>There's no need to worry too much, but if you still have concerns, you can consult a gastroenterologist at Changhua Hospital for your health. <br>Dr. <br>Tsai An-shun.

Frequency and shape of bowel movements?

Last year, I didn't pay much attention, but since the beginning of this year, after reading some online medical articles, I've been constantly worried about whether my bowel movements are normal.
There is no family history of colorectal cancer, but I have been diagnosed with generalized anxiety disorder.

Bowel movement frequency: From the beginning of the year to mid-year: usually once a day, occasionally two or three times a day.
From July to now: the frequency of two or three times a day has increased, while the frequency of once a day has decreased.
Since I started consuming more vegetables and fruits, such as water spinach, pomelo, or purple rice (I eat one to two bowls of purple rice prepared by my family), and guava, although the bloating has improved, the frequency of two or three times a day has significantly increased.
The first bowel movement is consistently in the morning after waking up; the timing of the second or third bowel movement is irregular.
Sometimes it occurs after breakfast, and other times in the afternoon or evening.
If I have a higher proportion or larger quantity of vegetables and fruits at dinner, I almost always have a second or third bowel movement after dinner.

My family doctor seems to think it is irritable bowel syndrome.
After taking medication (the family doctor prescribed a three-day course of gastrointestinal medication), there was short-term improvement, but it relapsed.
Additionally, since last year, I have experienced "diarrhea after eating pizza or street food." The portion size is usually large.
The two or three bowel movements a day typically consist of: the first being the largest, while the second or third tends to be smaller.

In terms of shape: the stools are noticeably thicker than my finger, sometimes cylindrical and sometimes thick and flat.
Usually, the stool shape starts with formed stools (cylindrical or thick and flat) followed by soft or unformed stools.

Color: all normal, with no blood in the stool.

Appetite: very good; I often eat a lot at dinner.

Bloating and abdominal pain: there is no bloating or abdominal pain after bowel movements.
I used to frequently experience gastrointestinal discomfort at work, but after increasing the proportion of vegetables and fruits in my meals, the abdominal pain and bloating have significantly improved, although the frequency of bowel movements has increased.

Weight: no significant weight loss; in fact, I have gained weight.

The main anxieties and concerns are: 1.
Occasionally passing thick, flat stools, but sometimes they are cylindrical (both types are noticeably thicker than my finger).
2.
Since the summer vacation, the frequency of bowel movements has gradually shifted from primarily once a day to primarily two or three times a day.
Therefore, I still worry about whether I might have a serious illness like cancer.
I hope the doctor can provide some answers.
Thank you!

Niming, 20~29 year old female. Ask Date: 2019/11/17

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: Hard and bulky stools may be related to not having a bowel movement for several days.
There's no need to worry too much, but if you still have concerns, you can consult a gastroenterologist at Changhua Hospital for your health.
Dr.
Tsai An-shun.

Reply Date: 2019/11/17

More Info

Understanding changes in bowel habits, particularly in terms of frequency and shape, can be concerning, especially for individuals with a history of anxiety or gastrointestinal issues. Your description of increased bowel movements from once a day to two or three times a day, along with variations in stool shape, is a common concern that many people experience.
Firstly, it’s important to recognize that bowel habits can be influenced by a variety of factors, including diet, stress levels, physical activity, and underlying medical conditions. In your case, the increase in fiber intake from fruits and vegetables, such as water spinach, guava, and purple rice, is likely a significant factor contributing to the changes in your bowel habits. A higher fiber diet can lead to more frequent bowel movements as fiber adds bulk to the stool and promotes regularity. This is generally a positive change, as fiber is essential for maintaining good digestive health.

The shape and consistency of your stools, which you describe as being sometimes cylindrical and other times flat or irregular, can also be influenced by your diet and hydration levels. Healthy stools are typically well-formed and can vary in shape, but significant changes in shape, especially if they are accompanied by other symptoms, can be a cause for concern. However, the fact that your stools are normal in color and you have not experienced blood in your stools is reassuring.
Your concerns about the possibility of colorectal cancer are understandable, especially given your increased awareness of gastrointestinal health. However, it’s important to note that changes in bowel habits alone, particularly in the absence of alarming symptoms such as blood in the stool, significant weight loss, or persistent abdominal pain, are not typically indicative of cancer. The fact that you have a family history free of colorectal cancer and that your previous colonoscopy was normal further reduces this risk.

The symptoms you describe, including the urgency to defecate after meals and the occurrence of diarrhea after consuming certain foods, may suggest a condition known as irritable bowel syndrome (IBS). IBS is characterized by a combination of symptoms, including abdominal pain, bloating, and changes in bowel habits, and is often triggered by dietary factors and stress. Managing IBS typically involves dietary adjustments, such as increasing fiber intake, staying hydrated, and possibly avoiding certain trigger foods.
Given your history of anxiety, it’s also worth considering the psychological aspect of your gastrointestinal symptoms. Anxiety can exacerbate gastrointestinal issues, leading to increased awareness of bowel habits and discomfort. It may be beneficial to address your anxiety through relaxation techniques, therapy, or medication if necessary.

In summary, while changes in bowel habits can be concerning, your symptoms appear to be more related to dietary changes and possibly IBS rather than a serious underlying condition. It’s advisable to continue monitoring your symptoms, maintain a balanced diet rich in fiber, and stay hydrated. If your symptoms persist or worsen, or if you develop new symptoms, it would be prudent to consult with a healthcare professional for further evaluation. Regular check-ups and open communication with your doctor can help alleviate your concerns and ensure your digestive health remains on track.

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